• 대한핵의학회지
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• 제35권3호
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• pp.117-124
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• 2001

Serum thyroglobulin measurement and I-131 whole-body scintigraphy (WBS) are well-established methods for the detection of recurrence in the follow-up of patients with thyroid carcinoma. However, inconsistent results are observed frequently, and these two methods are not always able to detect recurrence. In some patients, serum thyroglobulin level is elevated but the WBS is negative, because the recurrent tumor is too small and below the sensitivity of the diagnostic scan, or there is a dissociation between thyroglobulin synthesis and the iodine frapping mechanism. In such cases, various nuclear imaging methods including Tl-201 Tc-99m-sestamibi, and F-18-FDG PET can be used besides anatomical imaging methods. Among them, FDG PET localizes recurrent lesions in WBS-negative thyroid carcinoma with high accuracy. Several studies have suggested that empirical high-dose I-131 therapy resulted in a high rate of visualization in post-therapy scans with evidence of subsequent improvement. An important question is when to operate on patients with recurrent tumor. We believe that surgical removal is the best means of treatment for patients with localized persistent tumor, despite the high-dose I-131 therapy. with tumor in thyroid remnant, and with isolated recurrence in the lymph node, lung or bone. In addition, we recommend palliative resection of locally unresectable mass with subsequent treatment with high-dose I-131 therapy. Before I-131 therapy, the evaluation of sodium-iodide symporter expression in thyroid carcinoma can predict iodine uptake. Retinoic acid is known to induce redifferentiation, and to enhance I-131 uptake in thyroid carcinoma. Retinoic acid therapy may represent an alternative approach before high-dose I-131 therapy.

• Journal of Yeungnam Medical Science
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• 제31권2호
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• pp.148-151
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• 2014

Radioactive iodine (RAI) therapy is widely used for the treatment of Graves disease. After RAI therapy, 44% become hypothyroid and up to 28% remain hyperthyroid. The development of thyrotoxicosis after RAI therapy is believed to be mediated by 2 different mechanisms: a transient increased release of thyroid hormone due to radiation thyroiditis and the rare development of Graves disease due to the formation of antibodies to the thyroid-associated antigens released from the damaged follicular cells. A 55-year-old woman was hospitalized with severe headache, weight loss, and palpitation. She received a dose of 7 mCi of RAI (I-131) about 6 weeks earlier. Thyroid function test showed 7.98 ng/dL free T4, >8 ng/mL T3, < $0.08{\mu}IU/L$ thyroid stimulating hormone, and high titer thyroid stimulating immunoglobulin (TSI) (85.8 IU/L). She improved with propylthiouracil, propranolol, and steroid treatment. The TSI, however, was persistently elevated for 11 months.

• 대한두경부종양학회지
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• 제17권2호
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• pp.174-178
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• 2001

Background and Objective: Percutaneous ethanol injection therapy has been used in the treatment of the benign thyroid diseases. Although the reported side-effects of the therapy was mild and transient, some side-effects including local or radiating pain are troublesome to the patients. Radioactive iodine-131($Ra-^{131}I$) also has been effectively and safely used for management of the benign thyroid diseases. So we developed the percutaneous intranodular injection therapy of $Ra-^{131}I$ as an alternative of percutaneous ethanol injection therapy. Materials and Methods: From December 1998 to October 1999, we treated 29 outpatients (25 women and 4 men, mean age: $47{\pm}12$ years). Inclusion criteria were follows; age >30 years, cytologically benign, with normal thyroid function, cold nodule on thyroid scintigram, solid or mixed natured nodules in sonographical evaluation. Nodular volume was estimated by sonography according to the ellipsoid formula. $Ra-^{131}I$(0.1mCi/ml) was administered in a single dose injection. Follow-up studies every 3 months consisted of full history, thyroid function test, and sonography. We determined the therapeutic response is effective if the volume reduction of the nodule occurred above 30%. Results: After at least 3 months follow-up, 11 patients showed effective response, 12 patients showed minimal or unchanged response and 6 patients showed progression. Although side-effects such as injection pain, febrile reaction, and hormonal changes were absent, an infectious complication in injection site was developed from 1 case. Conclusion: Although we need a more prolonged follow-up to evaluate the delayed sequelae, we can suggest that percutaneous intranodular injection therapy of $Ra-^{131}I$ may be an attractive non-surgical treatment in selected cases of benign thyroid nodules.

• 대한후두음성언어의학회지
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• 제24권1호
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• pp.33-40
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• 2013

Background and Objectives:This study is to objectively compare and analyze the acoustic changes in the patients with total thyroidectomy before and after RI therapy. Subjects and Methods:For this study, a total of 50 patients with total thyroidectomy were participated as subjects. Voice samples were obtained at the time of post-operation (Post-OP), before high-dose radioactive iodine therapy (Pre-RIT), and after high-dose radioactive iodine therapy (Post-RIT). Acoustic analysis, the maximum phonation time and K-VHI (Korea-Voice handicap index) were used for subjective evaluation. Results:According to the comparison analysis of the three periods, mFo (Hz) was significantly reduced in all of the vowels /a/ and /i/ as the hormone was discontinued. This can be related to the reduction in vocal range. As thyroid hormone was discontinued, Shim (%) and APQ (%) values, which are the parameters related to the degree of aggressiveness, showed a significant increase in the middle vowel /a/. As thyroid hormone was discontinued, emotional index was significantly decreased in VHI (voice handicap index). Conclusion:These results can be assumed that thyroid hormone suspension is related to the increased changes in the vocal intensity, the increase in noise and the reduction in vocal range. Emotionally, these data can be assumed that the responsive factors of one's own voice disorders were significantly decreased in the patients with vocal handicap.

• 대한두경부종양학회지
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• 제38권1호
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• pp.1-9
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• 2022

Thyroid cancer is one of the slow-growing tumors with excellent oncological outcomes. However, a small set of patients with unexpectedly severe outcomes are usually ignored. Anaplastic thyroid cancer (ATC) remains one of the most aggressive and lethal solid tumors. Recently, dabrafenib and trametinib combination therapy or neoadjuvant BRAF induction therapy has shown promising results. In addition, a combination of targeted drugs, immunotherapy, surgery, and radiation therapy can improve overall survival in ATC patients. Another disease for which there is no breakthrough treatment is radioactive iodine-refractory differentiated thyroid cancer (DTC). To date, multikinase inhibitors (sorafenib, lenvatinib) targeting the growth factor signaling pathway have been developed and approved as anticancer agents for patients with advanced DTC. This review includes results from multikinase inhibitors to the emergence of new target molecules, including rearrangements during transformation (RET) and tropomyosin receptor kinase (TRK).

• Journal of Medicine and Life Science
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• 제19권3호
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• pp.95-102
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• 2022

This retrospective study aimed to investigate whether there was a difference in the success rate of removal of residual thyroid tissue in patients with the same cutoff serum thyroglobulin (Tg) value-measured 2 weeks after thyroid hormone withdrawal (THW)-for different radioactive iodine (RAI) activities. We identified 132 patients with papillary thyroid cancer who were treated with total thyroidectomy and RAI therapy to evaluate the efficacy of three radioactivities of I-131: 1,110, 3,700, and 5,550 MBq. Serum Tg testing was performed 1 week before RAI treatment and 2 weeks after THW (pre-Tg); the cutoff pre-Tg level was below 10 ng/mL. Stimulated Tg levels were measured on the day of I-131 administration (off-Tg). After 6 months of treatment, we compared the groups for complete ablation, defined as no uptake on a diagnostic I-131 scan, stimulated Tg level of <1.0 ng/mL, and Tg antibody level of <100 ng/mL. Ninety-five patients (72.0%) achieved complete ablation, with 57.1% (8/14), 78.2% (68/87), and 61.3% (19/31) in the 1,110 MBq, 3,700 MBq, and 5,550 MBq groups, respectively. There was no significant difference in the complete ablation rates between the three groups. In the multivariate analysis, the off-Tg level was a significant predictor of complete ablation. RAI therapy with low radioactivity (1,110 MBq) seemed sufficient for ablation in patients with papillary thyroid cancer with a pre-Tg level below 10 ng/mL. The off-Tg level is a promising and useful predictor of complete ablation after initial RAI therapy.

• Nuclear Engineering and Technology
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• 제54권2호
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• pp.689-700
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• 2022

In the present study, iodine-131 S values (r_T ← thyroid) were calculated for 30 target organs and tissues using the most recently developed Korean reference computational phantoms. The calculated S values were then compared with those of the International Commission on Radiological Protection (ICRP) reference computational phantoms to investigate the dosimetric impact of the Korean S values against those of the ICRP reference phantoms. The results showed significant differences in the S values due to the different anatomical/morphological characteristics between the Korean and ICRP reference phantoms. Most target organs/tissues showed that the S values of the Korean reference phantoms are lower than those of the ICRP reference phantoms, by up to about 4 times (male spleen and female thymus). Exceptionally, three target organs/tissues (gonads, thyroid, and extrathoracic region) showed that the S values of the Korean reference phantoms are greater, by 1.5-3.7 times. We expect that the S values calculated in the present study will be beneficially used to estimate organ/tissue doses of Korean patients under radioiodine therapy.

• 대한두경부종양학회지
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• 제40권1호
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• pp.7-13
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• 2024

The current standard of treatment for differentiated thyroid cancer is surgical resection followed by radioactive iodine therapy according to the recurrence risk. However, external beam radiotherapy may be recommended in limited cases where surgical resection is impossible or residual gross lesion remains or the aforementioned standard therapy is deemed insufficient in achieving local control. We report a case of 59 year old patient who presented with advanced papillary thyroid carcinoma of right neck but was unable to receive surgical resection due to underlying Eisenmenger syndrome. He received radiation therapy of 67.5 Gy in 30 fractions with palliative aim with no further treatment and has been maintaining long-term stable disease state for 38 months. Herein, we report a rare case of palliative aim radiation therapy alone for advanced papillary thyroid carcinoma with literature review.

• 한국산학기술학회논문지
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• 제11권12호
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• pp.4935-4944
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• 2010

본 연구의 목적은 방사성요오드 치료를 받는 갑상선암환자가 전처치기 및 입원치료기간 중 경험한 방사성 요오드 치료와 관련한 지각된 어려움, 의료진으로부터 제공받은 방사성요오드 치료정보 수준 및 치료과정에 대한 만족도를 파악하는 것이다. 조사대상은 갑상선전절제술과 방사성요오드 치료를 받은 총 165명의 갑상선암환자이었다. 구조화된 설문지와 개방형 질문을 이용해 수집된 자료는 기술통계와 내용분석법으로 분석하였다. 연구결과 방사성요오드 치료 전처치기 및 입원치료기에 환자들이 가장 빈번히 지각한 어려움은 갑상선 특이적 증상이었으며(38.2% vs 43.0%) 방사성요오드 치료와 관련한 의료진의 정보제공 수준은 보통 이상으로 평가하였다(평균$3.63{\pm}0.80$점). 방사성 요오드 치료과정에 대한 만족도는 중등도 수준(평균$6.43{\pm}2.21$점)으로 의학적 관심과 환자요구에 대한 의료진 대처절차에서 만족도($7.64{\pm}2.37$점)가 가장 높았다. 그러나 정보 적절성($5.67{\pm}2.78$점)에서 가장 낮았다. 따라서 방사성요오드 치료를 받는 갑상선암환자를 위한 간호중재 프로그램은 갑상선 특이적 증상과 관련한 환자의 요구를 지지할 수 있고 방사성요오드 치료절차에 대한 환자의 이해를 증진시킬 수 있도록 개발되어져야 하며 이를 통해 환자들은 치료 행위에 효과적으로 참여할 수 있는 역량을 가질 수 있을 것이다.

• 대한두경부종양학회지
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• 제12권1호
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• pp.32-42
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• 1996

This study was desinged to evaluate the effect of radioactive iodine-131 therapy in differentiated thyroid carcinoma treated at the Presbyterian Medical Center, Chonju during the 20-year period from 1975 to 1994. The authors reviewed 246 patients who received radioactive iodine-131. An analysis of the therapeutic response and survival rates of the 246 patients has been carried out. The male to female ratio was 1 : 3.6. The peak incidence was in the 4th and 6th decades. The histologic findings in the 246 patients were papillary adenocarcinoma in 200 cases, follicular adenocarcinoma in 29 cases, mixed type in 14 cases, and others in 3 cases. Combined treatment modalities of 246 patients consisted of sugery and radioiodine in 222 cases, surgery with radioiodine and external irradiation in 11 cases, and surgery with radioiodine, external irradiation and chemotherapy in 5 cases. 42 of the 246 cases showed recurrence and the commonest type of combined treatment for recurrent case was surgery followed by radioiodine-131. The highest accumulated total dosage of radioiodine-131 was 480mCi in that case femoral metastasis was noticed. The most common locoregional metastatic site was ipsilateral cervical node, and neighbouring muscle, vessel, trachea, recurrent layngeal nerve, in order of frequency. The determinate 10-year survival rate was 91.8% in the group receiving surgery followed by radioiodine-13l and 71.4% in patients receiving surgery, radioiodine-13l with XRT. The determinate 10-year survival rate was better for patients under 40 years of age who received radioiodine as compared to patients over 40 year of age(85.7% vs. 33.3%). The most usual primary therapeutic dosage in the group of cervical lesion was 90$\sim$120mCi after surgery.