Iodine isotope (131I) therapy for toxic nodular goitre: treatment efficacy parameters

BACKGROUND: When planning radioactive iodine therapy, itfrequently happens, both in Poland and world-wide, that inadequateattention is paid to such easily measurable parametersas: 1) the serum concentration of thyrotropin (TSH) beforeadministering radioiodine, which is a key factor for extranodular(non-autonomous) iodine uptake of the thyroid gland, 2) thyroidgland iodine uptake, and 3) the effective half-life of 131I (Teff.). Theaim of the study is to evaluate the impact of the above factorson the efficacy of 131I treatment in hyperthyroid patients.METHODS: The material consisted of 4140 patients: 2190 withautonomous toxic nodules (ATN) and 1950 with toxic multinodulargoitres (TMG). The patients were prepared for treatment insuch a way that the concentration of TSH did not exceed 0.1 mU/land Teff.< 5 days. The therapeutic activity of 131I was calculatedusing Marinelli’s formula. The selection of absorbed dose valuewas determined by the degree of suppression of extranodulartissue. Monitoring was performed every eight weeks.RESULTS: At one year after 131I administration showed thata euthyroid status was achieved in 94%, hypothyroidism was seen observed in 3%, while persistence or recurrence of hyperthyroidismin 3% of ATN patients and, respectively, 89%, 4% and7% of TMG patients.CONCLUSIONS: Patients with toxic nodular goitre who are to betreated with radioiodine should have the lowest possible serumconcentration of TSH. The suppression of extranodular determinesthe optimal value of absorbed dose for Marinelli’s formula

The influence of non-radioactive iodine (127I) on the outcome of radioiodine (131I) therapy in patients with Graves’ disease and toxic nodular goitre

BACKGROUND: The aim of the study was to achieve an effective target dose in the thyroid by increasing the effective half-life (Teff) of 131I by use of iodide (127I) two days after 131I 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 131I therapy. Only group A patients received 600 μg of iodide a day for 3 days, two days after 131I therapy. Radioiodine uptake (RAIU) after 24 and 48 hours, thyroid scintiscan and ultrasonography were done before and after 12 months of 131I 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 131I. CONCLUSIONS: Administration of 127I after 131I 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 131I. This may minimize whole-body exposure to radiation and reduces the cost of treatment. Nuclear Med Rev 2011; 14, 1: 9–1

Bone scan in metabolic bone diseases. Review

Metabolic bone disease encompasses a number of disordersthat tend to present a generalized involvement of the wholeskeleton. The disorders are mostly related to increased boneturnover and increased uptake of radiolabelled diphosphonate.Skeletal uptake of 99mTc-labelled diphosphonate depends primarilyupon osteoblastic activity, and to a lesser extent, skeletalvascularity. A bone scan image therefore presents a functionaldisplay of total skeletal metabolism and has valuable role toplay in the assessment of patients with metabolic bone disorders.However, the bone scan appearances in metabolic bonedisease are often non-specific, and their recognition dependson increased tracer uptake throughout the whole skeleton. Itis the presence of local lesions, as in metastatic disease, thatmakes a bone scan appearance obviously abnormal. In theearly stages, there will be difficulty in evaluating the bone scansfrom many patients with metabolic bone disease. However, inthe more severe cases scan appearances can be quite strikingand virtually diagnostic.Metabolic bone disease encompasses a number of disordersthat tend to present a generalized involvement of the wholeskeleton. The disorders are mostly related to increased boneturnover and increased uptake of radiolabelled diphosphonate.Skeletal uptake of 99mTc-labelled diphosphonate depends primarilyupon osteoblastic activity, and to a lesser extent, skeletalvascularity. A bone scan image therefore presents a functionaldisplay of total skeletal metabolism and has valuable role toplay in the assessment of patients with metabolic bone disorders.However, the bone scan appearances in metabolic bonedisease are often non-specific, and their recognition dependson increased tracer uptake throughout the whole skeleton. Itis the presence of local lesions, as in metastatic disease, thatmakes a bone scan appearance obviously abnormal. In theearly stages, there will be difficulty in evaluating the bone scansfrom many patients with metabolic bone disease. However, inthe more severe cases scan appearances can be quite strikingand virtually diagnostic

Parathyroid gland function after radioiodine (131I) therapy for toxic and non-toxic goitre

Wstęp: Efekt terapeutyczny radiojodu (131I) w wolu łagodnym opiera się na emisji niszczącego tkanki promieniowania beta. Maksymalnyzasięg promieniowania beta 131I w tkance wynosi do 2,4 milimetra. Dlatego, też w zasięgu tego promieniowania mogą się znajdowaćsąsiadujące z tarczycą przytarczyce. Celem pracy była ocena czynności przytarczyc u chorych z wolem nadczynnym i normoczynnympoddanych terapii 131I w okresie do 5 lat od zastosowanego leczenia.Materiał i metody: Badania zostały wykonane u 325 chorych z łagodnym wolem (220 z wolem guzowatym nadczynnym (TNG), 25z wolem guzowatym obojętnym (NTNG) i 80 z chorobą Gravesa-Basedowa (GD) poddanych leczeniu 131I. Aktywność lecznicza 131Idla każdego pacjenta wyliczana była z wzoru Marinellego. W trakcie radiojodoterapii oznaczano stężenia fT3, fT4, TSH, iPTH, Ca2+, Cai fosforanów w surowicy tydzień przed podaniem 131I, i następnie w odstępach dwumiesięcznych przez rok po terapii oraz po 3 i 5 latach.Wyniki: U wszystkich chorych po 2 miesiącach od momentu rozpoczęcia leczenia zaobserwowano znamienny statystycznie wzrost stężeniaiPTH ponad normę (do wartości prawie dwukrotnie powyżej normy u pacjentów z TNG), który utrzymywał się aż do 10 miesiąca,a następnie ulegał normalizacji. Stężenia Ca2+, Ca i fosforanów u wszystkich leczonych pozostawały w zakresie normy w trakcie całegobadania. Stężenia fT3 i fT4 w surowicy po podaniu 131I szybko się normalizowały i pozostawały w zakresie normy do końca badania.Wnioski: Radiojodoterapia łagodnych schorzeń tarczycy prowadzi do powstania przejściowej (trwającej maksymalnie do 10 miesiąca odpodania radiojodu) nadczynności przytarczyc. Stan ten istotnie nie wpływa na stężenia wapnia i fosforanów w surowicy.(Endokrynol Pol 2013; 64 (5): 340–345)Introduction: The therapeutic effect of radioactive iodine (131I) on benign goitre consists of the emission of tissue-destructive beta-radiation. Since the range of beta 131I radiation in tissue can reach 2.4 mm, it can affect the adjacent parathyroid glands. The purpose of this paperis to assess parathyroid function in patients with toxic and non-toxic goitres, up to five years following 131I therapy.Material and methods: The study sample consisted of 325 patients with benign goitres (220 with toxic nodular goitre (TNG), 25 withnon-toxic nodular goitre (NTNG), and 80 with Graves’ disease (GD) treated with 131I. The therapeutic activity of 131I for each patient wascalculated using Marinelli’s formula. The serum levels of fT3, fT4, TSH, iPTH and Ca2+, Ca and phosphates were determined one week before131I 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 131I, 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, Ca2+, Ca, phosphates concentration remained within normal range throughout the course of the study. The concentrations of fT3 and fT4 quickly returned to normal after 131I 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 131I administration) hyperparathyroidism.The condition does not influence the level of calcium and phosphates concentration in any significant way. (Endokrynol Pol 2013; 64 (5): 340–345

Value of direct radionuclide cystography in diagnosing vesico-peritoneal fistulae

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

Radiojodoterapia w chorobie Gravesa-Basedowa — czynniki wpływające na skuteczność leczenia w oparciu o analizę retrospektywną

Introduction: Radioiodine (131I) isotope therapy is the method of choice in the treatment of Graves’ disease relapse. The efficiency of this method is dependent on many factors; therefore, the present paper aims to identify the parameters that have a crucial impact on the efficacy of radioiodine therapy for Graves’ disease.Material and methods: The authors performed a retrospective analysis of the medical documentation of 700 Graves’ disease sufferers treated with131I. The patients were divided into three groups depending on the thyroid-absorbed dose of 131I: group I — 100 Gy, II — 150 Gy, and III — 200 Gy. The authors assessed the influence of gender, age, presence of orbitopathy, TRab titres, thyroid mass, iodine uptake after 24 and 48 hours, and the absorbed dose on the treatment efficacy at one year post-131I administration.Results: The volume of thyroid gland (P < 0.002) and the thyroid-absorbed dose (P < 0.001) were the only factors that had a significant impact on the outcome of the treatment. The likelihood of hyperthyroidism persisting (odds ratio: 3.71, 95% confidence interval: 2.4–5.87) was greatest in patients from group I. In group II, with thyroid volume amounting both to 25 mL and to 25–50 mL, the percentage of hyperthyroidism was lowest (1 and 0%). However, with thyroid volume > 50 mL, the percentage of hyperthyroidism was lowest in group III (10%).Conclusions: The absorbed dose of 131I and the volume of the thyroid gland are two parameters that have a significant influence on the efficacy of radioiodine therapy for Graves’ disease. 150 Gy is the optimal dose for glands < 50 mL. A goitre > 50 mL requires an absorbed dose of 200 Gy in order to minimise the risk of recurrent hyperthyroidism. (Endokrynol Pol 2015; 66 (2): 126–131)Wstęp: Metodą z wyboru w leczeniu nawrotów choroby Gravesa-Basedowa jest terapia izotopowa radiojodem (131I). Efektywność tego leczenia zależy od wielu czynników, dlatego też celem pracy było wskazanie parametrów mających decydujący wpływ na skuteczności radiojodoterapii choroby Gravesa-Basedowa.Materiał i metody: Przeanalizowano retrospektywnie dokumentację medyczną 700 pacjentów z chorobą Gravesa leczonych 131I. Ze względu na dawkę pochłoniętą 131I w tarczycy, pacjentów podzielono na trzy grupy (grupa I — 100 Gy, II — 150 Gy, III — 200 Gy). Zbadano zależność płci, wieku, obecności orbitopatii, miana TRAb, masy tarczycy, jodochwytności tarczycy po 24 i 48 godzinach, dawki pochłoniętej na efektywność leczenia, po roku od podania 131I.Wyniki: Objętość tarczycy (P < 0,002), dawka pochłonięta w tarczycy (P < 0,001) miały jedynie istotny wpływ na wyniki terapii. Największe ryzyko utrzymywania się hipertyreozy (iloraz szans [OR] 3,71, 95% przedział ufności [CI] 2,4–5,87) wystąpiło u pacjentów z grupy I. W grupie II przy objętości tarczycy 25ml jak i 25-50ml odsetek hiperytreozy był najmniejszy (1 i 0%). Natomiast przy objętości tarczycy > 50 ml odsetek hipertyreozy był najmniejszy w grupie III (10%).Wnioski: Dawka pochłonięta 131I, objętość tarczycy to parametry mające istotny wpływ na skuteczności radiojodoterapii choroby Gravesa-Basedowa. Optymalną dawką pochłoniętą w tarczycy z objętością < 50 ml jest 150Gy. Wole (> 50 ml) wymaga dawki pochłoniętej 200Gy celem zminimalizowania nawrotu hipertyreozy. (Endokrynol Pol 2015; 66 (2): 126–131

Selected markers of endothelial dysfunction in patients with subclinical and overt hyperthyroidism

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 &plusmn; 15.9 y) and 46 patients with overt (39 F/7 M, mean age 50.4 &plusmn; 13.2 y). The control comprised of 39 healthy volunteers (26 F/13 M, mean age 47.5 &plusmn; 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 &plusmn; 15.3 y, (42-subclinical, 29-overt). Morbus Graves-Basedow was diagnosed in 26 persons, 20 F/6 M, mean age 49.5 &plusmn; 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&#8217;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.Wstęp: Istnieje wiele czynników, które powodują dysfunkcję śródbłonka. Celem niniejszej pracy była analiza wybranych wskaźników uszkodzenia śródbłonka u pacjentów z jawną i subkliniczną nadczynnością tarczycy. Materiał i metody: Badaniu poddano 97 pacjentów z nadczynnością tarczycy: 51 z subkliniczną (SNT; 44 K/7 M; śr. wieku 49,3 &plusmn; 15,9 roku) oraz 46 z jawną nadczynnością tarczycy (JNT; 39 K/7 M; śr. wieku 50,4 &plusmn; 13,2 roku). Grupa kontrolna składała się z 39 zdrowych ochotników (26 K/13 M; śr. wieku 47,5 &plusmn; 11,8 roku). Stężenie fT3, fT4 oraz TSH oznaczono za pomocą metody MEIA, natomiast stężenia antyTPO, antyTG, E-selektyny, interleukiny 6, VCAM-1 i ICAM-1 - przy użyciu metody ELISA. Wyniki: Wole guzkowe stwierdzono u 71 osób (63 K/8 M), a średnia wieku wynosiła 49,9 &plusmn; 15,3 roku (42 - SNT, 29 - JNT). Chorobę Graves-Basedowa rozpoznano u 26 osób (20 K/6 M), a średnia wieku wynosiła 49,5 &plusmn; 12,8 roku (9 - SNT, 17 - JNT). Nie stwierdzono istotnych statystycznie różnic w stężeniach E-selektyny, IL-6, ICAM-1 u pacjentów z SNT i JNT w porównaniu z grupą kontrolną. Istotnie wyższe stężenie IL-6 obserwowano u pacjentów z chorobą Graves-Basedowa w porównaniu z grupą kontrolną (p < 0,05). Natomiast istotnie statystycznie wyższe stężenia VCAM-1 stwierdzono u pacjentów z JNT i SNT w porównaniu z grupą kontrolną (odpowiednio: p < 0,001; p < 0,001). Wnioski: U osób z jawną i subkliniczną nadczynnością tarczycy występują zaburzenia funkcji komórek śródbłonka naczyń, które nie zależą od przyczyny, ale od stopnia nasilenia tyreotoksykozy. Wzrost stężenia wskaźników uszkodzenia śródbłonka może świadczyć o zwiększonym ryzyku wystąpienia chorób układu sercowo-naczyniowego u osób z zaburzoną funkcją tarczycy

Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

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 &lt; 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 &lt; 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.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 &lt; 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 &lt; 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

The Role of the CYP11B2 Promoter Polymorphism in the Diagnosis of Primary Aldosteronism

Background: nowadays, primary aldosteronism (PA) is suggested to be the most frequent cause of secondary hypertension and it reaches 10% of whole hypertensive population. The CYP11B2 promoter polymorphism might cause aldosterone overproduction. The aim of this study was to establish whether the polymorphism CYP11B2 promoter has a significant impact on diagnostic of PA. Material and Methods: study group consisted of 239 hypertensive patients previously diagnosed with adrenal incidentaloma. For diagnose of PA were performed: screening test&ndash;aldosterone-renin ratio (ARR) and saline suppression test (SIT) as a confirmatory test. Genotyping was carried out by the real time PCR method. The significance of differences between the groups was evaluated through Student&rsquo;s t-test. Results: our study revealed that genotype TT had plasma aldosterone concentration (PAC), ARR and SIT significantly higher in comparison with CC patients. The mean PAC in CC was 12.71 ng/dL vs. 20.55 ng/dL in TT patients (p = 0.037), which consequently gave a higher ARR in TT patients (119 vs. 44, p = 0.034). Mean aldosterone concentration in SIT was 2.40 ng/dL in CC patients and 9.99 ng/dL in TT patients (p = 0.046). Patients with CC genotype required less hypotensive drugs in comparison with TT genotype (p = 0.044). PA was recognized in 16 patients. Nine patients had TC genotype, six TT, and one with CC genotype. Conclusion: our study revealed predisposing TT genotype to PA. Additionally, patients with TT genotype, regardless of the PA presence, had more severe hypertension. The determination of the CYP11B2 promoter polymorphism seems to be useful in the diagnosis of PA, especially in cases where it is difficult to properly prepare patients for hormonal tests or even results of the hormonal test are incoherent