Treatment of thyrotoxicosis with iodine-125: A clinical and laboratory study

This study is primarily a clinical assessment of a new radioisotope of iodine (iodine-125) for the treatment of thyrotoxicosis. The thesis consists of three sections, B and C. The first Chapter of Section A is concerned with the currently used treatments for thyrotoxicosis (Graves' disease), special attention being given, to iodine-131. There is no excuse for the proportion of the Chapter which deals with the poor results, side effects and complications of the therapies, and again prominence is given to iodine-131 in particular the problem of post therapy hypothyroidism. Included in this Chapter is a personally analysed combined radiotherapeutic trial using iodine-131 and carbimazole. The rationale for the use of iodine-125 is detailed in Section A Chapter II. The rich spectrum of low energy short range electrons emitted from iodine-125 preferentially irradiates the hormone producing region at the apox of the follicular cells without killing the cells. It is theoretically possible using iodine-125 to produce rapid control of the disease without causing post-treatment hypothyroidism. Animal experiments carried out by other investigators confirming this hypothesis are described. Section B consists of three Chapters which deal with the clinical trials of iodine-125 in patients. In Chapter I the excellent results of large therapy doses justified this approach and encouraged extension f the trials using smaller but empirioal doses. The method of calculating the rad dose at different levels of the follicular cell is described. The main clinical trial, the treatment of 265 thyrotoxic patients with different dose schedules of iodine-125, is detailed in Chapter II. The outcome is related to the sex and age of the patients, the total dose prescribed, the thyroid size before therapy, the dose of iodine-125 prescribed per gram of thyroid and the length of follow up. Clinical trials of iodine-125 in three centres are discussed and the overall pattern of results integrated. Complications which have arisen after iodine-125 treatment are included in Chapter III as are prospective investigations into potential hazards. Two Chapters in Section C deal with the radiobiological differences in the thyrotoxic thyroid after treatment with iodine-125 compared with iodine-131. In the first Chapter, routine radioiodine tests, an intravenous perchlorate discharge test, radiochromatograms of serum and combined use of serum thyroxine, T3 resin and T.S.H. assay are utilised. In the second mathematical techniques awe employed

Radiation Safety in the Treatment of Patients with Thyroid Diseases by Radioiodine 131I: Practice Recommendations of the American Thyroid Association

Background: Radiation safety is an essential component in the treatment of patients with thyroid diseases by 131I. The American Thyroid Association created a task force to develop recommendations that would inform medical professionals about attainment of radiation safety for patients, family members, and the public. The task force was constituted so as to obtain advice, experience, and methods from relevant medical specialties and disciplines. Methods: Reviews of Nuclear Regulatory Commission regulations and International Commission on Radiological Protection recommendations formed the basic structure of recommendations. Members of the task force contributed both ideas and methods that are used at their respective institutions to aid groups responsible for treatments and that instruct patients and caregivers in the attainment of radiation safety. There are insufficient data on long-term outcomes to create evidence-based guidelines. Results: The information was used to compile delineations of radiation safety. Factors and situations that govern implementation of safety practices are cited and discussed. Examples of the development of tables to ascertain the number of hours or days (24-hour cycles) of radiation precaution appropriate for individual patients treated with 131I for hyperthyroidism and thyroid cancer have been provided. Reminders in the form of a checklist are presented to assist in assessing patients while taking into account individual circumstances that would bear on radiation safety. Information is presented to supplement the treating physician's advice to patients and caregivers on precautions to be adopted within and outside the home. Conclusion: Recommendations, complying with Nuclear Regulatory Commission regulations and consistent with guidelines promulgated by the National Council on Radiation Protection and Measurement (NCRP-155), can help physicians and patients maintain radiation safety after treatment with 131I of patients with thyroid diseases. Both treating physicians and patients must be informed if radiation safety, an integral part of therapy with 131I, is to be attained. Based on current regulations and understanding of radiation exposures, recommendations have been made to guide physicians and patients in safe practices after treatment with radioactive iodine.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90492/1/thy-2E2010-2E0403.pd

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo