Assessment of the nuclear medicine personnel occupational exposure to radioiodine.

PURPOSE: To physically and cytogenetically screen medical personnel of Department of Endocrinology and Nuclear Medicine, Holy Cross Cancer Center, Kielce, Poland (DENM) who are occupationally exposed to 131I. MATERIALS AND METHODS: The exposure was monitored by whole-body and finger ring dosimeters. The thyroid iodine intake was measured by a whole-body spectrometer equipped with two semiconductor gamma radiation detectors. A cytokinesis-block micronucleus assay and the premature chromosome condensation technique were used to assess the aberration score. Cytogenetic analyses were carried out on a group of 29 workers and were compared to 32 controls (healthy donors), matched for gender and age. RESULTS: On average, the exposed group showed a significantly higher frequency of genetic damage and a higher proliferation index compared to the control group. Smoking status, age and duration of exposure influenced the observed effects in both groups. No differences in measured biomarkers were observed after stratification of the exposed group into two subgroups based on the measured 131I activity below and above 6 Bq. CONCLUSION: The findings suggest that radiation protection principles based on whole-body and finger ring dosimetry, supported by activity measurements with a whole-body spectrometer, may be insufficient to monitor the absorbed dose estimation of the nuclear medicine staff who are occupationally exposed to 131I. Furthermore, their future health risks are influenced by confounders. Direct assessments comparing physical and biological dose estimations on the larger group are needed to accurately monitor occupational radiation exposure.

Comparative assessment of calcitonin stimulation test using calcium gluconate and pentagastrin and the usefulness of procalcitonin basic and post-stimulation concentrations in the diagnosis of patients after surgery for medullary.

OBJECTIVES: The aim of the study was to compare the calcitonin (CT) stimulation tests with tests of calcium gluconate (CaG) and pentagastrin (PG), their tolerance and usefulness of PCT in the patients' diagnosis with active Medullary thyroid cancer (MCT) after thyroidectomy. METHODS: CT was marked in serum by the immunosorbent sandwich test. PCT was marked by the immunosorbent sandwich test, with the final reading of fluorenscence. PG was given intravenously at a dose of 0.5 mg/kg body weight for 10 seconds. CaG was also given by intravenous injection at a dose of 2.5 mg of elemental Ca/kg body weight at a rate of 5ml/min, for minimum 3 minutes. Blood was taken at the 0 minute, the 3 and 5 minute after getting the stimulating substances. RESULTS: The post-stimulation CT concentration in the 3 and 5 minute of the CaG test vs PG is significantly higher compared to the baseline. The maximal stimulation of the CT is in the 3 minute, but higher concentrations occurred using the CaG. CONCLUSION: The results of the study suggest a similar diagnostic value of the tests with CaG compared to the PG as stimulants. In the present study we noticed a trend of basic and post-stimulation concentrations of PCT to increase in the tests with PG and CaG which correspond with the elevated concentrations of CT.

Comparison of the usefulness of post-ablative and post-operative thyroglobulin concentration measuring in prognostic assessment of patients with differentiated thyroid cancer.

INTRODUCTION: Post-operative thyroglobulin (TgPO) is a recognised prognostic factor in patients following thyroidectomy due to differentiated thyroid cancer (DTC). However, its concentration is affected by thyroid remnants, which may diminish the prognostic value of TgPO. The aim of this paper is to assess the usefulness of stimulated post-ablative thyroglobulin (TgPA) measurements 6-9 months after 131I therapy, as a prognostic factor, and its possible advantage over TgPO determination. MATERIAL AND METHODS: The study involved 577 DTC patients treated in the Holycross Cancer Centre in the years 2000-2013. Exclusion criteria were: patients with no recommendation for 131I adjuvant therapy, positive thyroglobulin antibody titre, and initial distant metastases. On the basis of a ROC curve analysis, values of TgPO and TgPA concentrations were determined, which enable the most accurate identification of good prognosis. Calculating area under the curves (AUCs) allowed for comparison of the data. RESULTS: TgPO concentration ≤ 6.99 ng/mL, with 75.7% sensitivity and 94.7% specificity enables anticipation of remission of the disease. TgPA concentration ≤ 1.16 ng/mL under endogenous TSH stimulation with sensitivity of 91.1% and specificity of 94.7% allows anticipation of remission of the disease. TgPA concentration ≤ 1.24 ng/mL under rh TSH stimulation with sensitivity of 95.4% and specificity of 95.0% enables anticipation of remission of the disease. CONCLUSIONS: No differences in clinical usefulness of the assessment of TgPO and stimulated TgPA concentrations as indicators of good prognosis were found. However, TgPA allows anticipation of remission of the disease with higher sensitivity. It also appears that TgPA may be of particular prognostic importance in baseline high-risk patients (pT3-T4/N1). A sufficiently low TgPA concentration, demonstrating good response to 131I adjuvant therapy in these groups, is an indicator of improved prognosis.

[Assessment of 25(OH)D3, concentration levels in patients with papillary thyroid cancer compared to patients with Hashimoto's thyroiditis]. / Ocena stezenia 25(OH)D3 w grupie chorych z rakiem brodawkowatym tarczycy w porównaniu do chorych z choroba Hashimoto.

INTRODUCTION: The classic role of vitamin D is its effect on calcium and phosphate homeostasis. The subject of interest in recent years has been its non-calcemic impact on neoplastic processes and the immune system. The aim of the study was to assess 25(OH)D3 concentrations in patients treated for papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT). MATERIAL: The study included 80 patients aged 19-83 years (average age 52.96 years) treated between 2000-2011 in Swietokrzyskie Centrum Onkologii. The analysis was conducted in two groups of patients: a PTC group of 40 women aged 19 to 83 years (average age 50.40 years) and a HT group of 40 women aged 30 to 75 years (average age 55.73 years). The group of PTC patients was further divided into two subgroups: 19 patients with micro. carcinoma (T1a) and 21 patients with a higher grade of cancer (>T1a). A group of patients with HT comprised women treated with subsitutive doses of L-thyroxine for hypothyroidism. The serum concentration of 25(OH)D3 was compared in both groups: PTC vs. HT. Among patients with PTC serum 25(OH)D3 was analysed depending on the concentration of TSH: TSH< or = 0.1 microlU/ml vs. TSH> 0.1 microlU/ml, and depending on the stage of cancer: Tla vs.> T1a. RESULTS: There were no differences in the prevalence of hypovitaminosis and vitamin D deficiency in both groups (65% of patients with PTC vs. 62.5% with HT). In the PTC group no statistically significant differences in serum 25(OH)3, depending on the con. centration of TSH and cancer clinical stage, were found. CONCLUSION: This study showed no difference in concentrations of 25(OH)D3 in patients with papillary thyroid cancer and Hashimoto's thy. roiditis. Patients with PTC showed no relationship between serum 25(OH)D3 and clinical stage of the disease or TSH.level.

[Assessment of the quality of life in patients with differentiated thyroid carcinoma during a one-month withdrawal of levorotatory thyroxine preparations (L-T4) before a control diagnostics]. / Ocena jakosci zycia (QL) chorych ze zróznicowanym rakiem tarczycypodczas miesiecznej przerwy w przyjmowaniu preparatówlewoskretnej tyroksyny (L-T4) przed diagnostyka kontrolna.

INTRODUCTION: Monitoring of patients with differentiated thyroid carcinoma consists of a periodic control for thyroglobulin (Tg) concentration and radioiodine diagnostics during stimulation of endogenous TSH. Application of recombinant TSH is an alternative procedure which considerably increases cost of diagnostics but allows to avoid symptoms of hypothyreosis. This work was aimed at evaluating the influence of a withdrawal of L-T4 preparations preceding the control diagnostics on the quality of life in patients. MATERIAL AND METHODS: Investigation was performed in a group of 131 patients [115 women (87.75%) and 16 men (12.25%)] with differentiated thyroid carcinoma admitted for a periodic control diagnostics that included neck ultrasonography and an evaluation of Tg concentration, wholebody scintigraphy following a stimulation of endogenous TSH after a one-month break in taking L-T4 preparations. Research was conducted with a prepared questionnaire assessing several basic determinants of the quality of life on a 6-degree scale. RESULTS: During hypothyreosis quality of life in patients with differentiated thyroid carcinoma is worsened. The frequency and volume of symptoms increased twice. CONCLUSIONS: 1. One-month gap in taking L-T4 is associated with a significant deterioration of the quality of life in tested patients. 2. The symptoms are especially strongly expressed in the elderly. 3. Administration of recombinant TSH (rhTSH) for a control diagnostics may permit the patients with differentiated thyroid carcinoma to avoid a deterioration of the quality of life.