RESUMO
The activity of radioiodine (131I) used in adjuvant therapy for thyroid cancer ranges between 30 mCi (1.1 GBq) and 150 mCi (5.5 GBq). Dosimetry based on Marinelli's formula, taking into consideration the absorbed dose in the postoperative tumour bed (D) should systematise the determination of 131I activity. Retrospective analysis of 57 patients with differentiated thyroid cancer (DTC) after thyreidectomy and adjuvant 131I therapy with the fixed activity of 3.7 GBq. In order to calculate D from Marinelli's formula, the authors took into account, among other things, repeated dosimetry measurements (after 6, 24, and 72 h) made during scintigraphy and after administration of the therapeutic activity or radioiodine. In 75% of the patients, the values of D were > 300 Gy (i.e. above the value recommended by current guidelines). In just 16% of the patients, the obtained values fell between 250 and 300 Gy, whereas in 9% of the patients, the value of D was < 250 Gy. The therapy was successful for all the patients (stimulated Tg < 1 ng/ml and 131I uptake < 0.1% in the thyroid bed in follow-up examination). Dosimetry during adjuvant 131I therapy makes it possible to diversify the therapeutic activities of 131I in order to obtain a uniform value of D.
Assuntos
Radioisótopos do Iodo/uso terapêutico , Dosagem Radioterapêutica , Neoplasias da Glândula Tireoide/radioterapia , Absorção de Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Distribuição Tecidual , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The paper presents a pre-processing method which, based on positron-emission tomography (PET) images of 18F-fluorodeoxyglucose ([18F] FDG) hypermetabolic pulmonary nodules, makes it possible to obtain additional visual characteristics and use them to enhance the specificity of imaging. MATERIAL AND METHODS: A retrospective analysis of 69 FDG-PET/CT scans of solitary hypermetabolic pulmonary nodules (40 cases of lung cancer and 29 benign tumours), where in each case, the standardised uptake value of the hottest voxel within the defined volume of interest was greater than 2.5 (SUVmax > 2.5). No diagnosis could be made based on these SUVmax values. All of the PET DICOM images were transformed by means of the pre-processing method for contouring the uptake levels of [18F] FDG (PCUL-FDG). Next, a multidimensional comparative analysis was conducted using a synthetic variable obtained by calculating the similarities based on the generalised distance measure for non-metric scaling (GDM2) from the pattern object. The calculations were performed with the use of the R language. RESULTS: The PCUL-FDG method revealed 73.9% hypermetabolic nodules definitively diagnosed as either benign or malignant lesions. As for the other 26.1% of the nodules, there was uncertainty regarding their classification (some had features suggesting malignancy, while the characteristics of others made it impossible to confirm malignancy with a high degree of certainty). CONCLUSIONS: Application of the PCUL-FDG method enhances the specificity of PET in imaging solitary hypermetabolic pulmonary nodules. Images obtained using the PCUL-FDG method can serve as point of departure for automatic analysis of PET data based on convolutional neural networks.
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PURPOSE: It is possible to raise the rate of the uptake of 131I in the thyroid gland (RAIU) by increasing the endogenous TSH level through appropriate use of methimazole (MMI) prior to 131I therapy. The purpose of this paper is to assess the impact of pre treatment with MMI on the efficacy of 131I therapy in non-toxic multinodular goitre (NMG). METHODS: Thirty-one patients with NMG received 131I treatment in order to reduce the volume of the thyroid (TVR). Those in group 1 (n = 16) were administered 10 mg of methimazole for 6 weeks. Four days after its discontinuation, they received 131I. Patients in group 2 (n = 15) were given a placebo instead of MMI. The therapeutic activity of 131I was constant (800 MBq) and was repeated every 6 months. Treatment was discontinued when TVR reached <40 ml. RESULTS: In group 1, RAIU increased approximately twofold. Ten patients from group 2 and four patients from group 1 received further doses of 131I. The median of time until TVR decreased below 40 ml was 9 months [6-12 months] and 18 months [14-22 months] in group 2. At 2 years after the 131I therapy, the occurrence of hypothyroidism did not differ significantly (36% in group 1 and 33% in group2, p = 0.074). CONCLUSIONS: Radioiodine treatment of NMG preceded with appropriate application of MMI is efficient thanks to increased RAIU, shorter period of treatment, and lower frequency of 131I administration, without an increase in the incidence of post-treatment hypothyroidism.
Assuntos
Bócio Nodular , Bócio , Bócio Nodular/tratamento farmacológico , Bócio Nodular/radioterapia , Humanos , Radioisótopos do Iodo/uso terapêutico , Metimazol/uso terapêutico , TireotropinaRESUMO
A 36-year-old female patient underwent a laparoscopic surgery to remove a uterine fibroid. The procedure failed to relieve the pelvic pain, although its nature changed. After a period of observation, the patient was re-admitted to hospital on suspicion of a vesico-uterine fistula to be differentiated with endometriosis. Diagnostic investigations - cystography, cystoscopy, computed tomography and magnetic resonance - did not reveal a fistula. Laparoscopy was performed, with a possible biopsy in order to eliminate endometriosis. The result was negative, but chronic progressive reactive/inflammatory lesions were noticed, possibly indicating the presence of a vesico-peritoneal fistula. Therefore, a direct radionuclide cystography was performed. The scintigraphic images single-photon emission computed tomography (SPECT/CT) showed a radioactive spot, indicative of a vesico-peritoneal fistula. The fistula was treated for three months by catheterisation of the urinary bladder. The follow-up SPECT-CT did not reveal any urine leakage from the bladder. The clinical symptoms disappeared as well.
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The therapeutic activity of 131I administered to patients with Graves' disease can be calculated by means of Marinelli's formula. The thyroidal iodine uptake (131IUmax) needed for the calculation is usually determined with the use of 131I. The purpose of the paper was to estimate 131IUmax on the basis of technetium uptake in the thyroid at 20 min (99mTcU20min). Eighty patients suffering from Graves' disease were qualified for radioiodine therapy with measurement of fT4, fT3, thyroid-stimulating hormone and its receptor (TRAb). Prior to the treatment, all the patients were euthyroid. 131IUmax for each patient was determined according to the levels of 131I after 24 h (131IU24h), while effective half-life (T eff) according to the measurements of 131IU24h and 131I uptake after 48 h (131IU48h). Additionally, on the day before measuring 131IU24h, 99mTcU20min was calculated for each patient. It was demonstrated that there existed a correlation, with statistical significance at p < 0.05, between the following pairs of values: TRAb and 131IU24h, TRAb and 99mTcU20min, and 99mTcU20min and 131IU24h. The interdependence between 131IU24h and 99mTcU20min at the level of significance p < 0.05 is described by the following algorithms: 131IU24h = 17.72 × ln (99mTcU20min) + 30.485, if TRAb < 10 IU/ml, and 131IU24h = 18.03 × ln (99mTcU20min) + 38.726, if TRAb > 10 IU/ml. It is possible to predict thyroid iodine uptake 131IU24h in Graves' disease on the basis of measuring the uptake of 99mTcU20min. This shortens the time necessary for diagnosis and enables the calculation of 131I activity using Marinelli's formula.
Assuntos
Doença de Graves/radioterapia , Radioisótopos do Iodo/uso terapêutico , Compostos de Organotecnécio , Algoritmos , Feminino , Doença de Graves/diagnóstico por imagem , Humanos , Radioisótopos do Iodo/farmacocinética , Masculino , CintilografiaRESUMO
BACKGROUND: Radioiodine therapy (RIT) in patients with large nontoxic multinodular goiter (MNG) recently becomes more common method in comparison to surgery (especially in elderly patients and with contraindications because of severe chronic diseases other systems). Repeatedly low thyroid radioactive iodine uptake (RAIU) decreases effectiveness of RIT or makes it impossible. The recombinant human thyrotropin can increase RAIU and improve the results of RIT. THE AIM OF THE STUDY: was to assess the influence of a single very low dose (0.03 mg) of rhTSH on RAIU and thyroid function in euthyroid (MNG-EU) and subclinical hyperthyroid (MNG-SC) patients with a large multinodular goiter. MATERIAL AND METHODS: 40 patients (14 male, 26 female, age 57-80 yr) with large non-toxic MNG over 80 grams and with baseline RAIU < 40% were included into the double-blind randomized study and divided into two groups: rhTSH-group and control group. First group received the single intramuscular injection of 0.03 mg rhTSH and the second received placebo. The RAIU were measured 24 and 48 hours after the rhTSH and then all the patients were administered therapeutic doses of I-131. TSH and free thyroxine levels were measured at 1st and 2nd day after the injection of rhTSH and later, at 4 and 8 weeks after the RIT. RESULTS: The mean RAIU increased significantly from 30.44 ± 7.4% to 77.22 ± 8.7% (p < 0.001). There were no statistically significant differences in RAIU between euthyroid (MNG-EU) and subclinically hyperthyroid (MNG-SC) patients. The peak of serum TSH was noticed 24 hours after rhTSH injection and in MNG-EU patients it has remained within normal range, similarly as fT4. In the MNG-SC group the administration of rhTSH resulted in a significant increase in the TSH values after 24 hours, whose mean level slightly exceeded the upper limit of the normal range with normalization at 48 hours. 8 weeks after the RIT, the TSH and fT4 levels did not exceed the normal range and did not differ in a statistically significant way. CONCLUSIONS: Even the single very low dose of rhTSH increases the values of RAIU in significant way, in euthyroid and subclinically hyperthyroid patients. The administration of rhTSH is well-tolerated. Neoadjuvant administration of a low dose (0.03 mg) of rhTSH before I-131 seems to be an optimal method of management which may increase the effectiveness of RIT and decrease the exposure of the patients to absorbed doses of ionizing radiation.
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Bócio Nodular/metabolismo , Bócio Nodular/radioterapia , Radioisótopos do Iodo/metabolismo , Radioisótopos do Iodo/uso terapêutico , Tireotropina/farmacologia , Idoso , Idoso de 80 Anos ou mais , Transporte Biológico/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Bócio Nodular/complicações , Bócio Nodular/patologia , Humanos , Hipertireoidismo/complicações , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes/farmacologiaRESUMO
INTRODUCTION: The therapeutic effect of radioactive iodine ((131)I) on benign goitre consists of the emission of tissue-destructive beta-radiation. Since the range of beta (131)I radiation in tissue can reach 2.4 mm, it can affect the adjacent parathyroid glands. The purpose of this paper is to assess parathyroid function in patients with toxic and non-toxic goitres, up to five years following (131)I therapy. MATERIAL AND METHODS: The study sample consisted of 325 patients with benign goitres (220 with toxic nodular goitre (TNG), 25 with non-toxic nodular goitre (NTNG), and 80 with Graves' disease (GD) treated with (131)I. The therapeutic activity of (131)I for each patient was calculated using Marinelli's formula. The serum levels of fT3, fT4, TSH, iPTH and Ca(2+), Ca and phosphates were determined one week before (131)I administration, as well as every two months up to a year following the therapy, and then after three and five years post-treatment. RESULTS: After two months following the administration of (131)I, all the treated patients showed a statistically significant above normal increase in iPTH concentrations (amounting to a value almost twice the norm in patients with TNG), which remained stable up to ten months after treatment, to return to normal level in the following months. In all the patients, Ca(2+), Ca, phosphates concentration remained within normal range throughout the course of the study. The concentrations of fT3 and fT4 quickly returned to normal after (131)I administration, and remained within normal range until the completion of the study. CONCLUSION: Radioiodine treatment of benign thyroid disorders results in transient (up to ten months after (131)I administration) hyperparathyroidism. The condition does not influence the level of calcium and phosphates concentration in any significant way.
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Bócio/radioterapia , Radioisótopos do Iodo/efeitos adversos , Glândulas Paratireoides/efeitos da radiação , Feminino , Bócio/metabolismo , Doença de Graves/metabolismo , Doença de Graves/radioterapia , Humanos , Radioisótopos do Iodo/farmacocinética , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/metabolismo , Hormônio Paratireóideo/metabolismoRESUMO
BACKGROUND: When planning radioactive iodine therapy, it frequently happens, both in Poland and world-wide, that inadequate attention is paid to such easily measurable parameter sas: 1) the serum concentration of thyrotropin (TSH) before administering radioiodine, which is a key factor for extranodular(non-autonomous) iodine uptake of the thyroid gland, 2) thyroid gland iodine uptake, and 3) the effective half-life of 131I (Teff.). The aim of the study is to evaluate the impact of the above factors on the efficacy of 131I treatment in hyperthyroid patients. METHODS: The material consisted of 4140 patients: 2190 with autonomous toxic nodules (ATN) and 1950 with toxic multinodular goitres (TMG). The patients were prepared for treatment in such a way that the concentration of TSH did not exceed 0.1 mU/land Teff.< 5 days. The therapeutic activity of 131I was calculated using Marinelli's formula. The selection of absorbed dose value was determined by the degree of suppression of extranodulart issue. Monitoring was performed every eight weeks. RESULTS: At one year after 131I administration showed that a euthyroid status was achieved in 94%, hypothyroidism was seen observed in 3%, while persistence or recurrence of hyperthyroidism in 3% of ATN patients and, respectively, 89%, 4% and 7% of TMG patients. CONCLUSIONS: Patients with toxic nodular goitre who are to be treated with radioiodine should have the lowest possible serum concentration of TSH. The suppression of extranodular determines the optimal value of absorbed dose for Marinelli's formula.
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Bócio Nodular/radioterapia , Adulto , Feminino , Bócio Nodular/diagnóstico por imagem , Humanos , Hipertireoidismo/diagnóstico por imagem , Hipertireoidismo/radioterapia , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Cintilografia , Estudos Retrospectivos , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/radioterapia , Fatores de Tempo , Resultado do Tratamento , UltrassonografiaRESUMO
Metabolic bone disease encompasses a number of disorders that tend to present a generalized involvement of the whole skeleton. The disorders are mostly related to increased bone turnover and increased uptake of radiolabelled diphosphonate. Skeletal uptake of 99mTc-labelled diphosphonate depends primarily upon osteoblastic activity, and to a lesser extent, skeletal vascularity. A bone scan image therefore presents a functional display of total skeletal metabolism and has valuable role to play in the assessment of patients with metabolic bone disorders. However, the bone scan appearances in metabolic bone disease are often non-specific, and their recognition depends on increased tracer uptake throughout the whole skeleton. It is the presence of local lesions, as in metastatic disease, that makes a bone scan appearance obviously abnormal. In the early stages, there will be difficulty in evaluating the bone scans from many patients with metabolic bone disease. However, in the more severe cases scan appearances can be quite striking and virtually diagnostic.
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Doenças Ósseas Metabólicas/diagnóstico por imagem , Osso e Ossos/diagnóstico por imagem , Cintilografia/métodos , Difosfonatos , Humanos , Compostos de TecnécioRESUMO
BACKGROUND: The aim of the study was to achieve an effective target dose in the thyroid by increasing the effective half-life (Teff) of (131)I by use of iodide ((127)I) two days after (131)I therapy in patients with hyperthyroidism with low Teff. MATERIAL AND METHODS: The study was carried out in two groups. Group A - 41 patients, and Group B - 14 patients, all the patients were with hyperthyroidism with Teff less than 3 days qualified for (131)I therapy. Only group A patients received 600 µg of iodide a day for 3 days, two days after (131)I therapy. Radioiodine uptake (RAIU) after 24 and 48 hours, thyroid scintiscan and ultrasonography were done before and after 12 months of (131)I therapy. RESULTS: In group A a significant increase was seen in the Teff (5 days on average) resulting in an increase in the energy target dose by 28% and 37%, in patients with Graves' disease (GD) and toxic nodular goitre (TNG), respectively. After one year of therapy 50% of GD and 93% of TNG patients achieved euthyroidism; 28% of GD and 3% of TNG patients were in hypothyroidism. In Group B, all the patients had radioiodine treatment failure and received a second therapeutic dose of (131)I. CONCLUSIONS: Administration of (127)I after (131)I treatment can lead to an increase in its effective half-life. This will also increase the absorbed energy dose in thyroid tissue, thereby improving therapeutic outcome without administration of a higher or second dose of (131)I. This may minimize whole-body exposure to radiation and reduces the cost of treatment.
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Bócio Nodular/radioterapia , Doença de Graves/radioterapia , Iodo/farmacologia , Feminino , Bócio Nodular/sangue , Bócio Nodular/metabolismo , Doença de Graves/sangue , Doença de Graves/metabolismo , Meia-Vida , Humanos , Radioisótopos do Iodo/metabolismo , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Glândula Tireoide/efeitos dos fármacos , Glândula Tireoide/metabolismo , Glândula Tireoide/efeitos da radiação , Fatores de Tempo , Resultado do Tratamento , Tri-Iodotironina/sangueRESUMO
INTRODUCTION: There are many factors causing endothelial dysfunction. The aim was to observe chosen markers of endothelial function in patients with subclinical and overt hyperthyroidism. MATERIAL AND METHODS: We studied 97 patients with hyperthyroidism: 51 with subclinical (44 F/7 M; mean age 49.3 +/- 15.9 y) and 46 patients with overt (39 F/7 M, mean age 50.4 +/- 13.2 y). The control comprised of 39 healthy volunteers (26 F/13 M, mean age 47.5 +/- 11.8 y). Concentration of TSH, FT3, FT4 were measured by MEIA, TPO Ab, TG Ab, E-selectin, interleukin 6, VCAM-1, ICAM-1 by ELISA. RESULTS: The goiter was found in 71 persons 63F/8M, mean age 49.9 +/- 15.3 y, (42-subclinical, 29-overt). Morbus Graves-Basedow was diagnosed in 26 persons, 20 F/6 M, mean age 49.5 +/- 12.8 y (9-subclinical, 17-overt). There were no significant differences serum concentration of E-selectin, IL-6, ICAM-1 in patients with subclinical and overt hyperthyroidism compared to the control. Statistically significant differences were shown between concentration of IL-6 in patients with Graves-Basedow compared with the control (p < 0.05). Significance of VCAM-1 values were found in the patients with subclinical and overt hyperthyroidism compared to the control (p < 0.001; p < 0.001, respectively). CONCLUSIONS: Among persons with overt and subclinical hyperthyroidism occurs endothelial dysfunction which doesn't depends on exciting cause of thyrotoxicosis but on degree of hyperthyroidism. Elevated concentrations of endothelial markers may confirm that persons with thyroid disorders are extremely exposed to the occurrence of the cardiovascular diseases.
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Doenças Cardiovasculares/epidemiologia , Células Endoteliais/metabolismo , Endotélio Vascular/fisiopatologia , Hipertireoidismo/epidemiologia , Hipertireoidismo/fisiopatologia , Adulto , Idoso , Biomarcadores/metabolismo , Moléculas de Adesão Celular/sangue , Comorbidade , Endotélio Vascular/metabolismo , Feminino , Humanos , Hipertireoidismo/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Valores de Referência , Testes de Função Tireóidea , Molécula 1 de Adesão de Célula Vascular/sangueRESUMO
UNLABELLED: Experimental and clinical reports suggest the role of antiphospholipid antibodies (aPL) in the pathogenesis of atherosclerosis and arterial thrombosis. The aim of our study was to evaluate IgM and IgG anti-beta2-glycoprotein I (anti-beta2-GPI), as well as IgG antiphosphatydylserine (aPS) antibodies in 80 consecutive patients (mean age 58.6+/-8.3 years) referred for coronary angiography, dependent on the extent of atherosclerotic lesions in coronary vessels and the disturbances of glucose tolerance. Antiphospholipid antibodies were measured by ELISA. The mean values of aPS and anti-beta2-GPI did not differ significantly between patients with 1- (n = 17), 2- (n = 15) or 3-vessel disease (n = 14) and subjects without significant changes in coronary arteries (n = 34), as well as between patients with unstable (n = 12) and effort angina (n = 68). Significantly higher levels of IgG anti-beta2-GPI were found in the subgroup with type 2 diabetes in comparison with the subjects with impaired glucose tolerance (median 3,8 (1.9 -9.3) U/ml vs 2,8 (1.5-5.0) U/ml, p = 0.027). Current smokers (n = 11) had significantly higher values of aPS than non smokers (55.8 +/- 30.7 - 64.7) U/ml vs 38.7 (5.7 +/- 82.6) U/ml, p = 0.017). Abnormal aPS values were found in 34 subjects (42,5%): 16 (6 diabetics) with normal angiograms (47.0%), 9 (26.5%) with 1-vessel disease, 3 (8,8%) with 2-vessel disease and 6 (17,6%) with 3- vessel disease. Increased IgG anti- (2-GPI levels were found in 8 (10%), and IgM anti-beta2-GPI - in 4 patients (5%). All subjects with high IgM anti-beta2-GPI values, as well as 5 persons with high IgG anti-beta2-GPI levels (62.5%) had significant coronary artery lesions. Multiple regression analysis revealed that factors independently influencing the levels of aPS were: patient's age (Beta = -0.8417, p = 0.0003) and glycaemia 120 min. after glucose load (Beta = 0.6453, p = 0.025). CONCLUSIONS: our results do not confirm an association between aPS or/and anti-beta2-GPI antibodies and the extent of atherosclerotic lesions in coronary vessels, although they suggest an increased membrane phospholipids immunogenicity in relatively young patients with elevated postload glycaemia, as well as cigarette smokers.