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Giovanella L, Tuncel M, Aghaee A, Campenni A, Petranović Ovčariček P, De Virgilio A. Theranostics of Thyroid Cancer. Semin Nucl Med 2024:S0001-2998(24)00011-4. [PMID: 38503602 DOI: 10.1053/j.semnuclmed.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/21/2024]
Abstract
Molecular imaging is pivotal in evaluating and managing patients with different thyroid cancer histotypes. The existing, pathology-based, risk stratification systems can be usefully refined, by incorporating tumor-specific molecular and molecular imaging biomarkers with theranostic value, allowing patient-specific treatment decisions. Molecular imaging with different radioactive iodine isotopes (ie, I131, I123, I124) is a central component of differentiated carcinoma (DTC)'s risk stratification while [18F]F-fluorodeoxyglucose ([18F]FDG) PET/CT is interrogated about disease aggressiveness and presence of distant metastases. Moreover, it is particularly useful to assess and risk-stratify patients with radioiodine-refractory DTC, poorly differentiated, and anaplastic thyroid cancers. [18F]F-dihydroxyphenylalanine (6-[18F]FDOPA) PET/CT is the most specific and accurate molecular imaging procedure for patients with medullary thyroid cancer (MTC), a neuroendocrine tumor derived from thyroid C-cells. In addition, [18F]FDG PET/CT can be used in patients with more aggressive clinical or biochemical (ie, serum markers levels and kinetics) MTC phenotypes. In addition to conventional radioiodine therapy for DTC, new redifferentiation strategies are now available to restore uptake in radioiodine-refractory DTC. Moreover, peptide receptor theranostics showed promising results in patients with advanced and metastatic radioiodine-refractory DTC and MTC, respectively. The current appropriate role and future perspectives of molecular imaging and theranostics in thyroid cancer are discussed in our present review.
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Affiliation(s)
- Luca Giovanella
- Department of Nuclear Medicine, Gruppo Ospedaliero Moncucco, Lugano, Switzerland; Clinic for Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland.
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University, Ankara, Turkey
| | - Atena Aghaee
- Department of Nuclear Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alfredo Campenni
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Armando De Virgilio
- Department of Head and Neck Surgery Humanitas Research Hospital, Rozzano, Italy
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2
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Park S, Bang JI, Kim K, Seo Y, Chong A, Hong CM, Lee DE, Choi M, Lee SW, Oh SW. Comparison of Recombinant Human Thyroid-Stimulating Hormone and Thyroid Hormone Withdrawal for 131 I Therapy in Patients With Intermediate- to High-Risk Thyroid Cancer : A Systematic Review and Meta-analysis. Clin Nucl Med 2024; 49:e96-e104. [PMID: 38271262 DOI: 10.1097/rlu.0000000000005022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND This meta-analysis and systematic review aimed to evaluate the therapeutic efficacy and advantages associated with the use of recombinant human thyroid-stimulating hormone (rhTSH) for radioactive iodine (RAI) therapy in patients with intermediate- to high-risk differentiated thyroid cancer. PATIENTS AND METHODS MEDLINE, EMBASE, and Cochrane databases were searched to identify relevant articles reporting clinical outcomes of rhTSH compared with thyroid hormone withdrawal (THW) in patients with intermediate- to high-risk differentiated thyroid cancer published between January 2012 and June 2023. Meta-analyses were performed (PROSPERO registration number: CRD42022340915) to assess the success rate of radioiodine remnant ablation (RRA) in patients with intermediate to high risk and determine the disease control rate among patients with distant metastases, evaluated using the RECIST criteria. RESULTS Thirteen studies involving 1858 patients were included in the meta-analysis. Pooled analyses revealed significantly higher overall RRA success rate in the rhTSH group compared with the THW group, with a risk ratio (RR) of 1.12 (95% confidence interval [CI], 1.01-1.25). However, in the subgroup analysis of high-risk patients, pooled analyses showed no significant differences in RRA success rate between the rhTSH group compared with the THW group with a pooled RR of 1.05 (95% CI, 0.88-1.24). In patients with distant metastases, there were no significant differences in the disease control rate between groups, with a pooled RR of 1.06 (95% CI, 0.78-1.44). CONCLUSIONS rhTSH for RAI therapy is a practical option for RAI therapy in patients with intermediate- to high-risk thyroid cancer, including those with distant metastases.
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Affiliation(s)
- Sohyun Park
- From the Department of Nuclear Medicine, National Cancer Center Hospital, Goyang
| | - Ji-In Bang
- Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital and School of Medicine, Pusan National University, Pusan
| | - Youngduk Seo
- Department of Nuclear Medicine, Chungnam National University Sejong Hospital, Sejong
| | - Ari Chong
- Department of Nuclear Medicine, Chosun University Hospital and College of Medicine, Gwangju
| | - Chae Moon Hong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu
| | - Dong-Eun Lee
- Biostatistics Collaboration Team, National Cancer Center, Goyang
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul
| | - Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University, School of Medicine and Chilgok Hospital, Daegu
| | - So Won Oh
- Department of Nuclear Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
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Martínez-Montoro JI, Doulatram-Gamgaram VK, Olveira G, Valdés S, Fernández-García JC. Management of thyroid dysfunction and thyroid nodules in the ageing patient. Eur J Intern Med 2023; 116:16-26. [PMID: 37394383 DOI: 10.1016/j.ejim.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 07/04/2023]
Abstract
Thyroid dysfunction is a common endocrine disorder in the general population, with a reported prevalence of 10-15%. However, this rate is even higher in older adults, with an estimated prevalence of ≈25% in some populations. Since elderly patients usually present more comorbidities than younger individuals, thyroid dysfunction may carry a synergistic negative health impact, mainly due to increased cardiovascular disease risk. Moreover, thyroid dysfunction in the elderly can be more difficult to diagnose due to its subtle or even asymptomatic clinical presentation, and the interpretation of thyroid function tests may be affected by drugs that interfere with thyroid function or by the coexistence of several diseases. On the other hand, thyroid nodules are also a prevalent condition in older adults, and its incidence increases with age. The assessment and management of thyroid nodules in the ageing patient should take into account several factors, as risk stratification, thyroid cancer biology, patient´s overall health, comorbidities, treatment preferences, and goals of care. In this review article, we summarize the current knowledge on the pathophysiology, diagnosis, and therapeutic management of thyroid dysfunction in elderly patients and we also review how to identify and manage thyroid nodules in this population.
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Affiliation(s)
- José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Faculty of Medicine, University of Málaga, 29010 Málaga, Spain
| | - Viyey Kishore Doulatram-Gamgaram
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain
| | - Gabriel Olveira
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain; Faculty of Medicine, Departamento de Medicina y Dermatología, University of Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spain
| | - Sergio Valdés
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spain
| | - José Carlos Fernández-García
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain; Faculty of Medicine, Departamento de Medicina y Dermatología, University of Málaga, Málaga, Spain.
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4
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Giovanella L, Garo ML, Campenní A, Petranović Ovčariček P, Görges R. Thyroid Hormone Withdrawal versus Recombinant Human TSH as Preparation for I-131 Therapy in Patients with Metastatic Thyroid Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15092510. [PMID: 37173976 PMCID: PMC10177224 DOI: 10.3390/cancers15092510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Differentiated thyroid carcinoma (DTC) is characterized by an excellent prognosis with a 10-year survival rate > 90%. However, when DTC develops in a metastatic form, it has been shown to significantly impact patient survival and quality of life. Although I-131 has been shown to be an effective therapy in patients with metastatic DTC, whether its efficacy after recombinant human TSH (rhTSH) is comparable to endogenous TSH stimulation by thyroid hormone deprivation (THW) is still debated. Our present study was prompted to compare clinical results obtained in metastatic DTC by I-131 administered after rhTSH and THW stimulation protocols, respectively. METHODS A systematic search on PubMed, Web of Science, and Scopus was performed from January to February 2023. Pooled risk ratios with 95% CI were determined for evaluating the initial response after to I-131 therapy after preparation with rhTSH or THW and the disease progression. To track the accumulation of evidence and reduce type I errors because of small data, a cumulative meta-analysis was performed. A sensitivity analysis was also performed to examine the impact of individual studies on overall prevalence results. RESULTS Ten studies were included with a total of 1929 patients pre-treated with rhTSH (n = 953) and THW (n = 976), respectively. The cumulative data of our systematic review and meta-analysis showed an increase in the risk ratio over the years without any change in favour of a pre-treatment or the other on the effectiveness of I-131 therapy of metastatic DTC. CONCLUSIONS Our data suggest that pretreatment with rhTSH or THW has no significant impact on the effectiveness of I-131 therapy for metastatic DTC. This implies that concerns about the use of one or the other pretreatment should be deferred to clinical evaluations made considering patient characteristics and reduction in side effects.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, 6500 Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Maria Luisa Garo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
- Research Unit of Cardiac Surgery, Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
| | - Alfredo Campenní
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", 10000 Zagreb, Croatia
| | - Rainer Görges
- Clinic for Nuclear Medicine, University Hospital Essen, 45147 Essen, Germany
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5
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Coerts HI, de Keizer B, Marlowe RJ, Verburg FA. Recombinant or endogenous thyroid-stimulating hormone for radioactive iodine therapy in thyroid cancer: state of knowledge and current controversies. Eur J Endocrinol 2023; 188:6992577. [PMID: 36655579 DOI: 10.1093/ejendo/lvad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/12/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
For patients undergoing radioiodine therapy (RIT) of differentiated thyroid carcinoma (DTC), thyroid-stimulating hormone (TSH) stimulation prior to RIT can be achieved using thyroid hormone withdrawal (THW) or administration of recombinant human TSH (rhTSH). As THW can lead to nausea, headaches, vomiting, fatigue, and dizziness secondary to transient acute hypothyroidism, rhTSH could be a good alternative. Recombinant human TSH has been administered in patients in order to stimulate TSH for RIT since 2005. According to the Martinique criteria formulated by the leading professional societies involved in care of patients with DTC, rhTSH can be applied in 3 settings: for remnant ablation, adjuvant treatment, and treatment of known disease. Numerous studies have investigated the effects of rhTSH as a method of TSH stimulation on the thyroid cell, the systemic effects, biokinetics, and clinical outcomes; however, no consensus has been reached about many aspects of its potential use. Recombinant human TSH is able to stimulate sufficient TSH levels (>30 mIU L-1) and is hypothesized to decrease risks of tumor cell proliferation. As rhTSH-use avoids the transiently impaired renal function associated with THW, radioiodine excretion is faster with the former, leading to a lower iodine-131 uptake and a difference in fractional remnant uptake, effective half-life, mean residence time, and dose to the blood. Differences between rhTSH and THW were observed in radioiodine genotoxic effects and endothelial-dependent vasodilation and inflammation. For thyroid remnant ablation, THW and rhTSH lead to similar remnant ablation rates. For adjuvant therapy and treatment of known disease, insufficient trials have been conducted and future prospective studies are recommended. The current review provides a state-of-the-science overview on the issues and debates surrounding TSH stimulation through either rhTSH adminsitration orendogenous TSH production after levothyroxin withdrawal.
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Affiliation(s)
- Hannelore I Coerts
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, 3015 GD, The Netherlands
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Robert J Marlowe
- Spencer-Fontayne Corp., Jersey City, NJ 07304-1901, United States
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, 3015 GD, The Netherlands
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6
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Tsai JR, Wu ST, Chi SY, Yang YT, Chan YC, Lim LS, Chiew YEW, Chen WC, Chen YN, Chou CK. Recombinant human thyrotropin versus thyroid hormone withdrawal preparation for radioiodine ablation in differentiated thyroid cancer: Experience in a South Taiwanese medical center. Kaohsiung J Med Sci 2023; 39:175-181. [PMID: 36448726 DOI: 10.1002/kjm2.12621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022] Open
Abstract
This retrospective study was designed to compare the treatment response of patients with differentiated thyroid cancer (DTC) prepared for radioiodine ablation (RIA) with thyroid hormone withdrawal (THW) or recombinant human thyrotropin (rhTSH) stimulation. Patients with DTC were followed-up retrospectively between 2013 and 2018 in Kaohsiung Chang Gung Memorial Hospital, Taiwan. We compared the excellent response ratios between THW (49.9%) and rhTSH (50.1%) stimulation. Patients were then divided into subgroups, on the basis of age, sex, extrathyroidal extension, lymph node metastasis, and tumor-node-metastasis stage, for analysis. In all, 647 patients were followed-up after RIA. The ratios of THW or rhTSH use in the different subgroups were not statistically significant. In all the patients, the excellent response rate with THW and rhTSH was 80% and 76.5%, respectively, which was not statistically significant. The subgroup analysis, including age, sex, extrathyroidal extension, lymph node metastasis, and tumor-node-metastasis stage (low and high risk), showed similar results. Furthermore, the logistic regression analysis revealed no statistically significant differences among the subgroups. The multivariate analysis showed extrathyroidal extension, lymph node metastasis, and high I131 dose were the prognostic factors affecting the excellent response rate. In conclusion, the THW and rhTSH preparations for RIA were similar in terms of the excellent response rates and subgroup clinical outcomes.
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Affiliation(s)
- Jia-Ruei Tsai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Shu-Ting Wu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Shun-Yu Chi
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Yi-Ting Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Yi-Chia Chan
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Lay San Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Yvonne Ee Wern Chiew
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Wen-Chieh Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Yung-Nien Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Chen-Kai Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
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7
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Valerio L, Maino F, Castagna MG, Pacini F. Radioiodine therapy in the different stages of differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 2023; 37:101703. [PMID: 36151009 DOI: 10.1016/j.beem.2022.101703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Differentiated thyroid cancer is the most frequent type of thyroid cancer with an increasing incidence in the last decades. The initial management is represented by surgical treatment followed by radioactive iodine therapy that includes remnant ablation, adjuvant treatment or treatment of metastatic disease. Radioactive iodine treatment is performed only in selected cases based on the risk of recurrence and mortality during follow up, according to American Joint Committee on Cancer Union for international Cancer Control Tumor, Node, Metastasis (AJCC/TNM) staging system and the 2015 American Thyroid Association (ATA) risk stratification system. This article will review the key factors to consider when planning radioactive iodine therapy in differentiated thyroid cancer patients after surgery and during follow up.
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Affiliation(s)
- Laura Valerio
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy - Viale Bracci 16, 53100, Siena, Italy.
| | - Fabio Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy - Viale Bracci 16, 53100, Siena, Italy.
| | - Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy - Viale Bracci 16, 53100, Siena, Italy.
| | - Furio Pacini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy - Viale Bracci 16, 53100, Siena, Italy.
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8
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Wadsley J, Armstrong N, Bassett-Smith V, Beasley M, Chandler R, Cluny L, Craig AJ, Farnell K, Garcez K, Garnham N, Graham K, Hallam A, Hill S, Hobrough H, McKiddie F, Strachan MWJ. Patient Preparation and Radiation Protection Guidance for Adult Patients Undergoing Radioiodine Treatment for Thyroid Cancer in the UK. Clin Oncol (R Coll Radiol) 2023; 35:42-56. [PMID: 36030168 DOI: 10.1016/j.clon.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/31/2022] [Accepted: 07/13/2022] [Indexed: 01/04/2023]
Abstract
Radioactive iodine is a highly effective treatment for thyroid cancer and has now been used in clinical practice for more than 80 years. In general, the treatment is well tolerated. However, it can be logistically quite complex for patients due to the need to reduce iodine intake and achieve high levels of thyroid-stimulating hormone prior to treatment. Radiation protection precautions must also be taken to protect others from unnecessary radiation exposure following treatment. It has been well documented by thyroid cancer patient support groups that there is significant variation in practice across the UK. It is clear that some patients are being asked to observe unnecessarily burdensome restrictions that make it more difficult for them to tolerate the treatment. At the instigation of these support groups, a multidisciplinary group was assembled to examine the evidence and generate guidance on best practice for the preparation of patients for this treatment and the management of subsequent radiation protection precautions, with a focus on personalising the advice given to individual patients. The guidance includes advice about managing particularly challenging situations, for example treating patients who require haemodialysis. We have also worked together to produce a patient information leaflet covering these issues. We hope that the guidance document and patient information leaflet will assist centres in improving our patients' experience of receiving radioactive iodine. The patient information sheet is available as Supplementary Material to this article.
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Affiliation(s)
- J Wadsley
- Weston Park Cancer Centre, Sheffield, UK.
| | - N Armstrong
- Northern Centre for Cancer Care, Newcastle, UK
| | | | - M Beasley
- Bristol Cancer Institute, Bristol, UK
| | - R Chandler
- Northern Centre for Cancer Care, Newcastle, UK
| | - L Cluny
- Western General Hospital, Edinburgh, UK
| | - A J Craig
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - K Farnell
- Butterfly Thyroid Cancer Trust, Rowlands Gill, UK
| | - K Garcez
- Christie Hospital, Manchester, UK
| | - N Garnham
- East Suffolk and North Essex Foundation Trust, Colchester, UK
| | - K Graham
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Hallam
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Hill
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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9
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Hofmann MC, Kunnimalaiyaan M, Wang JR, Busaidy NL, Sherman SI, Lai SY, Zafereo M, Cabanillas ME. Molecular mechanisms of resistance to kinase inhibitors and redifferentiation in thyroid cancers. Endocr Relat Cancer 2022; 29:R173-R190. [PMID: 35975971 PMCID: PMC9534048 DOI: 10.1530/erc-22-0129] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/16/2022] [Indexed: 11/08/2022]
Abstract
Protein kinases play critical roles in cell survival, proliferation, and motility. Their dysregulation is therefore a common feature in the pathogenesis of a number of solid tumors, including thyroid cancers. Inhibiting activated protein kinases has revolutionized thyroid cancer therapy, offering a promising strategy in treating tumors refractory to radioactive iodine treatment or cytotoxic chemotherapies. However, despite satisfactory early responses, these drugs are not curative and most patients inevitably progress due to drug resistance. This review summarizes up-to-date knowledge on various mechanisms that thyroid cancer cells develop to bypass protein kinase inhibition and outlines strategies that are being explored to overcome drug resistance. Understanding how cancer cells respond to drugs and identifying novel molecular targets for therapy still represents a major challenge for the treatment of these patients.
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Affiliation(s)
- Marie-Claude Hofmann
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Muthusamy Kunnimalaiyaan
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer R. Wang
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naifa L. Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven I. Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Y. Lai
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria E. Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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10
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Sparano C, Moog S, Hadoux J, Dupuy C, Al Ghuzlan A, Breuskin I, Guerlain J, Hartl D, Baudin E, Lamartina L. Strategies for Radioiodine Treatment: What’s New. Cancers (Basel) 2022; 14:cancers14153800. [PMID: 35954463 PMCID: PMC9367259 DOI: 10.3390/cancers14153800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Radioiodine treatment (RAI) represents the most widespread and effective therapy for differentiated thyroid cancer (DTC). RAI goals encompass ablative (destruction of thyroid remnants, to enhance thyroglobulin predictive value), adjuvant (destruction of microscopic disease to reduce recurrences), and therapeutic (in case of macroscopic iodine avid lesions) purposes, but its use has evolved over time. Randomized trial results have enabled the refinement of RAI indications, moving from a standardized practice to a tailored approach. In most cases, low-risk patients may safely avoid RAI, but where necessary, a simplified protocol, based on lower iodine activities and human recombinant TSH preparation, proved to be just as effective, reducing overtreatment or useless impairment of quality of life. In pediatric DTC, RAI treatments may allow tumor healing even at the advanced stages. Finally, new challenges have arisen with the advancement in redifferentiation protocols, through which RAI still represents a leading therapy, even in former iodine refractory cases. RAI therapy is usually well-tolerated at low activities rates, but some concerns exist concerning higher cumulative doses and long-term outcomes. Despite these achievements, several issues still need to be addressed in terms of RAI indications and protocols, heading toward the RAI strategy of the future.
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Affiliation(s)
- Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Sophie Moog
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Julien Hadoux
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Corinne Dupuy
- UMR 9019 CNRS, Université Paris-Saclay, Gustave Roussy, 94800 Villejuif, France
| | - Abir Al Ghuzlan
- Département de Biologie et Pathologie Médicales, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Ingrid Breuskin
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Joanne Guerlain
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Dana Hartl
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Eric Baudin
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Livia Lamartina
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
- Correspondence:
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11
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Lee Y, Chung CH, Lin LF, Chiu CH, Chen YF, Chang CF, Cheng CY, Chien WC. Radioactive Iodine Treatment for Thyroid Cancer Patients Increases the Risk of Long-Term Gastrointestinal Disorders: A Nationwide Population-Based Cohort Analysis. Cancers (Basel) 2022; 14:cancers14102505. [PMID: 35626110 PMCID: PMC9140163 DOI: 10.3390/cancers14102505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary The standard treatment for well-differentiated thyroid cancer is thyroidectomy followed by radioactive iodine (RAI) treatment or active surveillance. Despite adequate documentation of acute gastrointestinal adverse effects after RAI treatment, whether the gastrointestinal exposure causes long-term comorbidity or not remained unclear. We conducted a nationwide, population-based retrospective cohort study using the data from the Taiwan National Health Insurance Research Database (NHIRD) to clarify the association between long-term gastrointestinal disorders (including ulcers, atrophic gastritis, and secondary stomach malignancy) and RAI treatment in thyroid cancer patients. We found that patients with RAI treatment were at a significantly higher risk of developing gastric and duodenal ulcers than those without. In addition, a higher cumulative dose is associated with higher risk. Therefore, follow-ups at gastrointestinal clinics might be of great importance for patients presenting with chronic gastrointestinal discomforts, after receiving a single RAI dose of more than 1.11 GBq, and undergoing repeated treatment due to recurrent or residual thyroid cancer. Abstract (1) Background: The study aimed to investigate the association between radioactive iodine (RAI) treatment and long-term gastrointestinal disorders including ulcers, atrophic gastritis, and secondary malignant neoplasm of the stomach in patients with thyroid cancer. (2) Methods: The data of the study were extracted from the National Health Insurance Database (NHIRD) of Taiwan between 2000 to 2015. Patients of ages older than 20 with thyroid cancer after thyroidectomy were included and divided into groups with RAI (study cohort) and without RAI (comparison cohort). Multivariate Cox proportional hazards regression analysis and the Kaplan–Meier method were used for statistical analysis. (3) Results: A total of 7250 (with RAI: 5800, without RAI: 1450) patients were included. The Kaplan-Meier analysis revealed a significantly higher cumulative risk for overall gastrointestinal disorders in the group with RAI (log-rank p = 0.034). The risk for gastrointestinal disorders was higher when receiving a cumulative RAI dose higher than 1.11 GBq in the Cox regression analysis. In the subgroup analysis, the risks of gastric and duodenal ulcers are significantly higher in the group with RAI treatment. (4) Conclusions: This study revealed that RAI was associated with an increased risk for long-term gastrointestinal disorders, specifically gastric and duodenal ulcers, in thyroid cancer, especially when the cumulative dose exceeds 1.11 GBq.
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Affiliation(s)
- Yueh Lee
- Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan; (Y.L.); (L.-F.L.); (C.-H.C.); (Y.-F.C.)
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan;
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei City 11490, Taiwan
| | - Li-Fan Lin
- Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan; (Y.L.); (L.-F.L.); (C.-H.C.); (Y.-F.C.)
| | - Chuang-Hsin Chiu
- Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan; (Y.L.); (L.-F.L.); (C.-H.C.); (Y.-F.C.)
| | - Yi-Feng Chen
- Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan; (Y.L.); (L.-F.L.); (C.-H.C.); (Y.-F.C.)
| | - Chao-Feng Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
| | - Cheng-Yi Cheng
- Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan; (Y.L.); (L.-F.L.); (C.-H.C.); (Y.-F.C.)
- Correspondence: (C.-Y.C.); (W.-C.C.); Tel.: +886-2-87927374 (C.-Y.C.); +886-2-87923311 (ext. 19189) (W.-C.C.)
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan;
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei City 11490, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei City 11490, Taiwan
- Correspondence: (C.-Y.C.); (W.-C.C.); Tel.: +886-2-87927374 (C.-Y.C.); +886-2-87923311 (ext. 19189) (W.-C.C.)
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12
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Gomes-Lima CJ, Chittimoju S, Wehbeh L, Dia S, Pagadala P, Al-Jundi M, Jhawar S, Tefera E, Mete M, Klubo-Gwiezdzinska J, Van Nostrand D, Jonklaas J, Wartofsky L, Burman KD. Metastatic Differentiated Thyroid Cancer Survival Is Unaffected by Mode of Preparation for 131I Administration. J Endocr Soc 2022; 6:bvac032. [PMID: 35356009 PMCID: PMC8962448 DOI: 10.1210/jendso/bvac032] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 01/13/2023] Open
Abstract
Context Recombinant human thyrotropin (rhTSH) is currently not Food and Drug Administration approved for the treatment of high-risk patients with differentiated thyroid cancer (DTC). Objective The goal of our study was to compare the outcomes in higher-risk patients with metastatic DTC prepared for radioiodine (RAI) therapy with rhTSH vs thyroid hormone withdrawal (THW). Methods A retrospective chart review was performed of patients with metastatic DTC in follow-up at MedStar Washington Hospital Center and MedStar Georgetown University Hospital from 2009 to 2017. Patients were divided according to their preparation for RAI therapy, with assessment of progression-free survival (PFS) and overall survival (OS). Results Fifty-five patients with distant metastases (16 men, 39 women) were prepared for RAI therapy exclusively either with rhTSH (n = 27) or with THW (n = 28). There were no statistically significant differences between the groups regarding clinicopathological features and history of RAI therapies. The median follow-up time for patients with rhTSH-aided therapies was 4.2 years (range, 3.3-5.5 years) and for patients with THW-aided therapies was 6.8 years (range, 4.2-11.6 years) (P = .002). Multivariate analysis showed that the method of thyrotropin stimulation was not associated with a difference in PFS or OS. Conclusion As has been shown previously for low-risk DTC, this study indicates that the mode of preparation for RAI therapy does not appear to influence the outcomes of patients with metastatic DTC. PFS and OS were similar for patients with THW-aided or rhTSH-aided RAI therapies.
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Affiliation(s)
- Cristiane J Gomes-Lima
- MedStar Clinical Research Center, MedStar Health Research Institute (MHRI), Hyattsville 20782-2031, Maryland, USA,Section of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Sanjita Chittimoju
- Internal Medicine - MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Leen Wehbeh
- Internal Medicine - MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Sunita Dia
- Internal Medicine - MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Prathyusha Pagadala
- Internal Medicine - MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Mohammad Al-Jundi
- Internal Medicine - MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Sakshi Jhawar
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA
| | - Eshetu Tefera
- MedStar Health Research Institute (MHRI), Hyattsville 20782-2031, Maryland, USA
| | - Mihriye Mete
- MedStar Health Research Institute (MHRI), Hyattsville 20782-2031, Maryland, USA
| | - Joanna Klubo-Gwiezdzinska
- National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK), Bethesda, Maryland 20892, USA
| | - Douglas Van Nostrand
- MedStar Clinical Research Center, MedStar Health Research Institute (MHRI), Hyattsville 20782-2031, Maryland, USA,Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Jacqueline Jonklaas
- Division of Endocrinology, Department of Medicine Georgetown University, Washington, District of Columbia 20057, USA
| | - Leonard Wartofsky
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA
| | - Kenneth D Burman
- Section of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia 20010, USA,Division of Endocrinology, Department of Medicine Georgetown University, Washington, District of Columbia 20057, USA,Correspondence: Kenneth D. Burman, MD, Section of Endocrinology, MedStar Washington Hospital Center, Suite 2A-72, 110 Irving St NW, Washington, DC 20010, USA.
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13
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Simões-Pereira J, C Ferreira T, Limbert E, Cavaco BM, Leite V. Response to "Radioiodine Is Molecular Radiotherapy Governed by Predictable Deterministic Radiobiology Expressed in Gray, Not Millicuries" by Kao. Thyroid 2022; 32:342-343. [PMID: 35045760 DOI: 10.1089/thy.2021.0644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joana Simões-Pereira
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Teresa C Ferreira
- Serviço de Medicina Nuclear, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Edward Limbert
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Branca Maria Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
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14
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Feasibility of Recombinant Human TSH as a Preparation for Radioiodine Therapy in Patients with Distant Metastases from Papillary Thyroid Cancer: Comparison of Long-Term Survival Outcomes with Thyroid Hormone Withdrawal. Diagnostics (Basel) 2022; 12:diagnostics12010221. [PMID: 35054388 PMCID: PMC8775305 DOI: 10.3390/diagnostics12010221] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023] Open
Abstract
Background: this study was designed to compare the long-term survival outcomes of patients prepared for radioiodine (RAI) therapy using either thyroid hormone withdrawal (THW) or recombinant human thyrotropin (rhTSH) stimulation, by specifically focusing on cases with distant metastases from papillary thyroid cancer (PTC). Methods: A retrospective analysis was performed on 88 patients with distant metastases from PTC. Fifty-one and thirty-seven patients were prepared for RAI treatment by either THW or rhTSH stimulation, respectively. The primary endpoints were progression-free survival (PFS) and disease-specific survival (DSS). Results: The 10-year DSS rates of patients prepared for RAI therapy using either THW or rhTSH stimulation were 62.2% and 73.3%, respectively. Using multivariate analysis, RAI-avid metastases (p = 0.025) and preparation with rhTSH (p = 0.041) were identified as independent prognostic factors for PFS. Notably, PFS in the group of patients with RAI-avid metastases and preparation with rhTSH was significantly better than that in the other groups (p = 0.025). Conclusions: Preparation for RAI therapy using rhTSH stimulation is not inferior to THW preparation in terms of long-term survival outcomes experienced by patients with PTC and distant metastasis. Patients with RAI-avid metastases and preparation with rhTSH had the most favorable PFS.
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15
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Campennì A, Giovanella L. Nuclear medicine therapy of thyroid cancer post-thyroidectomy. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Simões-Pereira J, Ferreira TC, Limbert E, Cavaco BM, Leite V. Outcomes of Thyrotropin Alfa Versus Levothyroxine Withdrawal-Aided Radioiodine Therapy for Distant Metastasis of Papillary Thyroid Cancer. Thyroid 2021; 31:1514-1522. [PMID: 34155923 DOI: 10.1089/thy.2021.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Thyrotropin alfa (rhTSH) is not currently approved by the Food and Drug Administration or European Medicines Agency for the preparation of radioactive iodine therapy (RAIT) in patients with distant metastatic papillary thyroid cancer (PTC). There are only a few studies comparing rhTSH with levothyroxine withdrawal (LTW) in this context. Our main aim was to compare the two methods of RAIT preparation in terms of avidity and structural/biochemical response in distant metastatic PTC. We also intended to evaluate whether the two methods of RAIT preparation represented independent prognostic factors for progression-free survival (PFS) and disease-specific survival (DSS) in this subset of patients. Methods: We performed a retrospective analysis of all patients with PTC treated with RAIT for distant metastatic disease between 2006 and 2018. We included 95 PTC patients-27 (28.4%) had LTW and 68 (71.6%) had rhTSH for RAIT. Results: The two groups presented similar clinicopathological characteristics, except for median age at PTC diagnosis, which was higher in the rhTSH group (p = 0.001), but the median age at first RAIT for distant metastatic disease was not different between the two methods of preparation, 63 years old (interquartile range [IQR] 23) in the LTW group versus 70 (IQR 26.75), p = 0.06. Avidity was similar between the two groups (p = 0.973). Median estimate PFS (p = 0.076) and DSS (p = 0.084) were also similar between LTW and rhTSH. Regarding RAIT-related side effects, only 1 (3.7%) patient and 5 (7.4%) patients in the LTW and rhTSH groups, respectively, reported sialadenitis (p = 0.670). Conclusions: There were no differences between the two methods of RAIT preparation regarding avidity and clinical response. rhTSH may be used as an alternative method of preparation for RAIT in patients with known distant lesions, as it presents similar clinical outcomes to LTW and a good safety profile.
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Affiliation(s)
- Joana Simões-Pereira
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Unidade de Investigação em Patobiologia Molecular (UIPM), Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Teresa C Ferreira
- Serviço de Medicina Nuclear, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Edward Limbert
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Branca Maria Cavaco
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Unidade de Investigação em Patobiologia Molecular (UIPM), Lisboa, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Unidade de Investigação em Patobiologia Molecular (UIPM), Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
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17
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Gulec SA, Ahuja S, Avram AM, Bernet VJ, Bourguet P, Draganescu C, Elisei R, Giovanella L, Grant F, Greenspan B, Hegedüs L, Jonklaas J, Kloos RT, Luster M, Oyen WJG, Smit J, Tuttle RM. A Joint Statement from the American Thyroid Association, the European Association of Nuclear Medicine, the European Thyroid Association, the Society of Nuclear Medicine and Molecular Imaging on Current Diagnostic and Theranostic Approaches in the Management of Thyroid Cancer. Thyroid 2021; 31:1009-1019. [PMID: 33789450 DOI: 10.1089/thy.2020.0826] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The American Thyroid Association (ATA), the European Association of Nuclear Medicine, the European Thyroid Association, and the Society of Nuclear Medicine and Molecular Imaging have established an intersocietal working group to address the current controversies and evolving concepts in thyroid cancer management and therapy. The working group annually identifies topics that may significantly impact clinical practice and publishes expert opinion articles reflecting intersocietal collaboration, consensus, and suggestions for further research to address these important management issues. Summary: In 2019, the intersocietal working group identified the following topics for review and interdisciplinary discussion: (i) perioperative risk stratification, (ii) the role of diagnostic radioactive iodine (RAI) imaging in initial staging, and (iii) indicators of response to RAI therapy. Conclusions: The intersocietal working group agreed that (i) initial patient management decisions should be guided by perioperative risk stratification that should include the eighth edition American Joint Committee on Cancer staging system to predict disease specific mortality, the modified 2009 ATA risk stratification system to estimate structural disease recurrence, with judicious incorporation of molecular theranostics to further refine management recommendations; (ii) diagnostic RAI scanning in ATA intermediate risk patients should be utilized selectively rather than being considered mandatory or not necessary for all patients in this category; and (iii) a consistent semiquantitative reporting system should be used for response evaluations after RAI therapy until a reproducible and clinically practical quantitative system is validated.
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Affiliation(s)
- Seza A Gulec
- Aventura Hospital and Medical Center, Aventura, Florida, USA
- Miami Cancer Research Center, North Miami, Florida, USA
- Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia, USA
| | - Sukhjeet Ahuja
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia, USA
| | - Anca M Avram
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia, USA
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Victor J Bernet
- Mayo Clinic College of Medicine, Jacksonville, Florida, USA
- American Thyroid Association, Falls Church, Virginia, USA
| | - Patrick Bourguet
- University Hospital of Martinique, University of Antilles, Pointe-à-Pitre, France
| | - Ciprian Draganescu
- University Hospital of Martinique, University of Antilles, Pointe-à-Pitre, France
| | - Rosella Elisei
- Department of Endocrinology, University of Pisa, Pisa, Italy
- The European Thyroid Association, Altdorf, Germany
| | - Luca Giovanella
- Clinic of Nuclear Medicine and Thyroid Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Nuclear Medicine, University of Zürich, Zürich, Switzerland
- The European Association of Nuclear Medicine, Vienna, Austria
| | - Frederick Grant
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia, USA
- Joint Program in Nuclear Medicine, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bennett Greenspan
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia, USA
| | - Laszlo Hegedüs
- The European Thyroid Association, Altdorf, Germany
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Jacqueline Jonklaas
- American Thyroid Association, Falls Church, Virginia, USA
- Division of Endocrinology, Georgetown University, Washington, District of Columbia, USA
| | | | - Markus Luster
- The European Association of Nuclear Medicine, Vienna, Austria
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Wim J G Oyen
- The European Association of Nuclear Medicine, Vienna, Austria
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Biomedical Sciences and Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
- Department of Nuclear Medicine, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
- Department of Radiology and Nuclear Medicine and Radboud UMC, Nijmegen, The Netherlands
| | - Johannes Smit
- The European Thyroid Association, Altdorf, Germany
- Department of Internal Medicine, Radboud UMC, Nijmegen, The Netherlands
| | - R Michael Tuttle
- American Thyroid Association, Falls Church, Virginia, USA
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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18
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Campennì A, Barbaro D, Guzzo M, Capoccetti F, Giovanella L. Personalized management of differentiated thyroid cancer in real life - practical guidance from a multidisciplinary panel of experts. Endocrine 2020; 70:280-291. [PMID: 32772339 PMCID: PMC7581611 DOI: 10.1007/s12020-020-02418-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The standard of care for differentiated thyroid carcinoma (DTC) includes surgery, risk-adapted postoperative radioiodine therapy (RaIT), individualized thyroid hormone therapy, and follow-up for detection of patients with persistent or recurrent disease. In 2019, the nine Martinique Principles for managing thyroid cancer were developed by the American Thyroid Association, European Association of Nuclear Medicine, Society of Nuclear Medicine and Molecular Imaging, and European Thyroid Association. In this review, we present our clinical practice recommendations with regard to implementing these principles in the diagnosis, treatment, and long-term follow-up of patients with DTC. METHODS A multidisciplinary panel of five thyroid cancer experts addressed the implementation of the Martinique Principles in routine clinical practice based on clinical experience and evidence from the literature. RESULTS We provide a suggested approach for the assessment and diagnosis of DTC in routine clinical practice, including the use of neck ultrasound, measurement of serum thyroid-stimulating hormone and calcitonin, fine-needle aspiration, cytology, and molecular imaging. Recommendations for the use of surgery (lobectomy vs. total thyroidectomy) and postoperative RaIT are also provided. Long-term follow-up with neck ultrasound and measurement of serum anti-thyroglobulin antibody and basal/stimulated thyroglobulin is standard, with 123/131I radioiodine diagnostic whole-body scans and 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography suggested in selected patients. Management of metastatic DTC should involve a multidisciplinary team. CONCLUSIONS In routine clinical practice, the Martinique Principles should be implemented in order to optimize clinical management/outcomes of patients with DTC.
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Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy.
| | | | - Marco Guzzo
- Head and Neck Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Capoccetti
- Service Department Macerata Hospital, ASUR Marche AV3, Nuclear Medicine Unit, Macerata, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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19
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Abe K, Ishizaki U, Ono T, Horiuchi K, Kanaya K, Sakai S, Okamoto T. Low-dose radioiodine therapy for patients with intermediate- to high-risk differentiated thyroid cancer. Ann Nucl Med 2019; 34:144-151. [PMID: 31834567 DOI: 10.1007/s12149-019-01432-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/28/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The efficacy of low-dose radioiodine therapy (RIT) for intermediate-risk or high-risk differentiated thyroid cancer (DTC) patients is controversial. Because of the country's shortage of medical facilities for RIT, 1110-MBq RIT for higher risk DTC patients has been performed on an outpatient basis since 2010 in Japan. Herein, we addressed this issue and attempted to determine prognostic factors for the prediction of RIT outcomes. METHODS We retrospectively analyzed the cases of 119 patients with papillary thyroid cancer who underwent their first RIT with 1110 MBq radioactive iodine (RAI) following a total thyroidectomy, including 65 (54.6%) intermediate-risk and 54 (45.4%) high-risk patients (according to Japan's 2018 clinical practical guidelines for thyroid tumors). Successful ablation was defined when a negative I-131 whole-body scan and thyroglobulin (Tg) < 2 ng/mL were obtained at a diagnostic scan performed 148-560 days (median 261 days) after the first RIT. RESULTS The overall ablation success rate was 23.4%. Although the ablation success rates of each pretreatment protocol [recombinant human thyroid stimulating hormone and thyroid hormone withdrawal (THW)] did not differ significantly, THW tended to result in a higher success rate than rhTSH. The Tg level at RIT was the only independent powerful predictive factor for successful ablation. The best cut-off value of Tg for predicting unsuccessful ablation was 9 ng/mL. CONCLUSIONS The ablation success rate was much lower than those of earlier studies; the most plausible reason would be that higher risk DTC patients were included in this study. The low-dose RIT routinely performed in Japan might be inadequate for the achievement of successful ablation. At least for patients with Tg > 9 ng/mL at the first RIT, a higher dose of RAI is recommended.
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Affiliation(s)
- Koichiro Abe
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Umiko Ishizaki
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Toshihiro Ono
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kiyomi Horiuchi
- Departments of Surgery II, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuko Kanaya
- Radiological Services, Tokyo Women's Medical University, Tokyo, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takahiro Okamoto
- Departments of Surgery II, Tokyo Women's Medical University, Tokyo, Japan
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Ylli D, Van Nostrand D, Wartofsky L. Conventional Radioiodine Therapy for Differentiated Thyroid Cancer. Endocrinol Metab Clin North Am 2019; 48:181-197. [PMID: 30717901 DOI: 10.1016/j.ecl.2018.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article presents an overview of the use of radioactive iodine (131-I) in the treatment of patients with differentiated thyroid cancer. Topics reviewed include definitions; staging; the 2 principal methods for selection of 131-I dosage; the indications for ablation, adjuvant treatment, and treatment; the recommendations for the use of 131-I contained in the guidelines of the American Thyroid Association and the Society of Nuclear Medicine and Molecular Imaging; the dosage recommendations and selection of dosage approach for 131-I by these organizations; the use of recombinant human thyrotropin for radioiodine ablation, adjuvant therapy, or treatment; and the MedStar Washington Hospital Center approach.
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Affiliation(s)
- Dorina Ylli
- Thyroid Cancer Research Center, MedStar Health Research Institute, 110 Irving Street, Washington, DC 20010, USA
| | - Douglas Van Nostrand
- Department of Nuclear Medicine, Nuclear Medicine Research, MedStar Health Research Institute and MedStar Washington Hospital Center, 110 Irving Street, Washington, DC 20010, USA
| | - Leonard Wartofsky
- Thyroid Cancer Research Center, MedStar Health Research Institute, 110 Irving Street, Washington, DC 20010, USA.
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21
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Luo H, Tobey A, Auh S, Cochran C, Zemskova M, Reynolds J, Lima C, Burman K, Wartofsky L, Skarulis M, Kebebew E, Klubo-Gwiezdzinska J. The effect of lithium on the progression-free and overall survival in patients with metastatic differentiated thyroid cancer undergoing radioactive iodine therapy. Clin Endocrinol (Oxf) 2018; 89:481-488. [PMID: 29972703 PMCID: PMC6138537 DOI: 10.1111/cen.13806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/13/2018] [Accepted: 07/02/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Pretreatment with lithium (Li) is associated with an increased residence time of radioactive iodine (RAI) in differentiated thyroid cancer (DTC) metastases. There are no data translating this observation into long-term outcomes. The study goal was to compare the efficacy of three methods of preparation for RAI therapy in metastatic DTC-thyroid hormone withdrawal (THW), THW with pretreatment with Li (THW+Li), and recombinant human TSH (rhTSH). DESIGN/PATIENTS/MEASUREMENTS We performed a cohort study comparing overall survival (OS) and progression-free survival (PFS) between the three groups: THW (n = 52), THW+Li (n = 41) and rhTSH (n = 42). Kaplan-Meier analyses were performed to compare OS and PFS between the groups. Cox proportional hazards regression model with a stepwise variable selection was performed to study the contribution of age, gender, histology, TNM status, a location of distant metastases and RAI dose. RESULTS During the follow-up of median 5.1 (IQR = 3.0-8.1) years, 52% of patients had disease progression and 12.6% died. Although THW+Li group was characterized by the longest OS (P = 0.007), only age (HR 1.05, CI 1.01-1.09, P = 0.01) and widespread disease (HR 3.8, CI 1.2-11.8, P = 0.02) were found to affect OS in a multivariate model. There was no difference in PFS between the groups (P = 0.47). Presence of distant metastases limited to the lungs only was associated with longer PFS (PFS HR 0.35, CI 0.20-0.60, P = 0.0002). CONCLUSION The older age is associated with shorter OS, while disease burden affects OS and PFS in patients with metastatic thyroid cancer. The method of preparation for RAI therapy does not affect the outcome.
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Affiliation(s)
- Hongxiu Luo
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Andrew Tobey
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Sungyoung Auh
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Craig Cochran
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Marina Zemskova
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - James Reynolds
- Radiology and Imaging Sciences Department, NIH Clinical Center, Washigton, DC
| | - Cristiane Lima
- Endocrine Section, Medstar Washington Hospital Center, Washigton, DC
| | - Kenneth Burman
- Endocrine Section, Medstar Washington Hospital Center, Washigton, DC
| | - Leonard Wartofsky
- Endocrine Section, Medstar Washington Hospital Center, Washigton, DC
| | - Monica Skarulis
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Electron Kebebew
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Joanna Klubo-Gwiezdzinska
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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Doğan M, Durmuş K, Hasbek Z, Altuntaş EE. Does the use of recombinant TSH in preparation for I-131 scintigraphy scan affect hearing function? J Otol 2018; 13:20-24. [PMID: 29937862 PMCID: PMC6002631 DOI: 10.1016/j.joto.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 11/28/2022] Open
Abstract
Objective The objective of this study was to examine the effect of hypothyroidism on hearing function in patients surgically treated for differentiated thyroid cancer and subsequently experienced hypothyroidism during preparation for follow up I-131 scintigraphy scan by either recombinant human thyroid stimulating hormone (rhTSH) treatment or thyroid hormone withdrawal (THW). Methods A total of 55 patients undergoing I-131 scintigraphy scan following surgeries for differentiated thyroid cancer were included in the study, including 25 patients prepared by administration of recombinant TSH (rhTSH Group) and 30 patients by thyroid hormone withdrawal (THW Group). Results Air conduction thresholds at 1, 2 and 4 kHz for both ears were higher during hypothyroid period than during euthyroid period for patients in the THW group (p < 0.05) but not for patients in the rhTSH group. Conclusion Sensorineural hearing loss was detected, especially at low frequencies, in patients with DTC after surgical treatment whose hormone replacement therapy was withdrawn but not in those receiving rhTSH. It is therefore preferred to use rhTSH when preparing for I-131 scintigraphy scan in patients at risk for hearing loss.
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Affiliation(s)
- Mehtap Doğan
- Department of Otolaryngology, Faculty of Medicine Cumhuriyet University 58140, Sivas, Turkey
| | - Kasım Durmuş
- Department of Otolaryngology, Faculty of Medicine Cumhuriyet University 58140, Sivas, Turkey
- Corresponding author. Fax: +90 346 2191155.
| | - Zekiye Hasbek
- Cumhuriyet Univ. School of Medicine, Dept. of Nuclear Medicine, Campus, 58140, Sivas, Turkey
| | - Emine Elif Altuntaş
- Department of Otolaryngology, Faculty of Medicine Cumhuriyet University 58140, Sivas, Turkey
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23
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Arpaia D, Ippolito S, Peirce C, Pontieri G, Biondi B. Importance of recombinant human thyrotropin as an adjuvant in the radioiodine treatment of thyroid cancer. Expert Rev Endocrinol Metab 2017; 12:261-267. [PMID: 30058883 DOI: 10.1080/17446651.2017.1338945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Radioiodine (RAI) therapy for treatment of differentiated thyroid cancer (DTC) requires high serum thyroid-stimulating hormone (TSH) levels to induce a sufficient iodine uptake within thyroid cells. Recombinant Human TSH (rhTSH) induces an exogenous TSH level increase without LT4 withdrawal. It is a valid alternative to LT4-withdrawal (LT4-W) to achieve the TSH levels required for RAI therapy. According to the recent American Thyroid Association (ATA) guidelines, candidates for RAI therapy should be selected based on their DTC risk of recurrence. Areas covered: In this review, we report the studies assessing the effects of rhTSH on RAI ablation compared to thyroid hormone withdrawal in patients with thyroid cancer at different ATA risk of recurrence. We focus our attention on high risk patients and metastatic disease in which RAI treatment is routinely recommended although there are few controversial data about the best possible way of preparing for it. Expert commentary: rhTSH-aided therapy is associated to a better quality of life and to a lower body radiation exposure. Several studies have reported an equivalent efficacy of RAI ablation after TSH stimulation with rhTSH or LT4-W in patients with DTC at low and intermediate risk of recurrence. Although more studies are required, the results are promising even in patients with high risk DTC and metastatic disease.
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Affiliation(s)
- Debora Arpaia
- a Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Serena Ippolito
- a Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Carmela Peirce
- a Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Gilda Pontieri
- a Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Bernadette Biondi
- a Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
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24
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Deandreis D, Schlumberger M, Tuttle RM. Reply: Comparison of Empiric Versus Dosimetry-Guided Radioiodine Therapy: The Devil Is in the Details. J Nucl Med 2017; 58:863-864. [DOI: 10.2967/jnumed.117.190496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Larson SM, Osborne JR, Grewal RK, Tuttle RM. Redifferentiating Thyroid Cancer: Selumetinib-enhanced Radioiodine Uptake in Thyroid Cancer. Mol Imaging Radionucl Ther 2017; 26:80-86. [PMID: 28117292 PMCID: PMC5283711 DOI: 10.4274/2017.26.suppl.09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In a recent article, we reported a restorative therapeutic intervention that turned individual thyroid cancer lesions into more efficient tissues for taking up radioactive iodine (RAI), resulting in clinically significant and durable responses. A group of Iodine-131 refractory thyroid cancer patients were treated with the MEK tyrosine kinase inhibitor (TKI) selumetinib, and RAI uptake was restored in a subset of patients. We employed Iodine-124 positron emission tomography to measure radiation absorbed dose, on a lesion by lesion basis. The process can be thought of as a re-differentiation of the cancer toward a more nearly normal state most like the tissue from which the cancer arose. Remarkably, in its own way, a change was detected within a few weeks of treatment, restoring uptake with therapeutically effective levels of RAI and in some patients, previously completely refractory to radioiodine treatment. In this article, we summarize the basic work that led to this seminal study, and make the case for lesional dosimetry in thyroid cancer with Iodine-124 as a new optimal radiotracer for precision medicine in patients with well differentiated thyroid cancer.
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Affiliation(s)
- Steven M Larson
- Memorial Sloan Kettering Cancer Center, New York, USA, Phone: 646888359, E-mail:
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27
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Plyku D, Hobbs RF, Huang K, Atkins F, Garcia C, Sgouros G, Van Nostrand D. Recombinant Human Thyroid-Stimulating Hormone Versus Thyroid Hormone Withdrawal in 124I PET/CT-Based Dosimetry for 131I Therapy of Metastatic Differentiated Thyroid Cancer. J Nucl Med 2017; 58:1146-1154. [PMID: 28104741 DOI: 10.2967/jnumed.116.179366] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/08/2016] [Indexed: 11/16/2022] Open
Abstract
Patients with metastatic differentiated thyroid cancer (DTC) may be prepared using either thyroid-stimulating hormone withdrawal (THW) or recombinant human thyroid-stimulating hormone (rhTSH) injections before 131I administration for treatment. The objective of this study was to compare the absorbed dose to the critical organs and tumors determined by 124I PET/CT-based dosimetry for 131I therapy of metastatic DTC when the same patient was prepared with and imaged after both THW and rhTSH injections. Methods: Four DTC patients at MedStar Washington Hospital Center were first prepared using the rhTSH method and imaged by 124I PET/CT at 2, 24, 48, 72, and 96 h after administration of approximately 30-63 MBq of 124I. After 5-8 wk, the same patients were prepared using the THW method and imaged as before. The 124I PET/CT images acquired as part of a prospective study were used to perform retrospective dosimetric calculations for 131I therapy for the normal organs with the dosimetry package 3D-RD. The absorbed doses from 131I for the lungs, liver, heart, kidneys, and bone marrow were obtained for each study (rhTSH and THW). Twenty-two lesions in 3 patients were identified. The contours were drawn on each PET image of each study. Time-integrated activity coefficients were calculated and used as input in OLINDA/EXM sphere dose calculator to obtain the absorbed dose to tumors. Results: The THW-to-rhTSH organ absorbed dose ratio averaged over 5 organs for the first 3 patients was 1.5, 2.5, and 0.64, respectively, and averaged over 3 organs for the fourth patient was 1.1. The absorbed dose per unit administered activity to the bone marrow was 0.13, 0.086, 0.33, and 0.068 mGy/MBq after rhTSH and 0.11, 0.14, 0.22, and 0.080 mGy/MBq after THW for each patient, respectively. With the exception of 3 lesions of 1 patient, the absorbed dose per unit administered activity of 131I was higher in the THW study than in the rhTSH study. The ratio of the average tumor absorbed dose after stimulation by THW compared with stimulation by rhTSH injections was 3.9, 27, and 1.4 for patient 1, patient 2, and patient 3, respectively. The ratio of mean tumor to bone marrow absorbed dose per unit administered activity of 131I, after THW and rhTSH, was 232 and 62 (patient 1), 12 and 0.78 (patient 2), and 22 and 11 (patient 3), respectively. Conclusion: The results suggest a high patient variability in the overall absorbed dose to the normal organs per MBq of 131I administered, between the 2 TSH stimulation methods. The tumor-to-dose-limiting-organ (bone marrow) absorbed dose ratio, that is, the therapeutic index, was higher in the THW-aided than rhTSH-aided administrations. Additional comparison for tumor and normal organ absorbed dose in patients prepared using both methods is needed before definitive conclusions may be drawn regarding rhTSH versus THW patient preparation methods for 131I therapy of metastatic DTC.
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Affiliation(s)
- Donika Plyku
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Robert F Hobbs
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland.,Department of Radiation Oncology, Johns Hopkins University, School of Medicine, Baltimore Maryland; and
| | - Kevin Huang
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Frank Atkins
- Medstar Health Research Institute and Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Carlos Garcia
- Medstar Health Research Institute and Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
| | - George Sgouros
- Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland.,Department of Radiation Oncology, Johns Hopkins University, School of Medicine, Baltimore Maryland; and
| | - Douglas Van Nostrand
- Medstar Health Research Institute and Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
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28
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Padovani RP, Tuttle RM, Grewal R, Larson SM, Boucai L. Complete blood counts are frequently abnormal 1 year after dosimetry-guided radioactive iodine therapy for metastatic thyroid cancer. Endocr Pract 2016; 20:213-20. [PMID: 24126230 DOI: 10.4158/ep13172.or] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Radioactive iodine (RAI) has been associated with hematologic abnormalities. Previous research has shown that even a single dose of RAI can cause changes in the peripheral complete blood count (CBC). It is unclear if the use of dosimetry guidance would prevent the effects of high doses of RAI on bone marrow suppression. METHODS CBC at baseline was compared to a CBC obtained 1 year after the last RAI treatment in 50 thyroid cancer patients that received ≥250 mCi RAI during the course of their disease. Cumulative dose, number of treatments, patients' age, and the use of external beam radiation therapy (EBRT) were considered in the analysis. RESULTS We observed a small but statistically significant decrease in hemoglobin (Hb), hematocrit (Hct), and platelet (Plt) counts at 1 year in 50 patients who had received ≥250 mCi RAI. We did not find a significant change in white blood cell count (WBC). Approximately 60% of patients who developed anemia had concomitant WBC and Plt abnormalities. RAI dose, number of treatments, and age at diagnosis did not confer a higher risk of bone marrow suppression. CONCLUSION High cumulative activities of RAI administered under dosimetric guidance are associated with a small but statistically significant decreases in Hb, Hct, and Plt counts. The clinical implications of these changes, if any, are unclear. The benefits obtained with high doses of RAI, when indicated, are likely to outweigh the minimal hematologic risks observed in the present study.
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Affiliation(s)
| | - R Michael Tuttle
- Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ravinder Grewal
- Nuclear Medicine Services, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Steve M Larson
- Nuclear Medicine Services, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Laura Boucai
- Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, New York
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29
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Abstract
The incidence of thyroid cancer has been increasing. After total thyroidectomy of well-differentiated thyroid tumors with intermediate- or high-risk features on pathology, radioiodine remains one of the mainstays of therapy for both thyroid remnant ablation as well as for treatment of metastatic disease. SPECT/CT, a relatively new modality, has been shown to play a pivotal role predominantly in the post-therapy setting by changing the risk stratification of patients with thyroid cancer. In the case of radioiodine treatment failure, FDG-PET/CT may provide prognostic information based on extent and intensity of metabolically active metastatic sites as well as serve as an important imaging test for response assessment in patients treated with chemotherapy, targeted therapies, or radiotherapy, thereby affecting patient management in multiple ways. The role of newer redifferentiation drugs has been evaluated with the use of I-124 PET/CT.
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Affiliation(s)
- Ravinder K Grewal
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Alan Ho
- Head and Neck Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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30
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Recombinant Human Thyroid Stimulating Hormone versus Thyroid Hormone Withdrawal for Radioactive Iodine Treatment of Differentiated Thyroid Cancer with Nodal Metastatic Disease. JOURNAL OF ONCOLOGY 2016; 2016:6496750. [PMID: 26977148 PMCID: PMC4763009 DOI: 10.1155/2016/6496750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 11/18/2022]
Abstract
Introduction. Recombinant human thyroid stimulating hormone (rhTSH) is approved for preparation of thyroid remnant ablation with radioactive iodine (RAI) in low risk patients with well differentiated thyroid cancer (DTC). We studied the safety and efficacy of rhTSH preparation for RAI treatment of thyroid cancer patients with nodal metastatic disease. Methods. A retrospective analysis was performed on 108 patients with histopathologically confirmed nodal metastatic DTC, treated with initial RAI between January 1, 2000, and December 31, 2007. Within this selected group, 31 and 42 patients were prepared for initial and all subsequent RAI treatments by either thyroid hormone withdrawal (THW) or rhTSH protocols and were followed up for at least 3 years. Results. The response to initial treatment, classified as excellent, acceptable, or incomplete, was not different between the rhTSH group (57%, 21%, and 21%, resp.) and the THW group (39%, 13%, and 48%, resp.; P = 0.052). There was no significant difference in the final clinical outcome between the groups. The rhTSH group received significantly fewer additional doses of RAI than the THW group (P = 0.03). Conclusion. In patients with nodal-positive DTC, preparation for RAI with rhTSH is a safe and efficacious alternative to THW protocol.
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31
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8349] [Impact Index Per Article: 1043.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Guo Y, Zhang Y, Chen Z, Xin Z. Effects of recombinant human thyroid stimulating hormone on 131I therapy for the treatment of differentiated thyroid cancer. Exp Ther Med 2015; 9:1847-1850. [PMID: 26136903 DOI: 10.3892/etm.2015.2330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 01/30/2015] [Indexed: 02/02/2023] Open
Abstract
The aim of the present study was to compare the advantages and disadvantages of the combined application of recombinant human thyroid stimulating hormone (rhTSH) with thyroid hormone withdrawal (THW) and THW alone prior to 131I therapy for the treatment of differentiated thyroid cancer. Four indicators were compared between the experimental group, who received a combined therapeutic method of rhTSH with THW, and the control group, who received THW therapy alone. With the exception of the elimination half-time of 131I in the blood in the experimental group, which was significantly shorter compared with that in the control group, the other three indicators, including the urinary iodine concentration, the relative 131I uptake ratio of the neck lesions and the one-time cure rate, were not significantly different between the two groups. In addition, the treatment efficacy of 131I therapy exhibited no statistically significant difference between the experimental and control groups. However, in the experimental group, the residence time of 131I in the blood was significantly shorter compared with that in the control group, indicating that the irradiation damage of radioactive iodine exposure to the non-target tissues was lower in the experimental group when compared with the control group. In addition, no evident hypothyroidism was observed in the patients. Thus, the combined application of rhTSH with THW prior to 131I therapy was demonstrated to be superior to the THW therapy alone.
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Affiliation(s)
- Yiling Guo
- Department of Nuclear Medicine, People's Hospital of Shenzhen, Shenzhen, Guangdong 518020, P.R. China
| | - Yingnan Zhang
- Department of Nuclear Medicine, People's Hospital of Shenzhen, Shenzhen, Guangdong 518020, P.R. China
| | - Zuowei Chen
- Department of Nuclear Medicine, People's Hospital of Shenzhen, Shenzhen, Guangdong 518020, P.R. China
| | - Zhenfu Xin
- Department of Nuclear Medicine, People's Hospital of Shenzhen, Shenzhen, Guangdong 518020, P.R. China
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Jun S, Lee JJ, Park SH, Kim TY, Kim WB, Shong YK, Ryu JS. Prediction of treatment response to ¹³¹I therapy by diffuse hepatic uptake intensity on post-therapy whole-body scan in patients with distant metastases of differentiated thyroid cancer. Ann Nucl Med 2015; 29:603-12. [PMID: 25980591 DOI: 10.1007/s12149-015-0983-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/08/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A diffuse hepatic uptake (DHU) on radioiodine whole-body scans (WBS) after (131)I therapy is caused by (131)I-labeled iodoproteins, particularly (131)I-labeled thyroglobulin (Tg). We hypothesized that the DHU intensity after (131)I therapy might correlate with subsequent serum Tg reduction, suggesting that DHU reflects destruction of functioning thyroid tissue as measured by serum Tg. MATERIALS AND METHODS We retrospectively reviewed the medical records and (131)I WBSs of 47 patients treated with (131)I therapy for distant metastasis from differentiated thyroid cancer (M:F = 15:32, median age 45 years, range 11-74 years). All patients received post-ablative (131)I scans (PAWBS) at first (131)I ablation after total thyroidectomy and post-therapy (131)I scan (PTWBS) at second (131)I therapy. The DHU intensities of the PAWBS and PTWBS were classified into 3 grades: 1, faint; 2, modest; and 3, intense. Serum thyroid-stimulating hormone-stimulated Tg (sTg) levels were measured at the time of each therapy and 1 year after the second (131)I therapy. RESULTS One year after the second (131)I therapy, 10 patients (21.3%) were in remission and 37 (78.7%) had persistent disease. The DHU intensity on PAWBS correlated with the percentage sTg reduction at the next follow-up point (σ = 0.466, p = 0.0016). The patients with intense DHU on PTWBS tended to have a higher percentage sTg reduction than the other patients, although statistical significances were marginal (Spearman's rank correlation: σ = 0.304, p = 0.054; Kruskal-Wallis test: p = 0.067). In univariate analysis, the DHU grades on PAWBS and the initial sTg levels were significantly different between patients in remission and those with persistent disease (PAWBS: p = 0.022; initial sTg: p = 0.0059). In multivariate logistic regression analysis, after adjusting for initial sTg levels, a DHU grade of 3 on PAWBS was an independent predictor of remission (PAWBS: p = 0.028; initial sTg <100 ng/ml: p = 0.043). CONCLUSIONS In patients with iodine-avid distant metastases, intensity of DHU on (131)I post-therapy scan correlated with subsequent percentage serum sTg reduction. Also, intense DHU could be one of the predictors of remission in these patients.
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Affiliation(s)
- Sungmin Jun
- Department of Nuclear Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea,
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Duan H, Gamper E, Becherer A, Hoffmann M. Quality of life aspects in the management of thyroid cancer. Oral Oncol 2015; 51:S1-5. [PMID: 25920747 DOI: 10.1016/j.oraloncology.2015.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/10/2015] [Accepted: 03/18/2015] [Indexed: 11/26/2022]
Abstract
While there is agreement that quality of life (QoL) is a central aim of medical treatment, the methods of its evaluation as well as its role in the patient's overall treatment experience are under continuous scrutiny. Different perspectives on patients' QoL have emerged; from the treating physician, from the psychologist, and naturally from the patient him/herself. This article provides insights into each of these views within the context of thyroid cancer where, as a consequence of increasing incidence and decreasing mortality rates, QoL aspects deserve close attention. Physicians often find themselves in situations where they perform a balancing act between what they know is best from a somatic point of view and learning about what is best for the individual patient. For psychologists in the field of oncology, a main area of interest is the incorporation of the patient's perspective into research by using patient-reported outcomes (PROs) which include QoL assessment. PROs can also be used in clinical practice as a way to start a conversation about symptoms and QoL aspects that perhaps patients might not volunteer, and this allows physicians to address QoL issues more directly. Patients usually appreciate being asked about all aspects of QoL, and need sound information about how their QoL might be affected by the disease and its treatment. By examining and understanding the different perspectives on QoL, and how QoL differs in patients with thyroid cancer compared with other cancers, it is hoped that the QoL can be enhanced in this particular patient group.
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Affiliation(s)
- H Duan
- Medical University of Vienna, Dept. of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Vienna, Austria
| | - E Gamper
- Innsbruck Medical University, Univ.-Clinic for Nuclear Medicine, Univ.-Clinic for Psychiatry and Psychotherapy, Innsbruck, Austria
| | - A Becherer
- Academic Teaching Hospital Feldkirch, Dept. of Nuclear Medicine, Feldkirch, Austria
| | - M Hoffmann
- Medical University of Vienna, Dept. of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Vienna, Austria.
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McLeod DSA, Carruthers K, Kevat DAS. Optimal Differentiated Thyroid Cancer Management in the Elderly. Drugs Aging 2015; 32:283-94. [DOI: 10.1007/s40266-015-0256-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sensitivity of preparation with rhTSH or thyroid hormone withdrawal using ¹³¹I-whole body scans to identify metastases of differentiated thyroid cancer. Int J Surg 2015; 16:107-112. [PMID: 25771100 DOI: 10.1016/j.ijsu.2015.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/12/2015] [Accepted: 02/24/2015] [Indexed: 11/22/2022]
Abstract
UNLABELLED It has been reported that there is a higher sensitivity for Thyroid Hormone Withdrawal (THW) in detection of metastases of Differentiated Thyroid Cancer (DTC) when compared to Recombinant Human Thyroid-Stimulating Hormone (rhTSH). This study aims to confirm this reported difference in the sensitivity using radioiodine whole body scans (WBS). MATERIALS AND METHODS In a retrospective study forty three patients with evidence or suspicion of metastatic differentiated thyroid cancer DTC (evaluated by thyroglobulin or abnormal findings in previous WBS) underwent WBS using of 24 h after oral administration of 370 MBq (131)I. The WBS was interpreted by two independent experienced observers categorizing their findings into a positive or negative for metastatic disease. The findings were controlled by stimulated thyroglobulin (TG) measurement and a two years follow-up. RESULTS Of the evaluated patients, 14 patients were prepared with rhTSH and 29 with THW. No statistical differences in patient characteristics were documented between the two groups (age, sex, thyroglobulin level, TSH level, type of cancer). In this study, no differences in the sensitivity of WBS of patients prepared with rhTSH or THW were found. There were 11 of 14 patients (78%) that were positive after rhTSH and 19 of 29 patients (65%) after THW. Metastatic disease was confirmed by stimulated thyroglobulin value and follow-up. CONCLUSION In contrast to previously published data, this study couldn't found any differences in the sensitivity of rhTSH or THW for the preparation of DTC patients undergoing (131)I imaging.
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Seo JH, Je JH, Lee HJ, Na YJ, Jeong IW, An JH, Kim SG, Choi DS, Kim NH. Metastatic papillary thyroid cancers with malignant pleural effusion aggravated during thyroid hormone withdrawal for radioiodine therapy. Yeungnam Univ J Med 2015. [DOI: 10.12701/yujm.2015.32.2.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ji Hye Seo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji Hye Je
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyun Jung Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young Ju Na
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Il Woo Jeong
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jee Hyun An
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sin Gon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dong Seop Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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McLeod DSA. Thyrotropin in the development and management of differentiated thyroid cancer. Endocrinol Metab Clin North Am 2014; 43:367-83. [PMID: 24891167 DOI: 10.1016/j.ecl.2014.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Thyrotropin (TSH) is the major regulator and growth factor of the thyroid. TSH may be important in the development of human thyroid cancer, with both suggestive animal models and clinical evidence, although definitive proof is still required. Applications for TSH in thyroid cancer management include TSH stimulation of radioiodine uptake, enhancement of biochemical monitoring through thyroglobulin measurement, and long-term suppression of TSH with supraphysiologic levothyroxine. This review synthesizes current knowledge of TSH in both the development and management of differentiated thyroid cancer.
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Affiliation(s)
- Donald S A McLeod
- Department of Internal Medicine & Aged Care, Royal Brisbane & Women's Hospital, Level 3, Dr James Mayne Building, Herston, Queensland 4029, Australia; Department of Endocrinology, Royal Brisbane & Women's Hospital, Level 1, Dr James Mayne Building, Herston, Queensland 4029, Australia; Department of Population Health, QIMR Berghofer Medical Research Institute, Herston Road, Herston, Queensland 4029, Australia.
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Vrachimis A, Schmid KW, Jürgens H, Schober O, Weckesser M, Riemann B. Cerebral metastases from thyroid carcinoma: complete remission following radioiodine treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:861-6. [PMID: 24399028 DOI: 10.3238/arztebl.2013.0861] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 07/11/2013] [Accepted: 07/11/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Brain metastases arise in roughly 0.9% of all cases of differentiated thyroid cancer. The median survival of adult patients with thyroid carcinoma that has metastasized to the brain is less than one year. Radioactive iodine treatment is only rarely given because its efficacy is not documented. In children, the situation may be different. METHOD In 2005, a 15-year-old girl underwent thyroidectomy, and an oxyphilic variant of papillary thyroid carcinoma was found in ectopic thyroid tissue. The patient underwent oral, high-dose radioactive iodine treatment. The post-therapeutic I-131 whole-body scan revealed multiple metastases in the skeleton, lungs, and the soft tissues, along with physiological uptake of the residual thyroid tissue. Magnetic resonance imaging of the head revealed two brain metastases. RESULTS When the initial treatment was completed, additional age-adapted high-dose radioactive iodine treatment was given, up to a total activity level of 35 GBq. There followed a complete remission of all metastases in the brain, bones, lungs, and soft tissues. Computed tomography of the chest revealed stable residuals. Over the ensuing 7.5 years of follow-up, the thyroglobulin values steadily declined to less than 2 ng/mL. The patient was asymptomatic at her last follow-up in May 2013. She did not develop any delayed reaction to high-dose radioactive iodine treatment (in particular, she did not develop leukemia or any other secondary malignancy). She remained fertile: after completion of the treatment, she had two healthy children. CONCLUSION In this patient with multifocal thyroid carcinoma, a rare entity, radioactive iodine treatment was successful as the single treatment. This case illustrates the point that a given therapeutic modality might succeed in an individual case despite a total or near-total lack of efficacy for most patients in the same situation.
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Affiliation(s)
- Alexis Vrachimis
- Department of Nuclear Medicine, University of Münster, Institute of Pathology and Neuropathology, University of Duisburg-Essen, Children's Hospital-Department for Pediatric Hematology and Oncology, University of Münster
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Melo M, Costa G, Ribeiro C, Carrilho F, Martins MJ, da Rocha AG, Sobrinho-Simões M, Carvalheiro M, Soares P. Stimulated thyroglobulin at recombinant human TSH-aided ablation predicts disease-free status one year later. J Clin Endocrinol Metab 2013; 98:4364-72. [PMID: 24037891 DOI: 10.1210/jc.2013-2267] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Thyroglobulin (Tg) levels measured at the time of remnant ablation after thyroid hormone withdrawal (THW) were shown to have prognostic value in predicting disease-free status. OBJECTIVES Our objectives were to determine whether stimulated Tg levels, measured at the time of remnant ablation performed under recombinant human TSH (rhTSH) stimulation, has value in predicting absence of detectable disease 1 year after radioiodine therapy and to compare the results obtained with this approach with a cohort of patients submitted to ablation after THW. DESIGN This was a prospective observational study. SETTING AND PATIENTS The study included 293 consecutive patients treated for a differentiated thyroid carcinoma with no initial evidence of distant metastasis. All patients were submitted to a total or near-total thyroidectomy, followed by ablation either under rhTSH (n = 151) or endogenous TSH stimulation (n = 142). Patients with positive Tg antibodies were excluded. MAIN OUTCOME MEASURES The predictive value of Tg at ablation was assessed by receiver operating characteristic curve analysis. RESULTS In the rhTSH group, 96 patients (73.3%) were considered disease-free at 1 year. Stimulated Tg at ablation after rhTSH was found to be an independent prognostic indicator of disease persistence 12 months later. The highest-accuracy cutoff value for absence of detectable disease was defined as 7.2 ng/mL, with a negative predictive value of 90%. In the THW group, Tg at ablation also proved to have independent predictive value. Using the same threshold (7.2 ng/mL), the negative predictive value of Tg was 95% in the THW group. CONCLUSIONS When rhTSH was used, stimulated Tg at ablation had independent predictive value for disease-free status 1 year later. A low stimulated Tg at rhTSH-aided ablation may be considered a favorable prognosis factor.
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Affiliation(s)
- Miguel Melo
- University Hospital of Coimbra, Department of Endocrinology, Diabetes and Metabolism, Praceta Mota Pinto, 3000-075 Coimbra, Portugal.
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Schneider DF, Chen H. New developments in the diagnosis and treatment of thyroid cancer. CA Cancer J Clin 2013; 63:374-94. [PMID: 23797834 PMCID: PMC3800231 DOI: 10.3322/caac.21195] [Citation(s) in RCA: 223] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 04/24/2013] [Accepted: 04/26/2013] [Indexed: 12/18/2022] Open
Abstract
Thyroid cancer exists in several forms. Differentiated thyroid cancers include those with papillary and follicular histologies. These tumors exist along a spectrum of differentiation, and their incidence continues to climb. A number of advances in the diagnosis and treatment of differentiated thyroid cancers now exist. These include molecular diagnostics and more advanced strategies for risk stratification. Medullary cancer arises from the parafollicular cells and not the follicular cells. Therefore, diagnosis and treatment differs from those of differentiated thyroid tumors. Genetic testing and newer adjuvant therapies have changed the diagnosis and treatment of medullary thyroid cancer. This review will focus on the epidemiology, diagnosis, workup, and treatment of both differentiated and medullary thyroid cancers, focusing specifically on newer developments in the field.
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Affiliation(s)
- David F Schneider
- Assistant Professor of Surgery, Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Klubo-Gwiezdzinska J, Burman KD, Van Nostrand D, Mete M, Jonklaas J, Wartofsky L. Potential use of recombinant human thyrotropin in the treatment of distant metastases in patients with differentiated thyroid cancer. Endocr Pract 2013. [PMID: 23186979 DOI: 10.4158/ep12244.ra] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In order to effectively treat differentiated thyroid cancer (DTC) with radioiodine (RAI) it is necessary to raise serum TSH levels either endogenously by thyroid hormone withdrawal (THW) or exogenously by administration of recombinant human TSH (rhTSH). The goal of this review is to present current data on the relative efficacy and side effects profile of rhTSH-aided versus THW-aided RAI therapy for the treatment of patients with distant metastases of DTC. METHODS We have searched the PubMed database for articles including the keywords "rhTSH", "thyroid cancer", and "distant metastases" published between January 1, 1996 and January 7, 2012. As references, we used clinical case series, case reports, review articles, and practical guidelines. RESULTS Exogenous stimulation of TSH is associated with better quality of life because it obviates signs and symptoms of hypothyroidism resulting from endogenous TSH stimulation. The rate of neurological complications after rhTSH and THW-aided RAI therapy for brain and spine metastases is similar. The rate of leukopenia, thrombocytopenia, xerostomia, and pulmonary fibrosis is similar after preparation for RAI treatment with rhTSH and THW. There is currently a controversy regarding RAI uptake in metastatic lesions after preparation with rhTSH versus THW, with some studies suggesting equal and some superior uptake after preparation with THW. Analysis of available retrospective studies comparing survival rates, progression free survival, and biochemical and structural response to a dosimetrically-determined dose of RAI shows similar efficacy after preparation for therapy with rhTSH and THW. CONCLUSION The rhTSH stimulation is not presently approved by the FDA as a method of preparation for adjunctive therapy with RAI in patients with metastatic DTC. Data on rhTSH compassionate use suggest that rhTSH stimulation is as equally effective as THW as a method of preparation for dosimetry-based RAI treatment in patients with RAI-avid metastatic DTC.
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Affiliation(s)
- Joanna Klubo-Gwiezdzinska
- Division of Endocrinology, Department of Medicine, Washington Hospital Center, Washington, DC 20010, USA
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Rosário PW, Ward LS, Carvalho GA, Graf H, Maciel RMB, Maciel LMZ, Maia AL, Vaisman M. Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus. ACTA ACUST UNITED AC 2013; 57:240-64. [DOI: 10.1590/s0004-27302013000400002] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Indexed: 12/11/2022]
Abstract
Thyroid nodules are frequent findings, especially when sensitive imaging methods are used. Although thyroid cancer is relatively rare, its incidence is increasing, particularly in terms of small tumors, which have an uncertain clinical relevance. Most patients with differentiated thyroid cancer exhibit satisfactory clinical outcomes when treatment is appropriate, and their mortality rate is similar to that of the overall population. However, relapse occurs in a considerable fraction of these patients, and some patients stop responding to conventional treatment and eventually die from their disease. Therefore, the challenge is how to identify the individuals who require more aggressive disease management while sparing the majority of patients from unnecessary treatments and procedures. We have updated the Brazilian Consensus that was published in 2007, emphasizing the diagnostic and therapeutic advances that the participants, representing several Brazilian university centers, consider most relevant in clinical practice. The formulation of the present guidelines was based on the participants' experience and a review of the relevant literature.
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Affiliation(s)
| | | | | | - Hans Graf
- Universidade Federal do Paraná, Brazil
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Wartofsky L, Van Nostrand D. Radioiodine treatment of well-differentiated thyroid cancer. Endocrine 2012; 42:506-13. [PMID: 22733393 DOI: 10.1007/s12020-012-9729-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 06/11/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Leonard Wartofsky
- Department of Medicine, Washington Hospital Center, Georgetown University Medical Center, 110 Irving Street, N.W., Washington, DC 20010, USA.
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Van Nostrand D, Wartofsky L, Atkins F. Reply: Recombinant Human TSH Versus Thyroid Hormone Withdrawal. J Nucl Med 2012. [DOI: 10.2967/jnumed.112.112094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hugo J, Robenshtok E, Grewal R, Larson S, Tuttle RM. Recombinant human thyroid stimulating hormone-assisted radioactive iodine remnant ablation in thyroid cancer patients at intermediate to high risk of recurrence. Thyroid 2012; 22:1007-15. [PMID: 22873801 DOI: 10.1089/thy.2012.0183] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Multiple studies have demonstrated successful radioactive iodine remnant ablation (RRA) following preparation with recombinant human thyroid stimulating hormone (rhTSH). Short-term studies in relatively low-risk patients have also suggested that rhTSH-stimulated RRA can have an effective adjuvant therapy function in destroying residual microscopic thyroid cancer cells. However, very few of these studies have included a significant number of intermediate or high-risk patients. The goal of this study was to examine clinical outcomes after rhTSH stimulated RRA in a larger cohort of thyroid cancer patients at higher risk of recurrence and disease-specific mortality. METHODS A retrospective chart review identified 586 thyroid cancer patients prepared for RRA with either a thyroid hormone withdrawal (THW) (n=321) or rhTSH preparation (n=265). The primary end points included both the best response to initial therapy and the clinical status at final follow-up. Clinical outcomes were compared within each of the American Thyroid Association (ATA) risk groups (low, intermediate, and high) and American Joint Committee on Cancer (AJCC) stages (I-IV) based on the method of preparation for RRA (THW vs. rhTSH). RESULTS Preparation with rhTSH was more likely to be associated with an excellent response to therapy (39.4% for rhTSH vs. 30% for TWH, p=0.03) and fewer additional therapies (29% for rhTSH vs. 37% for TWH, p=0.05) than THW. However, after a median follow-up period of 9 years, the final clinical outcomes were not significantly different with respect to recurrence rates (1.5% for rhTSH vs. 1.2% for TWH), likelihood of having persistent disease (46% for rhTSH vs. 48% for THW) or likelihood of having no evidence of disease (53% for rhTSH vs. 52% for TWH). Furthermore, clinical outcomes were similar between rhTSH and THW preparation across all ATA risk groups and AJCC stages. CONCLUSIONS rhTSH preparation for RRA is associated with a small, but statistically significant improvement in an initial response to therapy and similar final clinical outcomes across a wide range of risk of recurrence and risk of disease-specific mortality. These data suggest that rhTSH preparation for RRA can be effectively used in intermediate and high-risk patients without known distant metastases.
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Affiliation(s)
- Jonathan Hugo
- Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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