Transient hypothyroidism after iodine-131 therapy for Grave's disease

We studied 355 patients with Grave's disease to characterize transient hypothyroidism and its prognostic value following 131I therapy. METHODS: The patients received therapeutic 131I treatment as follows: 333 received a dose < 10 mCi (6.6 +/- 1.9 mCi) and 22 received a dose > 10 mCi (12.8 +/- 2.9 mCi). Diagnosis of transient hypothyroidism was based on low T4, regardless of TSH within the first year after 131I followed by recovery of T4 and normal TSH. RESULTS: After administration of < 10 mCi 131I, 40 patients developed transient hypothyroidism during the first year; transient hypothyroidism was symptomatic in 15. There was no transient hypothyroidism after high doses (> 10 mCi) of 131I. Iodine-131 uptake > 70% at 2 hr before treatment was a risk factor for developing transient hypothyroidism (Odds ratio 2.8, 95% confidence interval 0.9-9.4). At diagnosis of transient hypothyroidism, basal TSH levels were high (51%), normal (35%) or low (14%); therefore, the transient hypothyroidism was not centralized. If hypothyroidism developed during the first 6 mo after basal TSH > 45 mU/liter ruled out transient hypothyroidism. CONCLUSION: The development of transient hypothyroidism and its hormonal pattern did not influence long-term thyroid function. Since no prognostic factors reliably predicted transient hypothyroidism before 131I or at the time of diagnosis, if hypothyroidism appears within the first months after 131I, the reevaluation of thyroid function later is warranted to avoid unnecessary chronic replacement therapy.     

Evidence for two tissue-specific pathways for in vivo thyroxine 5'-deiodination in the rat

Propylthiouracil (PTU) is a well known inhibitor of thyroxine (T(4)) to triiodothyronine (T(3)) conversion as evidenced by its effect in several in vitro systems and by the decrease in serum T(3) caused by this drug in either rats or man receiving T(4) replacement. However, the failure of PTU to decrease the intrapituitary T(3) concentration and to completely blunt the serum T(3) concentration in T(4)-replaced athyreotic rats suggest that there may be a PTU-insensitive pathway of T(4) to T(3) conversion in some tissues. To address this question, we have studied the in vivo effect of PTU treatment on the generation of [(125)I]T(3) from [(125)I]T(4) in the serum and cerebral cortex (Cx), cerebellum (Cm), liver (L), and anterior pituitary (P) of euthyroid rats. Whereas PTU decreased the concentration of [(125)I]T(3) in the serum, L homogenates, and L nuclei after [(125)I]T(4), it did not affect the concentration of [(125)I]T(3) in homogenates or nuclei of Cx, Cm, or P. Iopanoic acid pretreatment significantly reduced the [(125)I]T(3) concentration in serum, homogenates, and cell nuclei of all these organs. Neither agent affected the metabolism or tissue distribution of simultaneously injected [(131)I]T(3). The presence of PTU in these tissues was evaluated by in vitro assessment of iodothyronine 5'-deiodinating activity using both [(125)I]rT(3) and [(125)I]T(4) as substrates. In agreement with the in vivo findings, generation of [(125)I]T(3) from T(4) in vitro was not affected by PTU in Cx, Cm, P but it was inhibited by 76% in L. However, rT(3) 5'-deiodination, known to be sensitive to PTU in these tissues, was inhibited in all four indicating that the PTU given in vivo was present in significant amounts. These results demonstrate that in rat Cx, Cm, and P unlike liver, PTU does not inhibit T(4) to T(3) conversion in vivo despite the presence of the drug in the tissues in amounts that significantly inhibit reverse T(3) 5'-deiodination. These results show that in vivo 5'-deiodination of T(4) proceeds via a PTU-insensitive pathway in the central nervous system and pituitary, while this pathway is not quantitatively important in the L. This mechanism accounts for the "locally generated" T(3) in central nervous system and pituitary and could also provide the approximately one-third of extrathyroidally produced T(3) not blocked by PTU administration in athyreotic T(4)-replaced rat.     

Thallium-201 scintigraphy to predict therapeutic outcome of iodine-131 therapy of metastatic thyroid carcinoma

We studied the relationship between 201Tl uptake and the efficacy of radioiodine therapy in thyroid carcinoma. METHODS: Forty-four patients with metastases of well-differentiated thyroid carcinoma received 201Tl scintigraphy within the 2 mo before their initial 131I therapy. Patients were classified into two groups according to the tumor-to-background (T/B) ratio on the late 201Tl scan: high 201Tl uptake (T/B > or = 2.1) and low 201Tl uptake (T/B < 2.1). The therapeutic outcome was judged by the percent reduction in the tumor diameter at 6 mo after the treatment. The treatment was defined as effective when the tumor showed more than 50% reduction in the tumor diameter. The patients in whom radioiodine was ineffective were followed up to determine if the tumor showed further growth. RESULTS: Of the 44 patients, 25 had high 201Tl uptake and 19 had low 201Tl uptake. The therapy was effective in 15 patients and was ineffective in 29. All the patients in whom radioiodine was effective had low 201Tl uptake. On the other hand, 25 of 29 patients in whom radioiodine was ineffective had high 201Tl uptake. Eight patients, in whom radioiodine was ineffective despite good 131I uptake, had high 201Tl uptake. There were no significant differences in the positive predictive value and the negative predictive value for effective treatment between 201Tl scintigraphy and therapeutic dose 131I scintigraphy. Among the 25 patients in whom radioiodine was ineffective and who had high 201Tl uptake, the tumor diameter increased in 7 (28%). However, none of the tumors with low 201Tl uptake increased in size during the follow-up period. CONCLUSION: Thallium-201 scintigraphy has a high predictive value for the efficacy of radioiodine therapy in metastatic thyroid carcinoma. Thus, it is helpful in determining the indication for radioiodine therapy and it seems to be an adjunct to tracer dose 131I scintigraphy.     

Neonatal Basedow's disease in twins from a mother with severe T3 hyperthyroidism

HISTORY AND CLINICAL FINDINGS: Dizygotic twin sisters were born to a woman who, shortly before becoming pregnant, had developed Graves' disease with markedly elevated triiodothyronine (T3) levels and highly positive TSH receptor antibody titres (TRAb: 169 mU/ml). From the second week of life onwards they had a goitre and hyperexcitability, tachycardia and failure to thrive were noted. In addition, twin I had mild exophthalmos. As thyrostatic treatment of the mother was very difficult, intrauterine hypothyroidism or transitory hyperthyroidism had presumably occurred in the twins. INVESTIGATIONS: Twin I had maximal thyroxine (T4) concentration of 26.2 micrograms/dl, while it was 24.7 micrograms/dl in twin II with suppressed TSH. Both twins had high concentrations of TRAb and antibodies against thyroid peroxidase. DIAGNOSIS, TREATMENT AND COURSE: With the diagnosis of neonatal Graves' disease established, both twins were treated with propranolol (2 mg/kg.d) and phenobarbitone (2-4 mg/kg.d). Twin I, whose symptoms were more severe, also received propylthiouracil (5 mg/kg.d) until euthyroidism had been achieved. Although twin II became euthyroid spontaneously, she gained weight only slowly and microcephaly developed together with definite motor and mental retardation. It remains unclear whether these were consequences of intrauterine hypothyroidism or post-partum hyperthyroidism. CONCLUSION: Graves' disease during pregnancy demands interdisciplinary collaboration between gynaecologist, physician and paediatrician to prevent severe sequelae in the children. Early risk assessment is possible by measuring the TSH receptor antibody titre in umbilical blood.     

Interleukin 1alpha and interleukin 6 promote the in vitro growth of both normal and neoplastic human cervical epithelial cells

We report here on a patient who was diagnosed with follicular carcinoma in 1985, and who was treated with total thyroidectomy. Two years later, when metastasis was found in his neck lesion, lung, pelvis and right femur, the patient received 131I treatment. Six years after receiving 131I treatment, the patient presented with hyperthyroidism. Whole-body scan with 131I revealed functioning metastasis in his right femur and pelvis. There was no hot spot in the neck region, confirming that no thyroid tissue remained. Blood panels revealed an increase in both TSH binding inhibitory immunoglobulin (TBII. 36.2%; normal. -10 approximately 10%) and thyroid stimulating antibody (TSAb, 176%; normal, less than 145%). Treatment with antithyroid drugs, dexamethasone and radioisotope therapy rapidly resolved his hyperthyroidism. Thyrotoxicosis and positive TRAb occurred in the absence of thyroid tissue, and many years after the completion of R1 therapy. The overproduction of thyroid hormone can therefore only be attributed to some mechanism of activity in the metastatic tumor tissue.     

Large, compressive goiters treated with radioiodine

OBJECTIVE: To evaluate the effectiveness of radioiodine therapy as an alternative for surgery in elderly patients with a large, compressive goiter using objective methods for measuring thyroid volume and tracheal compression. DESIGN: Prospective study. SETTING: University hospital in the Netherlands. PATIENTS: 19 patients (mean age +/- SD, 66 +/- 14 years) with a large, compressive multinodular goiter who had a high operative risk or refused to have thyroid surgery. INTERVENTION: A single intravenous dose of 131I at 2.6 +/- 1.0 GBq (70 +/- 28 mCi) (3.7 MBq or 100 microCi/g of thyroid tissue), followed by daily administration of L-thyroxine in doses that did not suppress thyroid-stimulating hormone. MEASUREMENTS: Clinical evaluation and measurements of thyroid volume, maximal tracheal deviation, and the smallest cross-sectional area of the tracheal lumen with magnetic resonance imaging before and 1 year after 131I treatment. RESULTS: No exacerbation of compressive symptoms after 131I therapy was observed. Thyroid volume was 269 +/- 153 mL before treatment and 154 +/- 73 mL 1 year after treatment (P < 0.001). Thyroid volume was reduced 40% +/- 15% (range, 19% to 68%). Maximal tracheal deviation (1.9 +/- 0.8 cm before and 1.5 +/- 0.7 cm 1 year after therapy) had decreased by 20% +/- 20% (range, -4% to 73%; P < 0.001), and the smallest cross-sectional area of tracheal lumen (0.78 +/- 0.38 cm2 before and 1.04 +/- 0.48 cm2 1 year after therapy) had increased by 36% +/- 38% (range, -3% to 125%; P < 0.001). Clinical signs and symptoms improved in 8 of 12 patients with dyspnea and inspiratory stridor and in both patients with compression of the superior vena cava. CONCLUSIONS: Therapy with 131I is an effective alternative to surgery for elderly patients with a large, compressive multinodular goiter.     

Acute effect of inorganic iodide after 131I therapy for hyperthyroidism

Patients treated with inorganic iodide weeks to years following 131I therapy for hyperthyroidism do not adapt to its antithyroid effect. To determine whether such adaptation occurs soon after 131I therapy, serum thyroxine (T4) and triiodothyronine (T3) concentrations were measured daily for 9-14 days following 131I therapy in seventeen hyperthyroid patients. Nine patients received 150 mg KI daily starting 48 h after 131I administration; eight received only 131I. Serum T4 and T3 concentrations did not change significantly in the patients who received only 131I. In the patients who received 131I and KI, serum T4 and T3 concentrations fell promptly, reaching nadir values 2-10 days after initiation of iodide, and then increased despite continuation of KI therapy. The mean maximal fall in serum T4 was 34% and in serum T3 42%. These results show that "escape" from the acute anti-thyroid effect of iodide occurs when it is given immediately after 131I therapy, thus limiting the utility of iodide as a therapeutic agent at this time.     

"High-dose" radioiodine therapy in advanced differentiated thyroid carcinoma

There is yet no consensus concerning the appropriate regimen of the application of [131I]sodium iodine (Nal) activities to patients suffering from advanced differentiated thyroid carcinoma. We report on a total of 167 applications of [131I]Nal, including 78 applications of 11.1 GBq. Response to high-activity radioiodine therapy (RIT) is correlated to the course of the disease as well as to the reaction of thyreoglobulin and acute/subacute side effects of radiation. METHODS: Following radioablation of thyroid remnants using 1.85 to 3.7 GBq[131I]Nal, 26 patients with advanced differentiated thyroid carcinoma (follicular, 11; papillary, 4;mixed-cell thyroid carcinoma, 11) were treated with repeated activities of 11.1 GBq[131I]Nal. Initial tumor staging according to UICC showed T4 in 54%, T3 in 19%, T2 in 19% and was not obtained in 8%. Differentiated thyroid carcinoma was multifocal in 23% of patients. Applied accumulated activities ranged from 14.8 to 99.9 GBq with a mean of 55.5 GBq per patient. RESULTS: Mean post-diagnostical follow-up was 73 mo, mean follow-up after diagnosis of metastatic spread was 48 mo. Follicular thyroid carcinoma remained as stable disease in 7 of 11 patients, 6 of whom showed metastatic disease after a mean of 20 mo, and only 1 complete remission was achieved using high-dose therapies, with progressive disease in the remaining patients. Overall, 73% of follicular thyroid carcinoma had progressive disease without major response to high-activity RIT. In contrast, only 20% of papillary thyroid carcinoma/mixed-cell thyroid carcinoma showed progressive disease, and complete remission was achieved in 47% of patients. Pulmonary and lymph node metastases in the majority of patients showed good response to therapy, whereas local recurrences and bone metastases showed minor reactions to RIT. After low-activity therapies 8% of patients showed WHO grade I hematotoxic reactions. After high-activity therapies, 38% of patients had WHO I, 8% WHO II and one patient had WHO III toxicity (4%). CONCLUSION: Use repetitive high-activity RIT with a maximum of 44.4 GBq applied during 1 yr and a maximum of 99.9 GBq accumulated activity resulted in a significant increase of hematotoxicity. However, during the follow-up period (mean, 4 yr), no clinical symptoms possibly related to low blood counts were seen in patients with advanced differentiated thyroid carcinoma. Initiation of high-activity RIT in reaction to metastatic tumor outspread to achieve complete remission was found to be useful in treating papillary thyroid carcinoma and mixed-cell thyroid carcinoma, but only in a minority of follicular thyroid carcinoma patients.     

Variations of the flexor digitorum superficialis tendon of the little finger

The use of 131I doses of several mCi for scans can stun the thyrocytes and thyroid cancer cells, whereas the usual dose (300 microCi) of 123I does not. We compared the diagnostic accuracy of the 123I (300 microCi) scans and that of 131I (3-10 mCi) scans in 155 patients. The diagnostic accuracy of a 123I scan in detecting functioning thyroid remnant/metastasis was 89.5% (77/86 scans) and that of a 131I scan was 92.9% (39/42) in 6 week-postoperative patients (p = 0.750). For radioablation therapy follow-up patients, the diagnostic accuracy of 123I in determining presence or absence of functioning remnant or metastasis was 69.4% (25/36) and that of 131I was 92.5% (49/53) with a p value of 0.079. The success rates for complete ablation of functioning tissue after radioiodine therapy administered after diagnostic 123I and after 131I were 72% (34/47) and 56% (24/43), respectively, with a p value of 0.125. Our study indicates the following: 1) for the first postoperative evaluation, the diagnostic accuracy of the 123I scan was essentially equal to that of the 131I scan, and the success rate of radioablation therapy appears to be better than 123I scan; and 2) for postablation follow-up surveys, the 131I scan appears to be better but carries the risk of stunning the functioning cells.     

Effects of 6-N-propyl-2-thiouracil on growth, hormonal profiles, carcass and reproductive traits of boars

Neonatal 6-N-propyl-2-thiouracil (PTU)-induced hypothyroidism reduces body weight but increases testicular size in adult male rodents. The objective of this study was to determine the effect of prepubertal PTU treatment on boars. For Experiment I, boars (n = 28) were randomly allotted to eight pens. Each pen received one of four PTU doses (0, 0.01, 0.03 and 0.1% in a basal diet) between 28 and 56 days of age (DOA). Due to a lack of difference among three PTU treatments, PTU-treated boars were pooled. Boars treated with PTU had lower (P < 0.05) ADG during treatment, lighter (P < 0.05) BW after 56 DOA and less (P < 0.05) developed epididymides at 154 DOA. For Experiment II, boars (n = 19) were randomly allotted to six pens. Each pen received one of three PTU treatments orally as: control (carrier), PTU-I (0.002% BW of PTU daily between 7 and 70 DOA), or PTU-II (0.002% BW of PTU daily between 28 and 91 DOA). During treatment, PTU-treated boars had lower (P < 0.05) serum T4 levels, rectal temperature, feed intake and ADG. Boars treated with PTU had lower (P < 0.05) BW between 63 and 154 DOA but higher (P < 0.05) gain/feed between 105 and 133 DOA. Boars treated with PTU had less (P < 0.05) developed epididymides and sperm count per gram testis at 238 DOA. These results suggest that prepubertal PTU-induced hypothyroidism had significant effects on growth, hormonal profiles, and reproductive traits of boars; however, it does not appear to be an effective method for increasing testis size and sperm production of commercial boars.     

Changes in thyroid volume in response to radioactive iodine for Graves' hyperthyroidism correlated with activity of thyroid-stimulating antibody and treatment outcome

This study investigated 1) the relationship between thyroid volume and thyroid function in radioactive iodine (RAI) treatment for Graves' disease, and 2) the activity of thyroid-related Ig in serum on the responsiveness of thyroid tissue to RAI. The changes in thyroid volume per megabecquerel (MBq) of 131I retained in thyroid tissue was calculated by ultrasonography as a quantitative indicator of the effect of RAI on thyroid volume. Of the 52 patients treated with 131I (3.7 MBq retained/g thyroid tissue), 26 patients showed thyrotoxicosis, 20 patients became euthyroid, and 6 patients developed hypothyroidism 6 months after therapy. The change in thyroid volume per MBq 131I was lower (P < 0.01) in the hyperthyroid patients than in the euthyroid or hypothyroid patients. The activity of thyroid-stimulating antibody in serum immediately before the therapy was greater (P < 0.01) in the hyperthyroid patients than in the euthyroid patients and was greater (P < 0.05) in the euthyroid patients than in the hypothyroid patients; it was inversely correlated with the changes in thyroid volume per MBq 131I (r = -0.667; P < 0.01). Accurate measurement of changes in thyroid volume during the course of RAI treatment provides evidence of the responsiveness of Graves' disease thyroid tissue to RAI, which is related to the outcome of thyroid function. Thyroid-stimulating antibody determination may be useful in deciding the appropriate dose of RAI to obtain euthyroidism instead of hyperthyroidism.     

Pharmacological effects of propylthiouracil on corticosterone secretion in male rats

BACKGROUND: We investigated the direct effects of propylthiouracil (PTU) on corticosterone secretion both in vivo and in vitro. METHODS: Male rats were divided into 4 groups and then injected subcutaneously with saline, PTU, PTU plus thyroxine (T4), or T4 once daily for 2 weeks. After 2 weeks, rats were decapitated or received adrenocorticotropic hormone (ACTH), intravenously. Zona fasciculata-reticularis (ZFR) cells from normal, saline-, PTU-, PTU plus T4-, or T4-treated rats were incubated with ACTH, forskolin, 8-Br-cAMP, deoxycorticosterone (DOC) +/- PTU (1, 2, or 5 mg/mL) at 37 degrees C for 2 hours. Corticosterone concentrations in plasma and cell media, and 3':5'-cyclic adenosine monophosphate (cAMP) production in ZFR cells were determined by radioimmunoassay. The effects of PTU on the activities of steroidogenic enzymes in ZFR cells were measured by the amounts of intermediate steroidal products separated by thin-layer chromatography. RESULTS: The basal and ACTH-stimulated levels of plasma corticosterone in PTU-treated rats were lower as compared to saline-treated animals. Both basal and ACTH-stimulated corticosterone secretion were inhibited by PTU > 2 mg/mL in rat ZFR cells. The cAMP production induced by forskolin was lower in PTU, PTU plus T4, or T4-treated rats than in saline-treated animals. Chronic administration of PTU or PTU plus T4 inhibited the 3 beta-hydroxysteroid dehydrogenase, 21 beta-hydroxylase, and 11 beta-hydroxylase activities. Administration of PTU (1, 2, and 5 mg/mL) suppressed the basal, ACTH, 8-Br-cAMP, forskolin, and DOC-stimulated corticosterone secretion in rat ZFR cells. Likewise, PTU > 2 mg/mL inhibited the ACTH and 8-Br-cAMP-stimulated levels of intracellular cAMP in rat ZFR cells. CONCLUSIONS: These results suggest that PTU counteracts both basal and ACTH-induced adrenal steroidogenesis through their attenuation of the activity of 11 beta-hydroxylase and cAMP production in rat ZFR cells.     

Determination of factors affecting the therapeutic outcome of radioiodine therapy in patients with Graves' disease

AIM: Of this study was to determine whether success of radioiodine therapy (RIT) in Graves' disease depends on thyroid volume, function, thyroideal receptor antibodies (TRAK), thyreostasis, therapeutic dosage, 131I uptake, or effective half-life. METHOD: 78 patients received an average of 626 +/- 251 MBq of iodine-131 orally for thyroid ablation. 60 were assessed for successful therapy 3 months after RIT. RESULTS: In patients showing hyperthyreosis or a TRAK value > 11 U/l at the beginning of RIT, a significantly lower therapeutic dosage and effective iodine half-life were found than in non-hyperthyreotic patients or patients with TRAK < or = 11 U/l. Patients with a thyroid volume < or = 25 ml showed a significantly lower 131I uptake, but a significantly higher relative uptake (131I uptake/ volume) than patients with a thyroid volume > 25 ml. All failures were treated thyreostatically during RIT and showed a significantly lower therapeutic iodine dosage and relative uptake, as well as a significantly higher thyroid volume than patients with a successful therapy. RIT caused a thyroid volume reduction of 44%, with therapy failures showing a significantly lower volume reduction. Patients who received a therapeutic dosage of < or = 250 Gy showed significantly worse results than did those who had received > 250 Gy. Only one case of therapy failure received a dosage > 250 Gy, while 50% of failures received dosages > 200 Gy but < 250 Gy. Multivariate analyses (MANOVA, factor analyses) showed thyreostasis as the decisive negative factor for a successful course of therapy. CONCLUSIONS: Since most treatment failures occurred in patients under thyreostatic medication we recommend raising the target dosage to 250 Gy for these cases.     

Clinical polymorphic presentation and natural history of active myocarditis: experience in 60 cases

Eight-hundred thirty patients (pts) with suspected myocardial disease of undefined etiology were observed from 1978 to 1996. In 350 pts, the clinical diagnosis was of dilated cardiomyopathy (DCM) or myocarditis. An endomyocardial biopsy was performed on all patients and in 54 of them (15%), an active myocarditis was identified. In six cases, myocarditis was detected at autopsy. There were 37 male patients and 23 females, with an average age of 35.5 +/- 15 years (range 1.67). Mean time interval between clinical onset and diagnosis was 4 +/- 10 months. Clinical presentation was characterized in 4 cases by fulminant myocarditis (Group I), in 8 cases by chest pain (Group II), in 14 cases by arrhythmia (Group III: hypokinetic in 9 pts and hyperkinetic in 5) and, in the last 34 pts, by congestive heart failure (CHF) (Group IV). Improvement was defined at 9 +/- 3 months according to a clinical score based on left ventricular shortening fraction (increase > or = 5 units), New York Heart Association Class improvement by (at least one Class) and left ventricular end-diastolic diameter (decrease > or = 10%). The main clinical and instrumental parameters characterizing the groups were: a more severe dilatation and left ventricular dysfunction in the pts belonging to Group I or IV with respect to those in Group II and III; a significantly worse prognosis in terms of evolution in DCM or death/cardiac transplantation (CT) in the pts from the Group II and III. After a follow-up period of 48 +/- 46 months, the mortality in the four groups was: 100% (4/4), 0% (0/8), 21% (3/14), 38% (13/34). Fifty percent of deaths were concentrated in the first 2 years of follow-up. Left ventricular end-diastolic diameter (OR 1.09, p < 0.05), age (OR 0.95), presence of left ventricular bundle branch block (OR 2.32), right ventricular function (OR 2.43) at clinical onset and the status of improvement at 9 +/- 3 months of follow-up (OR 0.24, p < 0.05) are predictors of evolution in DCM or death/CT for the pts with onset from CHF (Group IV). Immunosuppressive treatment has been utilized for the 76% of the pts. No conclusion can be drawn on the efficacy of this therapy, but no adverse events significantly related to therapy have been observed in a 9 +/- 3 months follow-up period. In conclusion, myocarditis can show a clinical presentation polymorphism, which influences the prognosis and natural history of the disease. Evolution in DCM and adverse events (death/CT) are more common in Groups I and IV. Some simple parameters evaluated at clinical presentation and the proposed classification as "improved" or "not improved" after a short-term follow-up (9 +/- 3 months) show good predictive accuracy. The present study does not allow us to draw any conclusion about the efficacy of immunosuppressive treatment. A randomized, controlled, large-scale trial, with adequate follow-up and advanced histological diagnosis techniques will help define the role of immunosuppressive therapy and patient eligibility criteria for this treatment.     

Comparative therapeutic efficacy of clinafloxacin in leucopenic mice

Assuming that the fractional uptake is the same, both after the administration of a diagnostic and a therapeutic activity, 131I uptake too low to be detected with 2-5 mCi may become detectable after the administration of 100 mCi. This should be performed routinely in patients with thyroglobulin levels above approximately 5 ng/mL during L-Thyroxine (LT4) treatment or 10 ng/mL off LT4 treatment for three main reasons: 1) in 80% of these patients, a post-therapy 131i total body scan showed foci of uptake in the neck or at distant sites, whereas in the other patients, metastases emerged clinically some years later; 2) 131I is not the only treatment modality, and, for instance, lymph node metastases may warrant further surgery; and 3) from a dosimetric point of view, the relevant parameter is the concentration of 131I, i.e., the ratio between the uptake and the mass of functioning tissue: a low uptake in a small metastasis may result in a higher 131I concentration than a higher uptake in a much larger metastasis.     

Pulmonary metastases in children and adolescents with well-differentiated thyroid cancer

In this study, 27 patients less than 18 yr old with pulmonary metastases from well-differentiated thyroid carcinoma were evaluated to determine their response to (131)I therapy. METHODS: Of 121 children and adolescents treated with (131)I between 1963 and 1996, 27 patients had pulmonary metastases associated with nodal disease. Treatment response from (131)I was measured by three parameters: chest radiograph, scintigraphic images and serum thyroglobulin levels. Total activity of (131)I administered ranged from 4.6 GBq (125 mCi) to 38.7 GBq (1.05 Ci). Four patients were given one treatment, 8 were given two treatments, 4 were given three treatments and 11 were given more than three treatments. Radiation doses to the lungs were estimated in 14 patients using the MIRD methodology. The minimum duration of follow-up was 6 mo. RESULTS: At the time of initial presentation, diagnostic (131)I studies revealed bilateral radioiodine uptake in the lungs in 19 (70.4%) patients, whereas 12 (44.4%) patients had abnormal chest radiographs. One patient was lost to follow-up and was excluded from the study. Of the 26 patients studied, complete ablation of pulmonary metastases was observed in 8 (30.8%), partial ablation in 17 (65.4%) and there was no response to treatment in 1 (3.8%). Dosimetric parameters such as radioiodine uptake as a percentage of therapeutic activity, effective half-life and radiation dose delivered to the lungs were evaluated with each therapy. There was a progressive decline in each of these parameters with successive therapies. No correlation was observed between the radiation dose delivered and the response of pulmonary metastases to therapy. The number of therapies and amount of radioiodine administered had no influence on the ablation response. Of the 26 patients, 13 had a follow-up duration of less than 5 yr, 7 had 5-10 yr and 6 had more than 10 yr. One patient developed new metastases after 7 yr of diagnosis and treatment. One patient died of the disease after 4 yr. All surviving patients were asymptomatic and leading normal lives. CONCLUSION: Complete response of pulmonary metastases after (131)I therapy is difficult to achieve. A partial response with reduction of metastatic disease is possible and, in general, the patients had a good quality of life with no further disease progression and a low mortality rate.     

Quantification of salivary gland function in thyroid cancer patients treated with radioiodine

PURPOSE: Damage to salivary gland function following external irradiation has been documented. However, the extent of damage following radioiodine (131I) therapy for thyroid cancer has not been adequately studied. We evaluated salivary dysfunction in Ca-thyroid patients treated with therapeutic doses of 131I. METHODS AND MATERIALS: A simple acquisition and analysis protocol using 99mTcO4- (pertechnatate) and a gamma camera computer system was planned. The uptake of 99mTcO4- by the salivary glands at 10 min and percent of excretion of 99mTcO4- from the glands in response to a sialogogue (lemon juice) was studied in 33 patients treated with 1.369-38.702 GBq of 131I (Mean = 10.16 GBq, standard deviation = 7.659 GBq) in addition to 14 athyreotic controls. RESULTS: Significant damage to the salivary gland in terms of abnormal percent uptake or excretion was noted in 72.73% of the patients. Forty-eight percent of the patients treated with 131I showed asymmetrical involvement of the salivary complexes as opposed to none of the controls. Reduction in uptake of 99mTc4- or response to sialogogue was dose dependent, being more marked with higher radioiodine doses. Parotid glands were more affected than submandibular glands following 131I therapy. CONCLUSIONS: 131I therapy produces a significant effect on salivary gland function that is dose related and becomes evident over a period of several months after treatment.     

Tetranucleotide STR system D8S1132: sequencing data and population genetic comparisons

A case of microcytic anemia, leukopenia (with lymphocytic reduction prevalence) and light thrombocytopenia is reported. The case occurred to a 63-year old diabetic woman suffering from Basedow's disease. The thyropathy was diagnosed first and the patient did not undergo to any previous treatment with antithyroid agents. The bone marrow aspiration only showed slight dyserythropoietic notes, with slight reduction of myeloid-erythroid ratio. The blood cell indexes rapidly normalized as soon as euthyroidism was achieved by radioiodine therapy (I131, 4mCi), and this led to think there was a relationship between thyropathy and blood modifications. The patient was subsequently treated with levothyroxine because of the occurrence of a iatrogenic hypothyroidism. Two years later, during a follow-up, all the hematologic parameters were normal, as well as the serum concentration of thyroid hormones and TSH (during opotherapy). We report the hematologic alterations most frequently observed in hyperthyroidism and underline the peculiarity of this case as it shows the simultaneous alterations of different cellular lines in the same patient.     

Treatment of hypercholesterolemia in patients undergoing multiple coronary angioplasties

BACKGROUND: Hypercholesterolemia is a known risk factor for coronary artery disease (CAD). Multiple studies have shown that its treatment will reduce the rate of progression of coronary atherosclerosis and lead to regression of the atherosclerotic process. Recent studies have also shown impact on mortality. Angioplasty (PTCA) is a well established revascularization procedure for many of these patients. In this study we investigated whether or not therapy for hypercholesterolemia in patients undergoing elective PTCA had been instituted and, if so, whether desirable cholesterol levels had been achieved. METHODS: We reviewed the charts of 129 patients (pts) who were consecutively admitted for elective PTCA between September 1993 and August 1994. All pts. had at least one PTCA in the past and all of them had the diagnosis of hypercholesterolemia. The list was made using a computer search of all pts. meeting the previous two diagnoses. Pts on whom PTCA was performed in the setting of acute ischemic events were excluded as well as pts with no known history of hypercholesterolemia. RESULTS: In 13 out of 129 pts., it was not possible to find cholesterol levels. The 116 pts in whom cholesterol levels were available were divided in two groups. Group I (54 pts.-46.5%) included pts. not being treated with any lipid lowering agent and group II (62 pts.-53.5%) included pts being treated with at least one of those drugs. Both groups were further subdivided into "A" and "B", depending on whether the PTCA was being performed because of a "new" lesion or because of "restenosis", respectively. Group IA had a total of 31 pts, IB 23 pts, IIA 29 pts and IIB, 33 pts. Group I pts had an average of 3.40 PTCA's and a mean cholesterol level of 227 mg/dl. Group II pts had an average number of PTCA's of 3.34 and a mean cholesterol level of 228 mg/dl. Group IA had an average number of PTCA's of 3.65 and a mean cholesterol level of 221 mg/dl; for group IIA these values were, respectively, 3.17 and 221 mg/dl. Group IB had an average number of procedures of 3.09 while for group IIB this number was 3.49; the mean cholesterol levels were, respectively, 235 mg/dl and 234 mg/dl. None of these differences is statistically significant. Group I had 14 pts (26%) with cholesterol levels below 200 mg/dl while group II had 16 pts. with cholesterol levels below 200 mg/dl (26%). In group I, 8 pts (14%) had lipid profiles documented. Only 1 pt. had an LDL level below 100 mg/dl and only 3 pts had an LDL level below 130 mg mg/dl. In group II, 15 pts (24%) had a lipid profile documented. Of these, no pt. had an LDL level below 100 mg/dl and only 4 pts had an LDL level below 130 mg/dl. CONCLUSIONS: A significant percentage of pts. undergoing multiple PTCA's are not being treated or monitored adequately for hypercholesterolemia despite aggressive invasive management.     

射频联合131I治疗失分化甲状腺癌的临床研究

Objective:The aim of this study was to explore clinical efficiency of radio frequency combined with 131I therapy for dedifferentiated thyroid carcinoma. Methods:All patients have been treated by radiofrequency connected with 131I in 29 cases of dedifferentiated thyroid carcinoma which performed radionuclide imaging and Ig array of blood serum before and after therapy, respectively. Results:There were 4 (4/29) positive cases of radionuclide imaging before treatment and 19 (19/29)cases 2 weeks after therapy, 25 (25/29) cases of overall efficacy and 15 (15/29) curative cases. Conclusion:Radiofrequency connected with 131I improve clinical efficacy of 131I treatment for dedifferentiated thyroid cancer of thyroid in view of higher absorbing 131I of thyroid cancerous cell.