جستجوی مقالات مرتبط با کلیدواژه « differentiated thyroid cancer » در نشریات گروه « پزشکی »

In systemic radionuclide therapy such as radioiodine (I-131) for differentiated thyroid cancer, post-therapy dosimetry is essential to verify pre-therapy predictions, which in turn informs the next treatment. However, post-therapy multi-time point dosimetry is resource intensive and unfeasible in many institutions. We devised a schema of rapid predictive dosimetry by circumventing post-First Strike multi-time point dosimetry with carefully assigned gestalt values of predicted kinetics to personalise the Second Strike prescription. Verification is performed after the First Strike. Patient-specific time-activity curve is plotted from serial measurements of whole body exposure rates to obtain its decay constant; its inverse is the whole body Time Integrated Activity Coefficient (TIAC). The percentage of whole body TIAC attributed to blood is carefully assigned by gestalt based on population kinetics tabulated in Part 1, adjusted by any metastasis on I-131 whole body scintigraphy. Marrow absorbed dose is calculated by EANM formularism. Lung safety threshold at 48h post-therapy is linearly scaled by height, where the patient’s risk of lung radiotoxicity is revealed from the whole body time-activity curve value at 48h. Predictive prescription for the second I-131 fraction (Second Strike) is by careful gestalt assessment based on predicted kinetics, remaining marrow and lung tolerance, marrow dose rate constraint per fraction (0.265 Gy/h), local regulatory and facility requirements in relation to radiation protection. Tumour dosimetry is obviated under the assumption of severe tumour absorbed dose heterogeneity. The final prescription for the Second Strike is usually the lowest I-131 activity amongst all clinical, dosimetric and regulatory constraints. This schema is incorporated into a Predictive Calculator spreadsheet for rapid predictive dosimetry, and is freely available. Calculations may be completed within minutes to generate personalised predictive prescriptions, making it feasible for routine clinical implementation. Our innovative schema of rapid verification and predictive dosimetry bridges the technological gap between empiric vs theranostic prescription to help institutions modernise. Its expeditious design makes this schema feasible to be integrated into the routine clinical workflow. Its predictive estimates provide invaluable dosimetric insight to inform the next I-131 fraction, allowing every prescription to be scientifically rationalised and personalised according to individual circumstances.

The traditional practice of empiric radioiodine (I-131) prescription is scientifically obsolete and inappropriate for inoperable metastatic differentiated thyroid cancer. However, theranostically guided prescription is still years away for many institutions. A personalized predictive method of radioiodine prescription that bridges the gap between empiric and theranostic methods is presented. It is an adaptation of the “maximum tolerated activity” method, where serial blood sampling is replaced by population kinetics carefully chosen by the user. It aims to maximize crossfire benefits within safety constraints to overcome tumour absorbed dose heterogeneity for a safe and effective first radioiodine fraction i.e., the First Strike.

The EANM method of blood dosimetry was incorporated with population kinetics, marrow and lung safety constraints, body habitus and clinical assessment of metastatic extent. Population data of whole body and blood kinetics in patients with and without metastases, prepared by recombinant human thyroid stimulating hormone or thyroid hormone withdrawal, and the maximum safe marrow dose rate were deduced from published data. For diffuse lung metastases, the lung safety limit was linearly scaled by height and separated into lung and remainder-of-body components.

The slowest whole body Time Integrated Activity Coefficient (TIAC) amongst patients with any metastases was 33.5±17.0 h and the highest percentage of whole body TIAC attributed to blood was 16.6±7.9%, prepared by thyroid hormone withdrawal. A variety of other average radioiodine kinetics is tabulated. Maximum safe marrow dose rate was deduced to be 0.265 Gy/h per fraction, where blood TIAC is normalised to administered activity. An easy-to-use calculator was developed which only requires height, weight and gender to populate recommendations for personalized First Strike prescription. The user decides by clinical gestalt whether the prescription is to be constrained by marrow or lung, then selects an activity depending on how extensive the metastases are likely to be. A Standard Female with oligometastasis and good urine output without diffuse lung metastasis is expected to safely tolerate 8.03 GBq of radioiodine as the First Strike.

This predictive method will help institutions rationalise the First Strike prescription based on radiobiologically sound principles, personalised to individual circumstances.

The present study aims to assess pre-thyroidectomy thyroid hormone disturbances among patients suffering from differentiated thyroid carcinoma (DTC).

This retrospective study was performed from September 2020 to March 2021. We analyzed the hospital files of 710 patients with DTC who underwent thyroidectomy and referred to nuclear medicine department from April 2013 to September 2019. Demographics, TNM stage, pre-surgery thyroid function tests, time-interval to achieve a complete response, recurrence rate, one-year response, final response, and the need for alternative treatment modalities were extracted. Then, we analyzed the potential association of pre-surgery TSH levels with the initial disease stage and treatment response. Chi-Square, Analysis-of-variance, and Kruskal-Wallis tests were used where appropriate.

The mean age of participants was 40.39 ± 13.85 years. History of Hashimoto's disease was detected in 130 (18.3%) patients. Multi-focal DTC was found in 221 (31.2%) patients. Lymph node involvement was significantly higher among men (p = 0.001). Men also had significantly higher thyroglobulin levels (p = 0.025). No statistically significant association was found between pre-surgery thyroid function status and TNM stage or multifocality of the malignancy. Baseline thyroid function tests also did not show a statistically significant relationship with thyroglobulin, anti-thyroglobulin antibody, time to first excellent response, and follow-up duration.

Baseline thyroid function status may not change the outcome of DTC. It could also be plausible that thyroid dysfunction before surgery would not increase invasiveness nor impact the treatment-response of the tumor compared to euthyroid patients.

Effective management of radioiodine (RAI)-refractory differentiated thyroid cancer is a challenge due to limited treatment options. Multikinase inhibitor therapy including sorafenib has been an optional treatment in recent years. This study aims to compare the clinical benefit rate, progression free survival, and quality of life between patients who received limited dose of sorafenib (200-400 mg per day) as opposed to the control group.

Twenty-two patients who received sorafenib and twenty-three cases in the control group were studied for two years. Baseline variables were comparable between two subgroups. The results of diagnostic imaging methods were also taken into consideration. Quality of life was measured using the EORTC (European Organization for Research and Treatment of Cancer) quality of life questionnaire.

Based on the RECIST (Response Evaluation Criteria in Solid Tumors) criteria, clinical benefit rate was 77.3% and 47.8% in sorafenib and control subgroups respectively (p value=0.042). The median of progression free survival for the sorafenib subgroup was 24 months and in the control subgroup was 22 months (p value=0.020). In a comparison between two groups regarding their quality of life, all subscales were statistically insignificant between the two groups except for the symptom subscale (p value=0.001).

Low-dose sorafenib maintenance therapy is an effective treatment option in RAI- refractory differentiated thyroid cancer with the main effect of stabilizing the disease. Except for unpleasant but tolerable adverse effects, this treatment has no significant negative influence on the quality of life as far as the physical, role, cognitive, emotional, financial and social functions are concerned.

Thyroglobulin elevated-negative iodine scintigraphy (TENIS) differentiated thyroid cancer (DTC) patients are a subgroup of DTC patients with almost rapid disease progression and reduced overall survival and them usually do not have an effective treatment modality. Surgery and metastatectomy is the best option for recurrent disease in cases of solitary or oligometastasis. Detection of the metastatic sites is of utmost importance in these patients. We present a patient with TENIS syndrome and negative [18F]FDG PET/CT and [68Ga]Ga-DOTATATE whole body PET/CT scan in whom just [68Ga]Ga-FAPI PET/CT helped in localizing the metastatic lesion to the iliac bone and subsequently the bone metastasis was resected and the pathology report confirmed the diagnosis.

 Accurate evaluation of response to treatment in differentiated thyroid cancer (DTC) is the sine qua non of preventing over-treatment in low-risk patients and implementing appropriate interventions in high-risk individuals.

 This study aimed to assess the response to therapy in DTC patients based on dynamic stratification method.

 In this cross-sectional study, 154 medical records of subjects with DTC (with at least 6 months after total thyroidectomy) and referred to endocrinology clinics in Ahvaz, Iran, from April 2020 to May 2021 were examined. Patients were stratified according to a dynamic risk stratification system (informed by their specific clinical, histopathological, and ultrasonography findings, and other diagnostic imagines) into four groups: Excellent response (ER), indeterminate response (IR), biochemical incomplete response (BIR), and structural incomplete response (SIR).

 For a mean follow-up period of 28.59 months, excellent response to treatment was observed in 92 patients (59.7%), indeterminate response to treatment was found in 32 patients (20.8%), biochemical incomplete response was detected in 2 patients (1.3%), and structural incomplete response was seen in 28 patients (18.2%). In the group with low risk of recurrence, ER and IR were observed in 79.2% and 15.6% of the patients, respectively (P < 0.0001). In the group with an intermediate risk of recurrence, ER was found in 32% of the patients, while IR and SIR + BIR were seen in 34% and 34% of the patients, respectively (P < 0.0001). No cases of ER or IR were observed in the group with high risk (P = 0.001).

 In sum, response to treatment significantly varied based on dynamic risk stratification, with ER being highest in the low-risk group, less likely in moderate risk group, and undetected in the high-risk group.

2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (2-[18F]FDG-PET/CT) is implemented in papillary thyroid cancer (PTC) patients with elevated Thyroglobulin (Tg) and negative Iodine-131 whole-body scan (131I-WBS). Here, we evaluated the impact of TSH stimulation after levothyroxine withdrawal on the detection rate of 2-[18F]FDG-PET/CT. A prospective study was performed on 60 PTC patients, presented with negative 131I-WBS and elevated or unjustifiably high Tg. 2-[18F]FDG-PET/CT was performed in 30 patients while they were on levothyroxine therapy (unstimulated-TSH [uns-TSH]) and after Levothyroxine withdrawal in the other 30 patients (stimulated-TSH [s-TSH]). Results of the two groups were compared using nonparametric tests. Receiver operating characteristic curve was used to find Tg cutoff values for predicting positive scan results. Overall, 2-[18F]FDG-PET/CT was positive in 63.3% of the patients, 80% (24/30) in s-TSH and 46.7% (14/30) in uns-TSH group. The detection rate was higher in s-TSH group (p=0.007). It was still significant in multiple regression analysis (p=0.041). In uns-TSH group, 2-[18F]FDG-PET/CT was more often positive in patients with higher uns-Tg level (p=0.002). An uns-Tg level of ≥19.00 ng/mL predicted positive results with the sensitivity of 0.786 and specificity of 0.750 (area under curve=0.819). Although statistically insignificant (p=0.055), s-Tg was higher in patients with positive 2-[18F]FDG-PET/CT studies in the s-TSH group. No relation was demonstrated between TSH and anti-Tg-antibody levels and 2-[18F]FDG-PET/CT positivity. TSH-stimulation after levothyroxine withdrawal might enhance the detection rate of 2-[18F]FDG-PET/CT in PTC patients. Additionally, 2-[18F]FDG-PET/CT is more often positive in patients with higher Tg levels.

The kidney is an unconventional site for thyroid metastasis. As of the writing of this article, only about 30 cases have been reported. It presents like a renal mass. We are reporting a man with thyroid carcinoma presenting with distant metastasis to the kidney. He had complaints of abdominal pain and haematuria. Initial imaging suggested a left renal mass. A diagnosis of renal cell carcinoma was made and a nephrectomy was performed. Histopathology revealed it to be a metastasis from cancer of the thyroid gland. Subsequently, an ultrasound of the thyroid gland was performed, which showed a malignant appearing thyroid nodule. Correlative bone scan showed uptake at multiple skeletal sites. Total thyroidectomy was done and it was found to be papillary thyroid cancer. Subsequently, high dose radioactive iodine was administered. The patient was followed up and has recently found to have metastasis to the brain and is undergoing radiotherapy.

Thyroid cancer and radioactive iodine (RAI) ablation for postsurgical management may lead to uncontrolled inflammation. This study was intended to assess the prophylactic and therapeutic immunomodulatory effects of omega-3 fatty acids in patients with differentiated thyroid cancer (DTC). A total of 85 patients with DTC were allocated into two groups based on RAI dosage after thyroidectomy. Patients in each group were randomly distributed into three subgroups: G1 with RAI ablation only, G2 treated with omega-3 for 30 days before RAI ablation, and G3 treated with omega-3 for 30 days after RAI ablation. Fifteen healthy individuals were included as controls. Serum cytokine levels including IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-17A, IL-17F, IL-21, IL-22, TNF-α and IFN-γ were determined by cytometric bead assay. IL-4, IL-6, IL-21 and IL-22 levels in patients with DTC were higher than in the healthy controls. Regardless of RAI dosage, IL-6 showed an increasing trend after RAI ablation. IL-4, IL-22, and IL-17A remained at considerably higher levels than in the healthy controls after RAI ablation. Within-group comparisons showed a significant reduction in Th1+Th17/Th2+Th22 ratio in G2 patients 1 week after RAI ablation. Between-group comparisons showed increased IL-10 levels in G3 compared with G1 patients one week after high-dose RAI ablation. In G3, Th1+Th17/Th2+Th22 and Th1+Th17/Th2+Th9+Th22 ratios were remarkably lesser than in G2 patients 1 month after intermediate-dose RAI ablation. Our results showed better anti-inflammatory effects of omega-3 when it was used therapeutically after RAI ablation in patients with DTC than when it was used prophylactically before RAI.

Differentiatedthyroid carcinoma (DTC) constitute approximately 90% of all thyroid tumors with an overall excellent prognosis. However, there is a small group of patients with a more aggressive form of disease, usually associated with certain poor prognostic factors. Using our large database of patients with DTC, the current study aims at identifying some of these factors. 

This retrospective study was based on the registry of patients with non-medullary thyroid carcinoma. Data were collected on the clinical, laboratory, and outcome characteristics of 501 patients followed at our department.

On multivariate analysis, the following variables were predictive of persistent disease: less than total thyroidectomy, residual disease on the post treatment whole body radioiodine scan (WBIS), higher received radioiodine activities, and higher levels of baseline stimulated thyroglobulin (Tg) and thyroid stimulating hormone (TSH). The greatest predictive value for the persistent/recurrent disease was attributed to the presence of residual disease on the post-treatment WBIS (odds ratio (OR): 33.72, 95% confidence interval (95% CI): 18.17-62.57), followed by type of surgical procedure (OR: 8.92, 95% CI: 2.90-27.39), radioiodine ablation dose (OR: 4.03, 95% CI: 1.56-10.39), stimulated baseline Tg level (OR: 2.79, 95% CI: 1.53-5.08) and finally, the stimulated baseline TSH level (OR: 2.21, 95% CI: 1.08-4.519).

In patients with DTCs, surgical procedures other than total thyroidectomy, presence of residual disease on the post-treatment WBIS, higher received radioiodine activities, higher baseline stimulated Tg and TSH levels are associated with a higher probability of having persistent disease and can be used in conjunction with other disease characteristics to reach proper decisions with regard to treatment and follow-up.

Finding optimum time of post ablation whole body iodine scan in patients with differentiated thyroid cancer(DTC) treated with I-131. 20 patients with DTC, who were treated with I131 underwent post ablation whole body iodine scan (WBIS) in days 4, 7 and 9 after treatment. A dual head gamma camera (e-cam, Siemens) equipped with high energy parallel hole collimator was used for imaging. The images were acquired with 7cm/min and stored in a 1024 ×256 matrix. 3 Patients had negative WBIS in all three sets of imaging and 17 patients had postsurgical thyroid remnants on all 3 scans. On days 4 and 7 we detected 11 patients with cervical lymph node metastases while on day 9 only 9 patients showed cervical lymph node metastases.(P=0.135)On all 3 sets of images, we encountered 4 patients with mediastinal lymph node metastases and 1 patient with bone metastasis. In addition, all 3 sets of images detected lung metastases in three patients. The total number of affected foci did not have any statistical differences in whole body scan of day 4, 7 and 9. (P = 0.083) According to the radiation safety hazards for staff and technicians of nuclear medicine department and lack of difference in scan findings between 4 and 7 days after RAI, scanning the DTC patients in the day 7 after RAI administration , is more practicable, with less probability of missing the sites of involvement. Performing whole body iodine scans after 1 week is not recommended.

TSH suppression by Levothyroxine consumption is a mainstay of thyroid cancer treatment. Tablet-splitting is a worldwide approach in dose adjustment in patients. However, it is highly recommended to evaluate the validity of tablet splitting for each distinctive drug by clinical trials before routinely using tablet halves in clinical practice. In this study we compared the effect of 150 μg dose of Levothyroxine by use of a100 and a 50 μg tablets or one and half 100 μg tablets in Differentiated thyroid cancer (DTC) patients.
One hundred DTC patients treated with one and half 100 μg Levothyroxine tablets were randomly divided into two groups. The first group continued taking medication as before and the second group received the same daily dose by taking one 100 and one 50 microgram Levothyroxine tablets. The mean changes in TSH and T3 levels and patients weight were compared between the groups.
91 patients completed the study. Levothyroxine consumption pattern, age, gender distribution, weight and TSH levels were comparable between groups at the beginning of the study. The mean change of body weights, serum levels of T3 and TSH showed no significant difference between groups in different time points during the study (P>0.05).
This study showed similar efficacy of tablet splitting and two tablets administration for Levothyroxine; however, patients preferred two tablets at the end of the study. It can be concluded that tablet splitting can be used as an alternative way when the 50 μg tablet is not available.

Cauda equina secondary to metastatic follicular thyroid cancer of the lumbosacral area is a rare entity. Case Report: We report an unusual case of a 52-year-old male who presented with backache, lower limb weakness, and perianal numbness. A CT-scan of the lumbosacral area showed an enhancing mass at the L4, L5 and S1 vertebrae. Histopathology after excision revealed a metastatic thyroid cancer. Hence, a CT scan of the neck and chest was performed which showed a nodule in the left lobe of the thyroid and a mass in the left chest wall. A total thyroidectomy and excision of the chest wall lesion was undergone, which was diagnosed as a follicular carcinoma of the thyroid. Metastatic workup of spinal metastasis should include evaluation of the thyroid gland.

Differentiated thyroid cancer (DTC), in which histologic examination often reveals evidence of lymphocytic infiltration at the edges of the tumour, is a good model for the interaction between human cancer and the immunocompetent host immune system. We tested sera from patients with DTC for cytotoxicity against cultured human thyroid, eye muscle and K562 cells in antibody- dependent cell mediated cytotoxicity (ADCC) and natural killer (NK) cell cytotoxicity assays. When cultured thyroid cells were used as targets in ADCC assay, specific cytotoxicity was increased (% specific lysis > mean + 2SD for normals) in only 2 out of 30 patients with DTC but decreased (% specific lysis < mean + 2SD for normals) in 19 patients and mean for the group was significantly less than that for the normals.The same effect was observed using human eye muscle cells as targets in an ADCC assay. Serum from patients with DTC, but not those from normal subjects, inhibited the ADCC activity against normal thyroid cells in serum from patients with Graves’ disease, in a dose dependent manner. Serum from patients with thyroid cancer inhibited natural cytotoxicity against human K562 cells while normal serum did not. Pretreatment of normal PBMC with pooled serum from patients with DTC abolished natural cytotoxicity against K562 cells whereas pooled normal serum had no significant effect. This phenomenon reflected inhibition of the natural cytotoxicity mediated by (NK) cells in the mixed peripheral blood mononuclear cells (PBMC) population by an unknown serum factor or factors. We confirmed this by performing experiments using sera from patients with DTC, human K562 cells as targets in NK cell assay and PBMC from normal subjects as source of NK cells. The inhibitory factor, which probably works at the level of the NK cells and is called natural cytotoxicity blocking factor (NKBF), may be a marker for invasive thyroid cancer, although this needs to be addressed in furtherstudies.