Reevaluation of the Impact of a Stringent Low-Iodine Diet on Ablation Rates in Radioiodine Treatment of Thyroid Carcinoma

Morris, Lilah F.; Wilder, Matthew S.; Braunstein, Glenn D.

doi:10.1089/10507250152484583

Cited by 66 publications

(115 citation statements)

References 17 publications

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“…15,16 These contradictory results notwithstanding, high 24h RAIU is still regarded as an important factor in the success of radioiodine therapy. 11 Decreasing the iodide pool by a low iodine diet 17 or increasing the retention of iodine in the thyroid gland by administering lithium carbonate have previously been proposed by several studies. 18 However, the use of lithium is not a generally accepted option as adjuvant to increase the first-dose success of radioiodine therapy.…”

Section: Discussionmentioning

confidence: 99%

The predictive role of 24h RAIU with respect to the outcome of low fixed dose radioiodine therapy in patients with diffuse toxic goiter

Damle

Bal

Kumar

et al. 2012

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radioactive iodine uptake (rAIU) is a test used to differentiate hyperthyroidism from thyroiditis and to calculate the radioiodine dose for treatment of Graves' disease. We aimed to evaluate the predictive role of 24h rAIU with respect to the outcome of radioiodine therapy in patients with diffuse toxic goiter (DTG). METHODs: case records of patients with DTG treated with radioactive iodine were reviewed retrospectively. Patients were divided into two groups based on 24h rAIU (normal range: 15% -35% at 24 h): the first group included patients with 24h rAIU values equal to or less than 50%, while the second group included patients with 24h rAIU values of over 50%. Gland size, duration of disease, treatment with antithyroid drugs (ATD) and its duration were the other factors considered. success of the first dose of 131 I was defined as a euthyroid or hypothyroid status at 12 months post-therapy without the need for additional radioiodine or ATD therapy. Data were analyzed with 95% power and 1% type I error (α=0.01). rEsULTs: six hundred thirty-three (633) consecutive patients with DTG were given a fixed-dose (5mci) of radioiodine between January 1987 and December 2006. One hundred seventy-five patients (175) had an rAIU ≤50% and 458 patients had an rAIU >50%. Firstdose success rate in the former group was 81.7% and in the second group 68.6% (p=0.001). The overall first-dose success was 72%. Multivariate analysis confirmed the significant role of 24h rAIU data to predict a successful outcome. cONcLUsION: A 24h rAIU value of ≤50% appears to be associated with a significantly better outcome compared to that of a 24h rAIU value of >50% in patients with DTG given as treatment a fixed dose of 185 MBq radioiodine.

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Section: Discussionmentioning

confidence: 99%

The predictive role of 24h RAIU with respect to the outcome of low fixed dose radioiodine therapy in patients with diffuse toxic goiter

Damle

Bal

Kumar

et al. 2012

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“…A stringent low-iodine diet was shown to significantly improve ablation success rates in Dutch DTC patients (Pluijmen et al 2003), although this effect was not observed in an American study comparing the stringent diet to a regular diet plus instruction to avoid salt, seafood, and iodine-containing multivitamins (Morris et al 2001b). Moreover, both these studies involved only adults, so the benefits of a low-iodine diet in children remain unconfirmed.…”

Section: Dosimetric Considerationsmentioning

confidence: 98%

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Jarząb¹,

Handkiewicz-Junak²,

Włoch³

2005

Endocr Relat Cancer

169

160

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Well under 15% of differentiated thyroid carcinoma (DTC) is diagnosed at £18 years of age. The population is heterogenous and the differences between prepubertal children and pubertals and adolescents are to be considered. Although very little has been reported on children with sporadic DTC under the age of 10 years, juvenile DTC has at least some undeniable differences with adult DTC: (1) larger primary tumor at diagnosis; (2) metastatic pattern and features, namely: (a) greater prevalence of neck lymph node and distant metastases at diagnosis, (b) lungs almost the sole distant metastatic site, (c) pulmonary metastases nearly always functional; (3) closer-to-normal and more frequent sodium-iodide symporter (NIS) expression; and (4) higher recurrence rate but longer overall survival. These differences are especially distinct in prepubertal children. The goals of primary treatment of juvenile DTC are to eradicate disease and extend not only overall, but recurrence-free survival (RFS). Extending RFS is itself a desirable goal in children because it improves quality-of-life, alleviates anxiety during psychologically formative years, reduces medical resource consumption, and may increase overall survival. Primary treatment of DTC generally comprises a combination of surgery, radioiodine ( 131 I) ablation, and thyroid hormone therapy applied at varying levels of intensity. Therapeutic decision-making must rely on retrospective adult and/or pediatric outcome studies and on treatment guidelines formulated mostly for adults. Differences between juvenile and adult DTC and physiology dictate distinct treatment strategies for children. We, and many others, advocate a routine intensive approach because of the more advanced disease at diagnosis, propensity for recurrence, and greater radioiodine responsiveness in children, as well as published evidence of significant survival benefits, especially regarding RFS. This intensive approach consists of total thyroidectomy and central lymphadenectomy in all cases, completed by modified lateral lymphadenectomy when necessary and followed by radioiodine administration. However, absence of prospective studies and of universal proof of overall causespecific survival benefits of this approach have led some to propose more conservative strategies. Most European centers give radioiodine ablation to the vast majority of juvenile DTC patients. Ablation seeks to destroy any residual cancer, including microfoci, as well as healthy thyroid remnant. Large studies have documented the procedure to decrease cause-specific death rates and, in children, to significantly lessen locoregional recurrence rates (by factors of 2-11) independent of the extent of surgery. There is universal agreement on treating inoperable functional metastases with large radioiodine activities. Treatment is especially effective in small tumor foci up to 1 cm in diameter, and should be administered every 6-12 months until complete response, loss of functionality, or attainment of cumulative activities between 18.5-3...

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“…Apesar de reduzir o valor absoluto de captação, a dieta livre dificilmente impede a realização de estudos diagnósticos, porém, se a intenção é terapêutica, qualquer redução da captação absoluta deve ser evitada. Apesar da difícil mensuração do impacto clínico da dieta pobre em iodo no tratamento ablativo (24), sabe-se que sua adoção reduz efetivamente o iodo disponível no organismo, com a conseqüente redução da iodúria para cerca de um terço do valor sem preparo (24,25) e com o aumento de até duas vezes na dose de radiação absorvida pelos tumores (25,26). Por este motivo, é recomendável manter baixa ingestão de iodo durante 10 a 20 dias pré-tratamento, se possível abaixo de 50µg/dia ou, no mínimo, suspender a ingestão de peixes e frutos do mar, suplementos vitamínicos e reduzir a ingestão de sal e leite.…”

Section: Métodos Para Aumentar a Dose Absorvidaunclassified

Tratamento do carcinoma diferenciado da tireóide com iodo-131: intervenções para aumentar a dose absorvida de radiação

Sapienza

Endo

Neto

et al. 2005

Arq Bras Endocrinol Metab

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RESUMOObjetivo: Analisar medidas tomadas para aumentar a dose de radiação absorvida (DOSE) durante o tratamento do carcinoma diferenciado da tireóide (CDT) com iodo-131. Métodos: As abordagens para aumentar a DOSE na radioiodoterapia são: redução da competição com iodo não-radioativo, estímulo da captação/retenção celular e aumento da atividade administrada. Revisaram-se os fundamentos e resultados de cada um destes métodos. Resultados: Apesar de ser difícil confirmar aumento de sobrevida, existe relação direta entre a DOSE e a resposta no CDT. Diferentes abordagens permitem o aumento da DOSE nos tecidos, inferindo-se uma possível melhora na resposta dos tumores ao tratamento com iodo-131. Apesar do prognóstico relativamente benigno da doença, a melhoria da resposta é importante nos casos de alto risco, em que as alternativas de tratamento são limitadas. Conclusões: As intervenções descritas permitem aumentar a DOSE durante o tratamento do CDT, podendo ser empregadas para casos de alto risco. Our aim was to analyze measures taken to increase the radiation absorbed dose (DOSE) during treatment of well-differentiated thyroid cancer (DTC) with iodine-131. Methods: An increase in DOSE is achieved by: avoiding competition with non-radioactive iodine, stimulating cellular uptake/retention, increasing the administered activity. Basis and results of each one of these methods were reviewed. Results: Although it is difficult to demonstrate an increase in survival, there is a direct relation between DOSE and tumoral response in DTC. Different approaches can be used aiming an increase in DOSE, with a possible improvement in tumoral response for treatment with iodine-131. Although DTC is a relatively benign disease, a better response to treatment is highly desirable in high-risk patients, who have few other options of therapy. Conclusions: An increase in DOSE during treatment of DTC can be achieved using the described interventions, which should be used in high-risk cases of DTC.

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Reevaluation of the Impact of a Stringent Low-Iodine Diet on Ablation Rates in Radioiodine Treatment of Thyroid Carcinoma

Cited by 66 publications

References 17 publications

The predictive role of 24h RAIU with respect to the outcome of low fixed dose radioiodine therapy in patients with diffuse toxic goiter

The predictive role of 24h RAIU with respect to the outcome of low fixed dose radioiodine therapy in patients with diffuse toxic goiter

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Tratamento do carcinoma diferenciado da tireóide com iodo-131: intervenções para aumentar a dose absorvida de radiação

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