The Use of 123I in Diagnostic Radioactive Iodine Scans in Children with Differentiated Thyroid Carcinoma

Background: Adult studies have shown that iodine-123 (123I) is as effective as 131I in detecting metastatic disease in patients with differentiated thyroid carcinoma. However, the type and administered activity of radioiodine used for diagnostic imaging of metastatic thyroid cancer has not been well studied in children. Here we describe our institution's experience with using 123I in diagnostic radioiodine scans in children with differentiated thyroid carcinoma. Methods: Every patient with differentiated thyroid carcinoma who completed diagnostic scanning followed by radioiodine therapy at our institution over the past 8 years was included in this retrospective chart review. Patient age, sex, presentation of thyroid disease, past medical history, thyrotropin, thyroglobulin, and antithyroglobulin antibodies were recorded. A single nuclear medicine radiologist evaluated all scans. Results: Thirty-three subjects completed 37 pairs of scans at a mean age of 13.4 years (range 6–17 years). The majority of subjects were female (81%) and had papillary thyroid cancer (91%). For diagnostic scanning, 5 received 2 mCi of 131I, 21 received 2 mCi of 123I, and 11 received 3 mCi of 123I. There was no statistically significant difference in rate of discordant scan pairs when comparing 131I and 123I (20% and 23% respectively, p=0.9). The detection of metastatic pulmonary disease on diagnostic scanning was not improved by increasing the dose of 123I from 2 mCi to 3 mCi (10% rate of missed lung detection with 2 mCi 123I vs. 20% with 3 mCi 123I). Conclusions: 123I is effective for use in diagnostic radioactive iodine scans in children with differentiated thyroid cancer. The primary advantages of using 123I include decreased radiation exposure and avoidance of stunning. However, in children there is a possibility of missed detection of metastatic pulmonary disease

Association of cord blood methylation with neonatal leptin: An epigenome wide association study.

BackgroundNeonatal adiposity is a risk factor for childhood obesity. Investigating contributors to neonatal adiposity is important for understanding early life obesity risk. Epigenetic changes of metabolic genes in cord blood may contribute to excessive neonatal adiposity and subsequent childhood obesity. This study aims to evaluate the association of cord blood DNA methylation patterns with anthropometric measures and cord blood leptin, a biomarker of neonatal adiposity.MethodsA cross-sectional study was performed on a multiethnic cohort of 114 full term neonates born to mothers without gestational diabetes at a university hospital. Cord blood was assayed for leptin and for epigenome-wide DNA methylation profiles via the Illumina 450K platform. Neonatal body composition was measured by air displacement plethysmography. Multivariable linear regression was used to analyze associations between individual CpG sites as well as differentially methylated regions in cord blood DNA with measures of newborn adiposity including anthropometrics (birth weight, fat mass and percent body fat) and cord blood leptin. False discovery rate was estimated to account for multiple comparisons.Results247 CpG sites as well as 18 differentially methylated gene regions were associated with cord blood leptin but no epigenetic changes were associated with birth weight, fat mass or percent body fat. Genes of interest identified in this study are DNAJA4, TFR2, SMAD3, PLAG1, FGF1, and HNF4A.ConclusionEpigenetic changes in cord blood DNA are associated with cord blood leptin levels, a measure of neonatal adiposity

Maternal BMI Associations with Maternal and Cord Blood Vitamin D Levels in a North American Subset of Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Participants.

OBJECTIVE:Obesity in pregnancy may be associated with reduced placental transfer of 25-hydroxyvitamin D (25-OHD). The objective of this study was to examine associations between maternal BMI and maternal and cord blood levels of 25-OHD in full term neonates born to a single racial cohort residing at similar latitude. Secondary objectives were to examine associations between maternal glucose tolerance with maternal levels of 25-OHD and the relationship between cord blood 25-OHD levels and neonatal size. METHODS:This study was conducted among participants of the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study meeting the following criteria: residing at latitudes 41-43°, maternal white race, and gestational age 39-41 weeks. Healthy pregnant women underwent measures of height, weight, and a 75-g fasting oral glucose tolerance test (OGTT) at approximately 28 weeks gestation. Maternal and cord blood sera were analyzed for total 25-OHD by HPLC tandem mass spectrometry. Statistical analyses included ANOVA and linear regression models. RESULTS:Maternal and cord blood (N = 360) mean levels (sd) of 25-OHD were 37.2 (11.2) and 23.4 (9.2) ng/ml, respectively, and these levels were significantly different among the 3 field centers (ANOVA p< 0.001). Maternal serum 25-OHD was lower by 0.40 ng/ml for BMI higher by 1 kg/m2 (p<0.001) in an adjusted model. Maternal fasting plasma glucose, insulin sensitivity, and presence of GDM were not associated with maternal serum 25-OHD level when adjusted for maternal BMI. Cord blood 25-OHD was lower by 0.26 ng/ml for maternal BMI higher by 1 kg/m2 (p<0.004). With adjustment for maternal age, field center, birth season and maternal serum 25-OHD, the association of cord blood 25-OHD with maternal BMI was attenuated. Neither birth weight nor neonatal adiposity was significantly associated with cord blood 25-OHD levels. CONCLUSION:These results suggest that maternal levels of 25-OHD are associated with maternal BMI. The results also suggest that interpretation of neonatal 25-OHD levels may need to incorporate specific maternal factors in addition to season of birth and latitude

Maternal BMI versus Cord Blood 25-OHD Levels.

<p>Scatterplot of cord blood 25-hydroxyvitamin D versus maternal BMI measured at OGTT, N = 360. Both the regression line (dotted line, β estimate = -0.26) and loess curve demonstrate the inverse association between these two variables.</p

Vitamin D levels by field center.

<p>Bars display mean levels +/- sd, solid gray for maternal serum and hatched light grey for cord blood. Cleveland, OH: n = 118; Maternal 25-OHD = 36.1 ± 10.6, cord blood = 25.0 ± 10.0 ng/ml; Chicago, IL: n = 112; Maternal 25-OHD = 41.7 ± 10.7, cord blood = 24.7 ± 9.0 ng/ml; Toronto, ON: n = 130; Maternal 25-OHD = 34.1 ± 11.0, cord blood = 20.6 ± 8.0 ng/ml. Field center levels of 25-hydroxyvitamin D were significantly different for both maternal and cord blood, (ANOVA p< 0.001).</p

Linear regression analysis of the relationship between maternal serum 25-OHD at OGTT and maternal factors.

<p>Linear regression analysis of the relationship between maternal serum 25-OHD at OGTT and maternal factors.</p