ABSTRACT
BACKGROUND: In this study, we aimed to evaluate ultrasonographical and cytological features of thyroid nodules in patients who were treated with radioactive iodine (RAI) for hyperthyroidism years ago. METHODS: Patients who had a history of RAI treatment for hyperthyroidism and had thyroid nodules that were evaluated with fine-needle aspiration biopsy (FNAB) were included in the study. RESULTS: There were 27 patients (22 female and 5 male) with a mean age of 59.3 ± 13.5. The indication for RAI treatment was Graves in 5 (18.6%), toxic nodular or multinodular goiter in 16 (69.2%), and unknown in 6 (22.2%) patients. A total of 48 thyroid nodules were evaluated with FNAB and cytological diagnosis were benign in 24 (50.0%), nondiagnostic in 15 (31.2%), atypia of undetermined significance in 5 (10.4%), suspicous for malignancy in 2 (4.2%), and malignant in 2 (4.2%) nodules. Thyroidectomy was performed in 10 patients, 5 were benign (50.0%), and 5 (50.0%) were malignant histopathologically. Ultrasonography features of 31 cytologically/histopathologically benign and five cytologically/histopathologically malignant nodules were compared. Prevalence of isoechoic nodules was higher in benign nodules (P = .025). Macrocalcification was observed in 4 (80.0%) of malignant and 10 (32.3%) of benign nodules (P = .042). CONCLUSION: In patients with a history of RAI treatment for hyperthyroidism, thyroid nodules with suspicious ultrasonography features, particulary hypoechoic appearence and macrocalcification, should be evaluated with FNAB irrespective of the time elapsed after RAI treatment.
Subject(s)
Hyperthyroidism/radiotherapy , Iodine Isotopes/adverse effects , Iodine Isotopes/therapeutic use , Thyroid Nodule/pathology , Adult , Aged , Biopsy, Fine-Needle , Calcification, Physiologic , Cytological Techniques , Female , Graves Disease/diagnosis , Humans , Hyperthyroidism/diagnosis , Hyperthyroidism/pathology , Male , Middle Aged , Thyroid Carcinoma, Anaplastic/diagnosis , Thyroid Carcinoma, Anaplastic/therapy , Thyroid Nodule/diagnosis , Thyroidectomy , Ultrasonography/methodsSubject(s)
Contrast Media/adverse effects , Iodine Isotopes/adverse effects , Sialadenitis/chemically induced , Sweet Syndrome/chemically induced , Aged , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/mortality , Fatal Outcome , Humans , Male , Neutrophil Infiltration , Neutrophils/immunology , Renal Insufficiency/diagnosis , Sweet Syndrome/immunologyABSTRACT
Exposure to ionizing radiation increases the risk of myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN), but such risks are not known in well-differentiated thyroid cancer (WDTC) patients treated with radioactive iodine (RAI). A total of 148 215 WDTC patients were identified from Surveillance, Epidemiology and End Results registries between 1973 and 2014, of whom 54% underwent definitive thyroidectomy and 46% received adjuvant RAI. With a median follow-up of 6.6 years, 77 and 66 WDTC patients developed MDS and MPN, respectively. Excess absolute risks for MDS and MPN from RAI treatment when compared to background rates in the US population were 6.6 and 8.1 cases per 100 000 person-years, respectively. Compared to background population rates, relative risks of developing MDS (3.85 (95% confidence interval, 1.7-7.6); P=0.0005) and MPN (3.13 (1.1-6.8); P=0.012) were significantly elevated in the second and third year following adjuvant RAI therapy, but not after thyroidectomy alone. The increased risk was significantly associated with WDTC size ⩾2 cm or regional disease. Development of MDS was associated with shorter median overall survival in WDTC survivors (10.3 vs 22.5 years; P<0.001). These data suggest that RAI treatment for WDTC is associated with increased risk of MDS with short latency and poor survival.
Subject(s)
Iodine Isotopes/adverse effects , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology , Myeloproliferative Disorders/etiology , Thyroid Neoplasms/radiotherapy , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Risk Factors , Thyroidectomy/methods , Young AdultSubject(s)
Contrast Media/adverse effects , Kidney Diseases/chemically induced , Kidney/drug effects , Biomarkers/analysis , Contrast Media/administration & dosage , Creatinine/blood , Follow-Up Studies , Glomerular Filtration Rate , Humans , Iodine Isotopes/administration & dosage , Iodine Isotopes/adverse effects , Kidney Diseases/prevention & control , Renal Insufficiency/chemically induced , Renal Insufficiency/prevention & control , Risk Assessment , Risk Factors , SafetyABSTRACT
PURPOSE: To expand the radiation dose rate measurement data set by measuring radiation under various prostate (125)I brachytherapy situations. METHODS AND MATERIALS: Measurements were obtained from 63 consecutive unselected patients at Tokyo Medical Center, Japan. Differences in factors during measurements, such as body postures, distances from the skin surface, and measurement directions were considered. Furthermore, shielding effects of lead-lined underwear, consisting mainly of 0.1-mm thickness of lead, were also assessed. RESULTS: Radiation exposure varies according to the patient's body posture, with results differing as much as approximately 40.0% in measured radiation dose rates at 30cm from the anterior skin surface. Weight, body mass index, and tissue thickness showed good correlations with measured radiation dose rates. The magnitude of radiation exposure attenuation by shielding was approximately 95.8%, similar to the attenuation ratio based on tissue measurements made in the lateral direction. The respective mean times required to reach 1mSv were 1.2, 7.6, and 65.4 days in the standing position and 0.6, 4.6, and 40.4 days in the supine position at the site of contact, and at 30 and 100cm from the anterior skin surface. CONCLUSIONS: This study obtained supplemental information pertaining to radiological protection and confirmed that shielding can be an effective tool for reducing exposures.
Subject(s)
Brachytherapy/adverse effects , Iodine Isotopes/adverse effects , Prostatic Neoplasms/radiotherapy , Radiation Injuries/prevention & control , Radiation Protection/methods , Aged , Aged, 80 and over , Brachytherapy/methods , Humans , Iodine Isotopes/therapeutic use , Japan , Male , Middle Aged , Radiation Dosage , Radiation Injuries/etiology , Radiopharmaceuticals/adverse effects , Radiopharmaceuticals/therapeutic use , Risk AssessmentABSTRACT
Well differentiated thyroid cancers (WDTC), including papillary (80%) and follicular (10%) types, are the most common endocrine cancers globally. Over the last few decades most the diagnosed cases have fallen into low risk categories. Radioactive iodine-131 (RAI) has an established role in reducing recurrence and improving the survival in high risk patients. In patients with primary tumor size <1 cm, RAI is not recommended by many thyroid societies. However, low risk WDTC has been an arena of major controversies, most importantly the role and dose of adjuvant RAI for remnant ablation to minimize chances of recurrence and improving survival. This review is an attempt to update readers about the previous and existing practice based on results of non- randomized trials and evolving trends fueled by recently published randomized studies.