Influence of initial large dose on subsequent uptake of therapeutic radioiodine in thyroid cancer patients

Jeevanram, R.K.; Shah, D.H.; Sk, Sharma; Ganatra, R. D.

doi:10.1016/0883-2897(86)90108-x

Cited by 47 publications

(42 citation statements)

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“…Clinical studies indicate that stunning is a prolonged effect lasting for many days (1,3,6,7,36). This finding was confirmed in the present study, in which no signs of recovery of the suppressed iodide transport were observed in cultures exposed to 131 I or 99m Tc up to 1 wk after the irradiation period.…”

Section: Discussionsupporting

confidence: 91%

“…Therefore, it is not surprising that radiation-induced loss of iodide transport develops gradually and rather slowly after the NIS gene transcription is significantly suppressed. Moreover, these in vitro findings support the many clinical reports of a delay in detection of stunning until several days after the administration of radioiodine for diagnostic purposes (1)(2)(3)(4)(5)(6)(7)36,37).…”

Section: Discussionsupporting

confidence: 72%

“…Thyroi d stunning is a complication of radiation therapy with 131 I, the consequences of which affect mainly the management of thyroid carcinoma patients (1)(2)(3)(4)(5)(6). The stunning phenomenon is characterized by less 131 I uptake at therapy than was predicted from the 131 I uptake measurement during dose planning.…”

mentioning

confidence: 99%

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Radiation-Induced Thyroid Stunning: Differential Effects of ¹²³I, ¹³¹I, ^99mTc, and ²¹¹At on Iodide Transport and NIS mRNA Expression in Cultured Thyroid Cells

Lundh

Lindencrona²,

Postgård³

et al. 2009

J Nucl Med

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Recent clinical and experimental data demonstrate that thyroid stunning is caused by previous irradiation and may influence the efficacy of 131 I radiation therapy of thyroid cancer and possibly hyperthyroidism. To avoid stunning, many clinics have exchanged 131 I for 123 I for pretherapeutic diagnostic imaging and dose planning. Furthermore, recent in vitro studies indicate that 131 I irradiation reduces iodide uptake by downregulating the expression of the sodium iodide symporter (NIS). The rationale for this study was therefore to study effects on iodide transport and NIS messenger RNA (mRNA) expression in thyrocytes exposed to both 123 I and 131 I in addition to some other potentially interesting radionuclides. Methods: Thyrotropin-stimulated thyroid cell monolayers were exposed to 0.5 Gy of 123 I, 131 I, 99m Tc, or 211 At, all being radionuclides transported via NIS, in the culture medium for 6 h, or to various absorbed doses of 123 I or 131 I for 48 h. NIS mRNA expression was analyzed using quantitative reverse-transcriptase polymerase chain reaction. Results: Iodide transport and NIS mRNA expression were reduced by all radionuclides. At the same absorbed dose, iodide transport was reduced the most by 211 At, followed by 123 I and 99m Tc (equally potent), whereas 131 I was least effective. The onset of NIS downregulation was rapid (,1 d after irradiation) in cells exposed to 123 I or 211 At and was delayed in cells irradiated with 131 I or 99m Tc. Iodide transport and NIS expression were recovered only for 211 At. 123 I reduced the iodine transport and the NIS mRNA expression more efficiently than did 131 I at an equivalent absorbed dose, with a relative biological effectiveness of about 5. Conclusion: The stunning effect per unit absorbed dose is more severe for 123 I than for 131 I. Despite the lower absorbed dose per unit activity for 123 I than for 131 I, stunning by 123 I cannot be excluded in patients. The degree to which iodide transport capacity and NIS mRNA expression are reduced seems to be related to the biological effectiveness of the type of radiation delivering the absorbed dose to the target, with 211 At (which has the highest relative biological effectiveness) causing the highest degree of stunning per unit absorbed dose in the present study.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 72%

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Radiation-Induced Thyroid Stunning: Differential Effects of ¹²³I, ¹³¹I, ^99mTc, and ²¹¹At on Iodide Transport and NIS mRNA Expression in Cultured Thyroid Cells

Lundh

Lindencrona²,

Postgård³

et al. 2009

J Nucl Med

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“…It had been reported that administration of 2-5mCi of diagnostic radioactive iodine 131 (RI131) deliver absorbed doses of 4-38 and 10-58Gy to thyroid remnants [14,15] . Medvedec 200516 added that absorbed doses >4Gy might result in thyroid stunning.…”

Section: Discussionmentioning

confidence: 99%

Effect of stunning of diagnostic 131-iodine doses on ablative doses for differentiated thyroid cancer patient’s outcome

Elsaban

Al-Sakhri²,

Al-Zahrani³

2013

JST

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Background: Thyroid stunning was defined as transient reduction of thyroid tissue uptake 131I (RAI-131) ablative dose after a diagnostic 131I dose that decreases the final absorbed dose in ablative therapy.Aim of the study: after following the proper precautions compare the response to the ablative dose given to patients with differentiated thyroid cancer with or without diagnostic radioactive iodine 131(RAI-131). Patients and methods:One hundred patients with differentiated thyroid cancer were included and divided into two groups: Group I, ablative dose of RAI-131according to their risk stratification without diagnostic dose and Group II, patients performing diagnostic whole body scan [5mCi] followed by ablative dose. Results:The current study have showed no significant associations between overall response in both groups and the different studied parameters except for the mean ablative dose of P<0.001 and r=0.7, P<0.001 in group I and group II respectively]. Correlation matrix was used in all patients revealed that overall response was highly correlated with risk stratification; cervical nodal status and RAI-131 ablative dose [P values <0.01; <0.01 and <0.01 respectively], while regression proved that the only predictor for response is the mean RAI-131 ablative dose. Conclusion:Following the proper precautions prevent stunning appearance after the diagnostic dose success rate to ablation will not be affected.

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“…We also realized that the dose to the metastases regrettably was B/10% of the intended dose. In a search of the literature we found Jeevanram et al's work from 1986 clearly describing the phenomenon of stunning [15]. After this incident we became very cautious, using low activities of 131 I or, alternatively, using the gamma emitter 123 I or simply avoiding diagnostic scans.…”

Section: Stunningmentioning

confidence: 99%

Radioiodine treatment for malignant thyroid disease

Berg

2006

Acta Oncologica

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Influence of initial large dose on subsequent uptake of therapeutic radioiodine in thyroid cancer patients

Cited by 47 publications

References 2 publications

Radiation-Induced Thyroid Stunning: Differential Effects of ¹²³I, ¹³¹I, ^99mTc, and ²¹¹At on Iodide Transport and NIS mRNA Expression in Cultured Thyroid Cells

Radiation-Induced Thyroid Stunning: Differential Effects of ¹²³I, ¹³¹I, ^99mTc, and ²¹¹At on Iodide Transport and NIS mRNA Expression in Cultured Thyroid Cells

Effect of stunning of diagnostic 131-iodine doses on ablative doses for differentiated thyroid cancer patient’s outcome

Radioiodine treatment for malignant thyroid disease

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Influence of initial large dose on subsequent uptake of therapeutic radioiodine in thyroid cancer patients

Cited by 47 publications

References 2 publications

Radiation-Induced Thyroid Stunning: Differential Effects of 123I, 131I, 99mTc, and 211At on Iodide Transport and NIS mRNA Expression in Cultured Thyroid Cells

Radiation-Induced Thyroid Stunning: Differential Effects of 123I, 131I, 99mTc, and 211At on Iodide Transport and NIS mRNA Expression in Cultured Thyroid Cells

Effect of stunning of diagnostic 131-iodine doses on ablative doses for differentiated thyroid cancer patient’s outcome

Radioiodine treatment for malignant thyroid disease

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Product

Resources

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Radiation-Induced Thyroid Stunning: Differential Effects of ¹²³I, ¹³¹I, ^99mTc, and ²¹¹At on Iodide Transport and NIS mRNA Expression in Cultured Thyroid Cells

Radiation-Induced Thyroid Stunning: Differential Effects of ¹²³I, ¹³¹I, ^99mTc, and ²¹¹At on Iodide Transport and NIS mRNA Expression in Cultured Thyroid Cells