• The Korean Journal of Nuclear Medicine Technology
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• v.15 no.1
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• pp.75-80
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• 2011

Purpose: Europe and U.S use multi-bed therapy rooms. Hereupon, this study aims to examine the safety when current one-bed therapy rooms in Seoul National University Hospital is changed into two-bed ones. Materials and Methods: This study evaluated external exposure by gamma radiation emitted from other patients and internal and external exposure caused by pollutions from other patients in case that Seoul National University Hospital installs a shielding wall between beds in existing therapy rooms. Results: When internal and external exposure was evaluated to evaluate safety of two-bed hospital rooms, 'isolation amount of patients' 5mSv exposure or below is received according to the Atomic Energy Act. Conclusion: With the increasing number of patients with thyoid cancer, patients using therapy rooms are on the rise. Therefore, improving one-person therapy rooms to two-person ones in line with international trend would increase cost reduction and management efficiency, and patients' alienation and isolation can be reduced to increase healing effects.

• Korean Journal of Head & Neck Oncology
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• v.22 no.1
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• pp.58-61
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• 2006

Differentiated thyroid carcinomas are rarely associated with macroscopic vascular invasion and intraluminal tumor thrombus in great cervical veins. The best treatment for such cases appears to be a total thyroidectomy with en-block resection of the involved vessels, followed by postoperative radioiodine therapy(RI). We report two cases of follicular thyroid carcinoma with vascular invasion and intraluminal tumor thrombosis in great cervical veins that were successfully treated using complete surgical resection and postoperative RI.

• Korean Journal of Head & Neck Oncology
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• v.23 no.1
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• pp.41-45
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• 2007

A 60 years old female patient presented with $8{\times}6\;cm$ sized painless oval mass in the left parietal region. She had left lobectomy of thyroid gland 10 years ago. Cranial CT, MRI, FGD PET-CT showed a solid mass which invaded left parietal bone. After embolization, craniectomy with tumor excision was performed. Histological examination revealed metastatic follicular cancer originated thyroid gland, with vascular and dura invasion. Postoperatively, neck CT showed right thyroid multiple nodules and right level III multiple lymph node enlargement. Thyroid function test was normal, but level of thyroglobulin was high (72ng/ml). So she had right lobectomy of thyroid gland with lymph node dissection under a diagnosis of follicular carcinoma. But histological examination revealed adenomatous hyperplasia and not lymph node metastasis. After operation, she received radioiodine therapy of 150mCi and then the level of thyroglobulin normalized (8.4ng/ml). The patient is under follow-up since she had operation 4 months ago.

• International journal of thyroidology
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• v.11 no.2
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• pp.78-81
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• 2018

Lenvatinib, an oral multi-kinase inhibitor, is a valuable treatment option for advanced differentiated thyroid carcinoma. However, severe treatment-related adverse events occur up to 30% of the patients receiving lenvatinib, making it a challenge for clinicians to maintain this drug and therefore affecting the outcome of therapy. Blood vessel related events, such as hypertension or proteinuria, are among the most frequent adverse events. We present a case of 65-year-old man with radioactive iodine refractory papillary thyroid carcinoma with cervical lymph node metastasis and tracheal invasion receiving lenvatinib who developed proteinuria and worsening of hypertension. Management with repeated dose reductions and using supportive medications allowed this patient to continue lenvatinib with his disease stably controlled. Early detection of patients at risk for these adverse events and cautious administration of lenvatinib at appropriate level are crucial in managing patients receiving lenvatinib.

• Journal of Radiopharmaceuticals and Molecular Probes
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• v.3 no.2
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• pp.103-112
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• 2017

The combination of nanoparticle with radioisotope could give the in vivo information with high sensitivity and specificity. However, radioisotope labeling of nanoparticle is very difficult and radioisotopes have different physicochemical properties, so the radioisotope selection of nanoparticle should be carefully considered. $^{18}F$ was first option to be considered for labeling of nanoparticle. For the labeling of $^{18}F$ with nanoparticle, Prosthetic group is widely used. Iodine, another radioactive halogen, is often used. Since radioiodine isotopes are various, they can be used for different imaging technique or therapy in the same labeling procedures. $^{99m}Tc$ can easily be obtained as pertechnatate ($^{99m}{TcO_4}^-$) by commercial generator. Ionic $^{68}Ga$ (III) in dilute HCl solution is also obtained by generator system, but $^{68}Ga$ can be substituted for $^{67}Ga$ because of the short half-life (67.8 min). $^{64}Cu$ emits not only positron but also ${\beta}-particle$. Therefore $^{64}Cu$ can be used for imaging and therapy at the same time. These radioactive metals can be labeled with nanoparticle using the bifunctional chelator. $^{89}Zr$ has longer half-life (78.4 h) and is used for the longer imaging time. Unlike different metals, $^{89}Zr$ should use the other chelate such as DFO, 3,4,3-(LI-1,2-HOPO) or DFOB.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.4
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• pp.301-306
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• 2008

Purpose: Recently, a number of patients needed total thyroidectomy and high dose radioiodine therapy (HD-RAI) get increased more. The aim of this study is to evaluate whether pathological staging (PS) and serum thyroglobulin (sTG) level could replace the diagnostic I-123 scan for the determination of therapeutic dose of HD-RAI in patients with differentiated thyroid cancer. Materials and Methods: Fifty eight patients (M:F=13;45, age $44.5{\pm}11.5\;yrs$) who underwent total thyroidectomy and central or regional lymph node dissection due to differentiated thyroid cancer were enrolled. Diagnostic scan of I-123 and sTG assay were also performed on off state of thyroid hormone. The therapeutic doses of I-131 (TD) were determined by the extent of uptakes on diagnostic I-123 scan as a gold standard. PS was graded by the criteria recommended in 6th edition of AJCC cancer staging manual except consideration of age. For comparison of the determination of therapeutic doses, PS and sTG were compared with the results of I-123 scan. Results: All patients were underwent HD-RAI. Among them, five patients (8.6%) were treated with 100 mCi of I-131, fourty three (74.1%) with 150 mCi, six (10.3%) with 180 mCi, three (5.2%) with 200 mCi, and one (1.7%) with 250 mCi, respectively. On the assessment of PS, average TDs were $154{\pm}25\;mCi$ in stage I (n=9), $175{\pm}50\;mCi$ in stage II (n=4), $149{\pm}21\;mCi$ in stage III (n=38), and $161{\pm}20\;mCi$ in stage IV (n=7). The statistical significance was not shown between PS and TD (p=0.169). Among fifty two patients who had available sTG, 25 patients (48.1%) having below 2 ng/mL of sTG were treated with $149{\pm}26\;mCi$ of I-131, 9 patients (17.3%) having $2{\leq}\;sTG\;<5\;ng/mL$ with $156{\pm}17\;mCi$, 5 patients (9.6%) having $5{\leq}\;sTG\;<10\;ng/mL$ with $156{\pm}13\;mCi$, 7 patients (13.5%) having $10{\leq}sTG\;<50\;ng/mL$ with $147{\pm}24\;mCi$, and 6 patients (11.5%) having above 50 ng/mL with $175{\pm}42\;mCi$. The statistical significance between sTG level and TD (p=0.252) was not shown. Conclusion: In conclusion, PS and sTG could not replace the determination of TD using I-123 scan for first HD-RAI in patients with differentiated thyroid cancer.

• The Korean Journal of Nuclear Medicine
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• v.27 no.1
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• pp.118-122
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• 1993

To evaluate the genotoxic effect of $^{131}I$, lymphocytes from 9 patients who underwent large dose (150 mCi) $^{131}I$ therapy after total thyroidectomy were studied for sister chromatid exchanges (SCE) before and after their first radioiodine treatments. Frequency of SCE (FSCE) was counted in chromosomes of 30 lymphocytes in each patients, and was expressed as numbers of SCE per cell. Numbers of leukocytes were also observed during $^{131}I$ therapy. Pretreatment FSCE ($4.2{\pm}0.7$) was not different from the control ($3.8{\pm}0.4$, p=0.17). However, the frequency was significantly elevated after $^{131}I$ administration (at the second day, $7.9{\pm}0.8$, p<0.001) and was diminished but still significantly elevated after a week (at 9th day, $6.4{\pm}0.6$, p<0.001). While counts of leukocytes in the peripheral blood showed no change (p> 0.05). In conclusion, chromatids of human lymphocytes were significantly damaged after $^{131}I$ treatment without any bone marrow supression. And the repair of SCE was not complete within one week.

• The Korean Journal of Nuclear Medicine
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• v.30 no.1
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• pp.77-85
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• 1996

Radioiodine($^{131}I$) has been used for the treatment of Graves' hyperthyroidism since the late 1940's and is now generally regarded as the treatment of choice for Graves' hyperthyroidism who does not remit following a course of antithyroid drugs. But for the dose given, several different protocols have been described by different centers, each attempting to reduce the incidence of long-term hypothyroidism while maintaining an acceptable rate control of Graves' hyperthyroidism. Our goals were to evaluate effective half-life and predict absorbed dose in Graves' hyperthyroidism patients, therefore, to calculate and readminister radioiodine activity needed to achieve aimed radiation dose. Our data showed that the mean effective $^{131}I$ half-life for Graves' disease is 5.3 days(S.D=0.88) and mean biologic half-life is 21 days, range 9.5-67.2 days. The mean admininistered activity and the mean values of absorbed doses were 532 MBq(S.D.=254), 112 Gy (S.D.=50.9), respectively. The mean activity needed to achieve aimed radiation dose were 51MBq and marked differences of $^{131}I$ thyroidal uptake between tracer and therapy ocurred in our study. We are sure that the dose calculation method that uses 5 days thyroidal $^{131}I$ uptake measurements after tracer and therapy dose, provides sufficient data about the effective half-life and absorbed dose of $^{131}I$ in the thyroid and predict the effectiveness of $^{131}I$ treatment in Graves' hyperthyroidism.

• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.3
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• pp.48-55
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• 2009

Purpose: As Korean nuclear law doesn't have any clear guideline about the dose and the external dose rate(uSv/h) requiring hospitalization in radioactive iodine treated patients, the patients are discharged when they meet the guideline of IAEA Basic Safety Standards(BSS). We measured external dose rate(${\mu}Sv/h$) of inpatient underwent 3700MBq (100 mCi) $^{131}I$ radioiodine treatment and considering external dose rate(${\mu}Sv/h$), residual activity(mCi) and excretion rate(%) we found the time for RA to be lowered from 3700MBq (100 mCi) to 1110 MBq (30 mCi) to give reference to set a guideline for discharge. Materials and Methods: Forty-two patients underwent thyroidectomy and scheduled for radioiodine treatment, who received 3700MBq (100 mCi) of $^{131}I$ orally and had no renal disease were examined. After 1, 2, 4, 8, and 20, 24, 40 hours iodine uptake and before/after the urination, the external dose rate(${\mu}Sv/h$) measured using FH40G-L(Thermo Fisher Scientific Inc., MA) at a distance and a height of 1 m for 20 sec on the average. Results and Conclusions: At 20 hours, the external dose rate was decreased to $49{\pm}13\;{\mu}Sv$/h, namely, 78% of administrated radioactivity was excreted and 814 MBq (30 mCi) was residual, and it met the accepted limit for discharge of (IAEA, BSS) under 1110 MBq (30 mCi) (1 m at 66 uSv/h).

• The Korean Journal of Nuclear Medicine
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• v.37 no.2
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• pp.110-119
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• 2003

Purpose: Radioiodine (I-131) therapy is an effective modality to reduce both recurrence and mortality rates in differentiated thyroid cancer. Whether higher doses shows higher therapeutic responses was still debatable. The purpose of this study was to validate curve-fitting (CF) method measuring maximum permissible dose (MPD) by a biological dosimetry using metaphase analysis of peripheral blood lymphocytes. Materials and Methods: Therapeutic effects of MPD was evaluated in 58 patients (49 females and 9 males, mean age $50{\pm}11$ years) of papillary thyroid cancer. Among them 43 patients were treated with ${\Leq}7.4GBq$, while 15 patients with ${\geq}9.25GBq$. The former was defined as low-dose group, and the latter high-dose group. Therapeutic response was defined as complete response when complete disappearance of lesions on follow-up I-131 scan and undetectable serum thyroglobulin levels were found. Statistical comparison between groups were done using chi-square test. P value less than 0.05 was regarded as statistically significant. Results: MPD measured by CF method using tracer and therapeutic doses were $13.3{\pm}1.9\;and\;13.8{\pm}2.1GBq$, respectively (p=0.20). They showed a significant correlation (r=0.8, p<0.0001). Exposed doses to blood measured by CF and biological methods were $1.54{\pm}0.03\;and\;1.78{\pm}0.03Gy$ (p=0.01). They also showed a significant correlation (r=0.86, p=0.01). High-dose group showed a significantly higher rate of complete response (12/15, 80%) as compared to the low-dose group (22/43, 51.2%) (p=0.05). While occurrence of side effects was not different between two groups (40% vs. 30.2%, p=0.46). Conclusion: Measurement of MPD using CF method is reliable, and the high-dose I-131 therapy using MPD gains significantly higher therapeutic effects as compared with low-dose therapy.