Radioiodine의 체내오염(體內汚染)에 대(對)한 긴급처치연구(緊急處置硏究)

정인용,김태환,정현우,진수일,윤택구,Chung, In-yong,Kim, Tae-hwan,Chung, Hyun-woo,Chin, Soo-yil,Yun, Taik-koo 대한수의학회 1988 大韓獸醫學會誌 Vol.28 No.2

Appreciable radiation exposures certainly occur in the workers who handle radioiodine in biochemical research, nuclear medicine diagnostics with the development of nuclear industries. But in the case of occurring the nuclear accidents, the early medical treatment of radiation injury should be necessary but little was reported in korea till now. Accordingly, to achieve of the basic data for protective roles and medical treatment of radiation injury, the present studies were carried out to evaluate the decontamination of radioiodine by the administration of the antithyroid drugs. The results observed are summarized as follows: 1. The administration of sodium iodide and potassium iodide results in rapid excretion of radioiodine and reduction of the whole body retention than the saline-only group. 2. Reguarding to thyroid protective effects, sodium iodide, potassium iodide and saline were effected significant in order. 3. In the control(saline) group, if administered with enough fluids, the whole body retention of radioiodine is reduced temporary shifts. But as far as radioprotective effects is concerned, saline was not more in the protective effects than the other groups. In conclusion, in case of nuclear accidents, if being administered sodium iodide and saline as quickly as possible, the radioprotective effects against the radiation hazard might be markedly increased in the internal contamination of radioiodine.

Augmentation of Radioiodine Uptake by Pulmonary Metastasis of Papillary Thyroid Carcinoma Treated with Dabrafenib and Trametinib

Elona Malja 대한핵의학회 2024 핵의학 분자영상 Vol.58 No.2

Redifferentiation therapy with Dabrafenib (a BRAF inhibitor) and Trametinib (a MEK inhibitor) restores radioiodine avidityof radioiodine-refractory papillary thyroid carcinoma (PTC). A 50-year-old man was diagnosed with radioiodine-refractoryPTC pulmonary metastasis post prior total thyroidectomy and radioiodine ablation. The patient was treated with Dabrafeniband Trametinib, followed by second radioiodine ablation with I-131 sodium iodine. Diffuse increased radioiodine uptakeby pulmonary metastasis was visualized on post ablation whole body scan. Response to second radioiodine ablation wasdemonstrated by decrease in size of pulmonary nodules seen on chest CT, along with decrease of thyroglobulin level.

그레이브스병에서 방사성 요오드 치료에 따른 갑상선 자극 호르몬 수용체 결합억제 면역글로불린(Thyrotropin Binding Inhibitory Immunoglobulin, TBII)의 변화

조영석,권기현,이준철,나소영,이효진,홍우정,이유선,김군순,송민호,김영건,노흥규 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Prediction of thrapeutic response to radioiodine in Graves' disease is poorly understood. Although thyrotropin binding inhibitor immunoglobulin(TBII) level is a strong index for relapse after antithyroid drug medication, conflicting results are reported regarding its prognostic significance in Graves' disease treated with RAI. This study is dengned to evaluate possible relationship between post-treatment hypothyroidism and TBII in Graves' disease treated with RAI. Fourty two patient with Graves' disease after radioiodine treatment were studied retrospectively. The subject were divided into hypothyroid group and euthyroid or hyperthyroid group. We evaluated the association of hypothyroidism and TBII with radioiodine treatment dose. The mean age of hypothyroid group was 48±11 years and euthyroid or hyperthyroid group was 47±12 years. There was no difference in two groups. And there was no significant difference in post- treatment TBII between two groups(49.9±28.5%, 29.9±14.3%, p-value >0.05). The treatment-dose had no influence on post-treatment thyroid state. Euthyroid or hyperthyroid group was done with 13.6±6.9mCi and hypothyroid group was 17.0±10.4mCi(p-value > 0.05). TBII had no prognostic significance on long-term hypothyrodism in Graves' disease treated with radioiodine. And, treatment-dose had no influence on post-treatment thyroid state.

A case of therapy-related acute myeloid leukemia with inv(16)(p13.1q22) after single low-dose iodine-131 treatment for thyroid cancer

Ji Hun Jeong,안정열,Soon Ho Park,Mi Jung Park,김경희,홍준식 대한혈액학회 2012 Blood Research Vol.47 No.3

Radioiodine is regularly used in the treatment of thyroid cancer to eliminate residual malignant tissue after thyroidectomy and to treat metastasis. Because of the low dose of radioiodine used to treat thyroid cancer patients, leukemia is an uncommon complication of exposure to radioiodine. Here, we present a patient who developed therapy-related acute myeloid leukemia with inv(16)(p13.1q22);CBFb-MYH11, eosinophilia, and K-ras mutation and who had been treated with very low-dose radioiodine following total thyroidectomy.

Defining Radioiodine-Refractory Differentiated Thyroid Cancer: Efficacy and Safety of Lenvatinib by Radioiodine-Refractory Criteria in the SELECT Trial

Kiyota, Naomi,Robinson, Bruce,Shah, Manisha,Hoff, Ana O.,Taylor, Matthew H.,Li, Di,Dutcus, Corina E.,Lee, Eun Kyung,Kim, Sung-Bae,Tahara, Makoto Mary Ann Liebert, Inc. 2017 Thyroid Vol.27 No.9

<P><B><I>Background:</I></B> While there is a clear consensus for defining radioiodine-refractory differentiated thyroid cancer (RR-DTC), it is unknown whether these criteria are equally valid for determining when radioiodine (RAI) therapy is no longer beneficial and systemic treatment should be considered. Lenvatinib, a multikinase inhibitor, significantly prolonged progression-free survival (PFS) compared to placebo in a Phase 3 trial in RR-DTC (SELECT; hazard ratio [HR]: 0.21 [99% confidence interval (CI) 0.14–0.31]; <I>p</I> < 0.001). This sub-analysis compared clinical outcomes of lenvatinib-treated patients in SELECT stratified by RR-DTC inclusion criteria.</P><P><B><I>Methods:</I></B> In SELECT, patients with measurable RR-DTC and radiologic evidence of disease progression ≤13 months prior to study entry were randomized 2:1 to lenvatinib (24 mg/day; 28-day cycle) or placebo. In this analysis, patients were stratified based on the following RR-DTC inclusion criteria: no RAI uptake, disease progression within 12 months of RAI therapy despite RAI avidity at the time of treatment, and extensive (>600 mCi) cumulative RAI exposure. All had disease progression as an inclusion criterion for SELECT.</P><P><B><I>Results:</I></B> Of 392 patients (261 lenvatinib; 131 placebo) enrolled, 275, 235, and 73 patients met the inclusion criteria for no RAI uptake, disease progression despite RAI avidity, and extensive RAI exposure, respectively. There was significant overlap between the patient groups, with 167 (42.6%) patients meeting more than one inclusion criterion. Lenvatinib improved median PFS compared to placebo in all groups (“no RAI uptake”: lenvatinib not quantifiable [NQ; CI 14.8–NQ] vs. placebo, 3.7 months [CI 2.5–5.3]; “disease progression despite RAI avidity”: lenvatinib 16.5 months [CI 12.8–NQ] vs. placebo, 3.7 months [CI 1.9–5.4]; “extensive RAI exposure”: lenvatinib 18.7 months [CI 10.7–NQ] vs. placebo, 3.6 months [CI 1.9–5.5]). Objective response rates were 71.8%, 60.0%, and 56.0% for patients with no RAI uptake, disease progression despite RAI avidity, and extensive RAI exposure, respectively. Lenvatinib-related adverse events were similar across groups.</P><P><B><I>Conclusions:</I></B> Comparable efficacy and safety profiles were observed in lenvatinib-treated patients regardless of RR-DTC criteria, possibly because of a large overlap among patients fulfilling each criterion. However, differing definitions for RR-DTC may be equally valid because both lenvatinib and placebo arms exhibited similar PFS outcomes across groups.</P>

Alternative Medical Treatment for Radioiodine-Refractory Thyroid Cancers

Paeng, Jin-Chul,Kang, Keon-Wook,Park, Do-Joon,Oh, So-Won,Chung, June-Key The Korea Society of Nuclear Medicine 2011 핵의학 분자영상 Vol.45 No.4

Thyroid cancer is one of the most rapidly increasing cancers in many countries. Although most thyroid cancers are differentiated cancers and easily treated with radioiodine (RI), a portion of differentiated and undifferentiated cancers is refractory not only to RI therapy, but also to radiotherapy and chemotherapy. Thus, various alternative therapies have been tested in RI-refractory thyroid cancers. These alternative therapies include two major categories: redifferentiation therapy and recent molecular target therapy. Several clinical trials have investigated these therapies. They demonstrated potential effects of the therapies, although the results have been somewhat limited so far. Thus, the future strategy for undifferentiated thyroid cancers will involve individualized, lesion-specific, and combined therapy. In this review, the basic mechanism of each redifferentiation and molecular target therapy is discussed, and results of recent clinical trials using these therapeutic agents are summarized.

Comparable Ablation Efficiency of 30 and 100 mCi of I-131 for Low to Intermediate Risk Thyroid Cancers Using Triple Negative Criteria

Fatima, Nosheen,Zaman, Maseeh uz,Zaman, Areeba,Zaman, Unaiza,Tahseen, Rabia Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.3

Background: There is controversy about ablation efficacy of low or high doses of radioiodine-131 (RAI) in patients with differentiated thyroid cancers (DTC). The purpose of this prospective study was to determine efficacy of 30 mCi and 100 mCi of RAI to achieve successful ablation in patients with low to intermediate risk DTC. Materials and Methods: This prospective cross sectional study was conducted from April 2013 to November 2015. Inclusion criteria were patients of either gender, 18 years or older, having low to intermediate risk papillary and follicular thyroid cancers with T1-3, N0/N1/Nx but no evidence of distant metastasis. Thirty-nine patients were administered 30 mCi of RAI while 61 patients were given 100 mCi. Informed consent was acquired from all patients and counseling was done by nuclear physicians regarding benefits and possible side effects of RAI. After an average of 6 months (range 6-16 months; 2-3 weeks after thyroxin withdrawal), these patients were followed up for stimulated TSH, thyroglobulin (sTg) and thyroglobulin antibodies, ultrasound neck (U/S) and a diagnostic whole body iodine scan (WBIS) for ablation outcome. Successful ablation was concluded with stimulated Tg< 2ng/ml with negative antibodies, negative U/S and a negative diagnostic WBIS (triple negative criteria). ROC curve analysis was used to find diagnostic strength of baseline sTg to predict successful ablation. Results: Successful ablation based upon triple negative criteria was 56% in the low dose and 57% in the high dose group (non-significant difference). Based on a single criterion (follow-up sTg<2 ng/ml), values were 82% and 77% (again non-significant). The ROC curve revealed that a baseline sTg level ${\leq}7.4ng/ml$ had the highest diagnostic strength to predict successful ablation in all patients. Conclusions: We conclude that 30 mCi of RAI has similar ablation success to 100 mCi dose in patients with low to intermediate risk DTC. A baseline $sTg{\leq}7.4ng/ml$ is a strong predictor of successful ablation in all patients. Low dose RAI is safer, more cost effective and more convenient for patients and healthcare providers.

고용량 방사성옥소 치료 병실의 최대치 산출

이경재,조현덕,고길만,박영재,이인원,Lee, Kyung-Jae,Cho, Hyun-Duck,Ko, Kil-Man,Park, Young-Jae,Lee, In-Won 대한핵의학기술학회 2010 핵의학 기술 Vol.14 No.1

갑상선암 환자가 증가함에 따라 고용량 방사성옥소 치료환자 또한 적체되고 있는 추세이다. 따라서 현재 시설의 수용 능력을 고려하여 치료할 수 있는 병실의 최대치를 산출해 보고자 한다. 본원에 입원하는 고용량 방사성옥소 치료 환자의 방출 오 폐수량과 오 폐수의 방사능을 측정하고 고용량 방사성옥소 치료 병실에서 대기 중으로 방출하는 공기 중의 방사능 농도를 측정한다. 측정된 오 폐수의 방사능과 방출하는 공기 중의 농도가 교육과학기술부에서 고시하는 기준인 배수 중의 배출 관리 기준 30 Bq/L 및 배기 중의 배출관리기준 3 $Bq/m^3$을 만족할 때 치료 가능한 병실의 최대치를 계산한다. 가장 보수적인 수치로 계산하여 환자 1명을 치료할 경우 배출되는 오 폐수의 평균 방사능의 농도는 8 MBq/L였으며, 정화조에서 117일의 감쇠 시간을 거친 후의 평균 방사능의 농도는 29.5 Bq/L였다. 환자 2명을 치료할 경우 배출되는 오 폐수의 평균 방사능의 농도는 16 MBq/L였으며, 정화조에서 70일의 감쇠 시간을 거친 후의 평균 방사능의 농도는 29.7 Bq/L였다. 또한 같은 조건일 경우 치료 병실에서 RI 배기 filter를 통과하여 방출된 공기 중의 방사능 농도는 0.38 $Bq/m^3$였다. 수용 능력을 고려하여 치료할 수 있는 고용량 방사성옥소 치료 병실의 최대치를 산출하여 현재의 시설에 적용하고 병실 내 구조개선 등으로 2인실로 운영한다면 적체되어 있는 환자의 치료 대기 기간을 단축할 수 있으리라 사료된다. Purpose: According to increment of thyroid cancer recently, patients of high dose radioiodine therapy were accumulated. Taking into consideration the acceptance capability in the current facility, this study is to calculate the maximum value of high dose radioiodine therapy in patients for treatment. Materials and Methods: The amount and radioactivity of waste water discharged from high dose radioiodine therapy in patients admitted at present hospital as well as the radiation density of the air released into the atmosphere from the high dose radioiodine therapy ward were measured. When the calculated waste water's radiation and its density in the released air satisfies the standard (management standard for discharge into water supply 30 Bq/L, management standard for release into air 3 $Bq/m^3$) set by the Ministry of Education, Science and Technology, the maximum value of treatable high dose radioiodine therapy in patients was calculated. Results: When we calculated in a conservative view, the average density of radiation of waste water discharged from treating high dose radioiodine therapy one patient was 8 MBq/L and after 117 days of diminution in the water-purifier tank, it was 29.5 Bq/L. Also, the average density of radiation of waste water discharged from treating high dose radioiodine therapy two patients was 16 MBq/L and after 70 days of diminution in the water-purifier tank, it was 29.7 Bq/L. Under the same conditions, the density of radiation released into air through RI Ventilation Filter from the radioiodine therapy ward was 0.38 $Bq/m^3$. Conclusion: The maximum value of high dose radioiodine therapy in patients that can be treated within the acceptance capability was calculated and applied to the current facility, and if double rooms are managed by improving the ward structure, it would be possible to reduce the accumulated treatment waiting period for radioiodine therapy in patients.

High Serum Levels of Thyroid-Stimulating Hormone and Sustained Weight Gain in Patients with Thyroid Cancer Undergoing Radioiodine Therapy

서효정,정준기,강건욱,김의신,천기정,팽진철,이동수,박영주,박도준,최재걸 대한갑상선학회 2016 International Journal of Thyroidology Vol.9 No.1

Background and Objectives: The extent of weight gain and its association with clinical factors in patients undergoing radioiodine therapy for differentiated thyroid cancer remain unclear. We analyzed clinical factors related to sustained weight gain after serum thyroid-stimulating hormone (TSH) stimulation for radioiodine (I-131) therapy. Materials and Methods: The study population included 301 adult patients who underwent total thyroidectomy followed by radioiodine therapy and visited the thyroid clinic regularly. Group 1 received a single radioiodine therapy treatment, while group 2 received multiple radioiodine treatment. Data on transient weight gain, defined as weight gain that resolved (±5%) within 1 year after radioiodine therapy, were collected from medical records. Sustained weight gain was defined as body mass index after treatment (BMIpost) – BMI before treatment (BMIpre) ≥2 kg/m2 more than 1 year following radioiodine therapy. Subjective symptoms were scored by questionnaire. Logistic regression analysis was performed using various clinical and laboratory factors to identify risk factors associated with sustained weight gain. Results: Two hundred and fifty-nine (86%) patients showed transient weight gain and 23 (8%) patients showed sustained weight gain. TSH at therapy and T4-on TSH differed significantly in all patients and in the patients in group 1 with sustained weight gain. The proportion of patients with basal BMI≥25 kg/m2 in group 1 with sustained weight gain also differed significantly. Univariate analysis revealed that high serum levels of TSH at therapy (≥100 μIU/mL) and hypercholesterolemia were associated with sustained weight gain in group 1. Multivariate analysis showed that TSH at therapy levels ≥100 μIU/mL was associated with sustained weight gain in group 1. Of 283 patients remaining after excluding those with insufficient TSH suppression during follow-up, T4-on TSH levels were lower in the sustained weight gain group compared to those without sustained weight gain. TSH at therapy levels ≥100 μIU/mL were significantly associated with sustained weight gain in multivariate analysis. Conclusion: Most patients (86%) had transient weight gain after TSH at therapy, while 8% of patients showed sustained weight gain. Univariate and multivariate analysis revealed relatively high TSH levels (≥100 μIU/mL) to be a risk factor for patients that received a single dose of radioiodine therapy. Insufficient T4 dose was not associated with sustained weight gain.

Relations Between Pathological Markers and Radioiodine Scan and 18F-FDG PET/CT Findings in Papillary Thyroid Cancer Patients With Recurrent Cervical Nodal Metastases

이정원,민혜숙,이상미,권현우,정준기 대한핵의학회 2015 핵의학 분자영상 Vol.49 No.2

Purpose The aimof this study was to investigate relationships between the immunohistochemical results and radioiodine scan and 18F-FDG PET findings in papillary thyroid cancer (PTC) patients with recurrent cervical nodal metastases. Methods A total of 46 PTC patients who had undergone a radioiodine scan and/or 18F-FDG PET/CT and a subsequent operation on recurrent cervical lymph nodes were enrolled. Twenty-seven patients underwent 18F-FDG PET/CT, 8 underwent radioiodine scans, and 11 underwent both scans. In all surgical specimens, the immunoexpressions of thyroglobulin (Tg), sodium-iodide symporter (NIS), glucose transporter 1 (Glut-1), and somatostatin receptor 1 and 2A (SSTR1 and SSTR2A) were assessed, and associations between these expressions and radioiodine scan and 18F-FDG PET findings were evaluated. Results Of the 38 patients who underwent 18F-FDG PET/CT, all patients with weak Tg expression had positive 18F-FDG uptake, while only 45 % of the patients with moderate or strong Tg expression showed positive uptake (p=0.01). The proportion of patients with positive 18F-FDG uptake increased as the degree of Glut-1 expression with luminal accentuation increased. Of the 19 patients who underwent a radioiodine scan, the proportion with positive radioiodine uptake was greater among patients with strong NIS and SSTR2A expression than among patients expressing these markers at weak levels (p=0.04 for all). All three patients with weak Tg expression were negative for radioiodine uptake. Conclusion The 18F-FDG uptakes of recurrent cervical nodes are related to strong Glut-1 expression with luminal accentuation and weak Tg expression, whereas radioiodine uptake is related to the strong expressions of NIS and SSTR2A.