Nuclear medicine techniques such as radioactive iodine scans and therapy are important in evaluating and treating thyroid diseases. Radioactive iodine is selectively taken up and concentrated in the thyroid gland, allowing functional imaging and selective internal radiotherapy for hyperthyroidism and thyroid cancer. Radioactive iodine therapy is the primary treatment for Graves' disease and toxic multinodular goiter. It is also used to ablate residual thyroid tissue after surgery and treat thyroid cancer metastases. Precautions must be taken after radioactive iodine therapy to limit radiation exposure to others.
Hyperparathyroidism exists in three different forms: primary, secondary and tertiary. Primary hyperparathyroidism (pHPT) is the most frequent pathological condition of the parathyroid glands and one of the most frequent endocrine disorders overall. The most probable location of parathyroid gland is posterior to the thyroid gland. The parathyroid glands produce parathyroid hormone (PTH), which is important for maintaining calcium, phosphate and vitamin D homeostasis, and ultimately bone health.
Primary hyperparathyroidism is characterized by increased production and secretion of parathyroid hormone. This condition causes nephrocalcinosis, urolithiasis, osteoporosis, gastrointestinal disturbances, neuromuscular manifestation and neuropsychiatric disorders. Parathyroidectomy is the only curative treatment for pHPT. pHPT is typically caused by a solitary parathyroid adenoma (80%-90%), hyperplasia (10%) and less frequently parathyroid carcinoma (5%).
Secondary hyperparathyroidism develops as a consequent to a chronic hypocalcemic condition that can be caused by renal failure, gastroinstinal malabsorption, dietary rickets and ingestion of drugs. Secondary hyperparathyroidism is a frequent and serious complication in haemodialysis patients. Tertiary hyperparathyroidism is a condition where parathyroid hyperplasia, secondary to chronic hypocalcemia, becomes autonomous with development of hypercalcemia. Tertiary hyperparathyroidism is used to designate hyperparathyroidism that persists or develops after renal transplantation.
Localization of hyperfunctioning parathyroid tissue (adenomas or hyperplasia) in primary hyperparathyroidism is useful before surgery to help the surgeon localize the lesion, thus shortening the time of the procedure. Parathyroid glands can be imaged with multiple modalities, including scintigraphy, high-resolution ultrasonograhy, thin-section CT and MRI. Parathyroid scintigraphy may also be indicated for localization of hyperfunctioning parathyroid tissue in patients with persistent or
recurrent disease. For this situation scintigraphy is superior to any other radiological modalities, including MRI, CT scan, ultrasonography combined with needle aspiration and also some invasive techniques like arteriography, selective venography and mediastinoscopy.
Hyperparathyroidism exists in three different forms: primary, secondary and tertiary. Primary hyperparathyroidism (pHPT) is the most frequent pathological condition of the parathyroid glands and one of the most frequent endocrine disorders overall. The most probable location of parathyroid gland is posterior to the thyroid gland. The parathyroid glands produce parathyroid hormone (PTH), which is important for maintaining calcium, phosphate and vitamin D homeostasis, and ultimately bone health.
Primary hyperparathyroidism is characterized by increased production and secretion of parathyroid hormone. This condition causes nephrocalcinosis, urolithiasis, osteoporosis, gastrointestinal disturbances, neuromuscular manifestation and neuropsychiatric disorders. Parathyroidectomy is the only curative treatment for pHPT. pHPT is typically caused by a solitary parathyroid adenoma (80%-90%), hyperplasia (10%) and less frequently parathyroid carcinoma (5%).
Secondary hyperparathyroidism develops as a consequent to a chronic hypocalcemic condition that can be caused by renal failure, gastroinstinal malabsorption, dietary rickets and ingestion of drugs. Secondary hyperparathyroidism is a frequent and serious complication in haemodialysis patients. Tertiary hyperparathyroidism is a condition where parathyroid hyperplasia, secondary to chronic hypocalcemia, becomes autonomous with development of hypercalcemia. Tertiary hyperparathyroidism is used to designate hyperparathyroidism that persists or develops after renal transplantation.
Localization of hyperfunctioning parathyroid tissue (adenomas or hyperplasia) in primary hyperparathyroidism is useful before surgery to help the surgeon localize the lesion, thus shortening the time of the procedure. Parathyroid glands can be imaged with multiple modalities, including scintigraphy, high-resolution ultrasonograhy, thin-section CT and MRI. Parathyroid scintigraphy may also be indicated for localization of hyperfunctioning parathyroid tissue in patients with persistent or
recurrent disease. For this situation scintigraphy is superior to any other radiological modalities, including MRI, CT scan, ultrasonography combined with needle aspiration and also some invasive techniques like arteriography, selective venography and mediastinoscopy.
https://www.snmclub.com/presentation
PET/MRI Current & Future Status
DALE BAILEY PhD , Principal Physicist
Departement of Nuclear Medicine, Royal North Shore Hospital
Professor in Medical Radiation Sciences, University of Sydney
Sydney, Australia
icrm2018
https://www.snmclub.com/presentation
PET/MRI Current & Future Status
DALE BAILEY PhD , Principal Physicist
Departement of Nuclear Medicine, Royal North Shore Hospital
Professor in Medical Radiation Sciences, University of Sydney
Sydney, Australia
icrm2018
Thyroid and Adrenal Gland Function Determine many aspects of health, wellness and overall energy. If there is a miscommunication between these and other glands, it can lead to interferences in health, such as weight gain, infertility, digestive disorders and mood disorders. The Natural Nurse, Ellen Kamhi, PhD RN explains the basic function and feedback mechanisms involved in gland communication, along with Natural Remedy Support.
On the occasion of National Epilepsy Day 2014, Dr. Rama Krishnan gave a talk titled "Integrated Diagnostics – A Unique Epilepsy Approach" at the Epilepsy Knowledge Forum in Chennai organised by Neurokrish & Trimed and Sponsored Medall.
PowerPoint. Nonradioactive iodine competes with radioactive iodine. This has implications for the use of recombinant human TSH (rhTSH) when preparing differentiated thyroid cancer patients for radioiodine scanning with continued levothyroxine, because the latter contains iodine.
Radioiodine ablation of normal remnants after less-than-total thyroidectomy f...Herbert Klein
After less-than-total thyroidectomy for thyroid cancer, I-131 is commonly used to ablate the remnant, as distinct from treatment of metastases. This PowerPoint discusses the rationale for ablation and the evidence in the medical literature regarding this, with clinical examples.
Fear of stunning: I-123 vs 131 for whole body imaging in thyroid cancerHerbert Klein
Whole body imaging is used to detect metastatic differentiated thyroid cancer. It can be done with I-123 or I-131. The points for one or the other are discussed in this PowerPoint presentation, with special attention to the possibility that a scan using I-131 might decrease the impact of subsequent therapeutic doses of I-131, by a so-called stunning effect on the iodine-avid lesions. Clinical examples are presented.
There are many guidelines and recommendations suggesting ablation/therapy in Differentiated Thyroid Carcinoma. This presentation will be focused on the details of these recommendations and guidelines.
Furthermore, it will be discussed the use of recombinant human thyrotropin (rhTSH) prior to radioactive iodine remnant ablation for patients with differentiated thyroid cancer.
The role of nuclear medicine in differentiated thyroid cancer (DTC)Herbert Klein
PowerPoint: Guidelines for the management of differentiated thyroid cancer are discussed with special reference to the use of radioiodine imaging and therapy.
The crucial point to contemplate during restorative dentistry procedures with composite resins is to obtain satisfactory restorations with an adequate photo polymerization technique. This procedure requires sufficient light energy intensity and an adequate wavelength in order to activate the photo initiator within these materials, which will react with the reducer agent to form free radicals and initiate the polymerization process.
Laser science is principally concerned with quantum electronics, laser construction, optical cavity design, the physics of producing a population inversion in laser media, and the temporal evolution of the light field in the laser. It is also concerned with the physics of laser beam propagation, particularly the physics of Gaussian beams, with laser applications, and with associated fields such as non-linear optics and quantum optics.
Soft skills is a term often associated with a person's "EQ" (Emotional Intelligence Quotient), the cluster of personality traits, social graces, communication, language, personal habits, interpersonal skills, managing people, leadership, etc. that characterize relationships with other people.
When a sales person demonstrates a feature, talks about a benefit or uses a sales closing technique, their customer may well respond in the negative sense, giving excuses or otherwise heading away from the sale. The response to this is to handle these objections. This is 'objection-handling'.
CAD – leading cause of death
Cardiac SPECT – steady growth in last two decades & played an important role in clinical mangement
Radionuclide ventriculography (MUGA)
First pass studies
PET/CT
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. What is Nuclear Medicine?
Branch of Medicine in which patients are
given radioactive substances (to be taken
internally) either to diagnose or to treat a
disease.
Differs from traditional radiology or
radiotherapy techniques, where radiation is
normally applied from an external source.
3. Nuclear Medicine techniques provide this functional information
that can be vital in early diagnosis and can help in appropriate
management
4. Nuclear medicine: FUNCTIONAL
IMAGING
Most other imaging modalities:
STRUCTURAL OR ANATOMICAL
IMAGING
Nuclear medicine images can be
superimposed on images from
modalities such as CT or MRI to
highlight which part of the body the
radiopharmaceutical is concentrated
in: IMAGE FUSION OR
COREGISTRATION
8. Isotopes in Thyroidology
DIAGNOSTIC ROLE:
In-Vivo imaging: Pre and post operative scans
In-Vitro tests: Hormone assays
THERAPEAUTIC ROLE
9. Types Of Scans in Thyroidology
1. MORPHOLOGICAL SCAN:99TcO4(pertechnetate
scan): assess size, shape and nature of nodule
2. METABOLIC SCAN: Radioiodine scan(131/123),
18 FDG PET scan
3.RECEPTOR SCAN: 131/123-MIBG scan
4.NON-SPECIFIC SCAN: Thallium scan, DMSA(V)scan,
Sestamibi scan
5.FUSION IMAGING: CT & Isotope scan FUSED image
10. Routine Thyroid Scan
99mTcO4(pertechnetate scan):
- 6hours half-life & hence less radiation dose,
ideal for all age group
- isotope is trapped by thyrocytes and is NOT
further organified
- is ideal for assessing size,shape and nature
of nodule.
11. INDICATIONS IN THYROIDOLOGY
SOLITARY THYROID NODULE
THYROTOXICOSIS--- Graves’ vs Thyroiditis
ECTOPICTHYROID
AGENESIS OFTHYROID
THYROID CANCER FOLLOWUP
RETROSTERNAL GOITRE
15. •Colloid nodules may be either mono or polyclonal
•THUS TUMORS REPRESENT THE PERSISTENT GROWTH OF THE
PROGENY OF ONE CELL THAT HAS SOMEHOW ESCAPED THE
MECHANISMS WHICH MAINTAIN THE NORMAL CELL DIVISION AT
ABOUT ONCE IN EACH 8.5 YEARS
Tc-99m scanI-131 scan
16. Adult female with
dysphagia: I-123 scan
An enlarged thyroid
(thyromegaly) is often
discovered on chest
radiography.
18. Radio-iodine scan(I-131/I-123)
Invented by Prof.Robley Evans from MIT
First isotope used for imaging in humans
Chemically analogous to stable iodine which
is preferentially handled by thyroid & hence
called “metabolic scan”
19. Isotope is trapped by thyrocytes (Na I Symporter or NIS) and further undergoes
organification into MIT,DIT and thyroxine formation. Hence uptake indicates the
function of thyrocytes.
Normal NIS protein expression is limited to basolateral membrane in a small % of
thyroid follicular cells at any one time
Radio-iodine: Mechanism of
uptake
20. I-131
I-131 has 8 days half life
& both beta and gamma
radiations—hence more
radiation to thyroid
than fromTcO4 scan
•Scan has to be done after 48hours of isotope
administration whereas Tc scan is done30min after
isotope(one visit)
•Not ideal for children
•Ideal for ectopic thyroid scanning, functional
assessment, thyroid cancer
21. I-123
Expensive isotope, Not available in India
Has 100 min half life,only gamma radiation &
hence better than both 131-I &Tc scans
Trapping and organification of iodine by
thyrocyte provides a unique opportunity for
“internal selective radiotherapy” in context of
“metabolic radionuclide therapy” with low dose to
other organs
I-131
22. Radioactive iodine (RAI) therapy
for Benign thyroid diseases
RAI (I-131) therapy has been used for over 50 years
Graves’ disease
Solitary hyperfunctioning nodule
Toxic MNG
RAI may also benefit pts. of subclinical hyperthyroidism
particularly patients at a risk for cardiac or systemic
complications
RAI treatment leads to long standing reduction in
thyroid function and thyroid volume and has been
aptly termed as “unbloody thyroid surgery”
23. Mechanism of action of I-131
• RAI with I-131 relies on emission of high energy
beta particles to cause damage to thyroid gland
tissue local inflammation & fibrosis
reduction of synthetic capacity of the thyroid
gland.
• For this therapy to be effective thyroid tissue must
accumulate and retain iodine long enough for
adequate amounts of radiation to be delivered
24. Contraindications to I-131
RAI has no role for treatment of hyperthyroid
conditions that are self limited or when thyroid
tissue is not hyperfunctioning
Silent, subacute & postpartum thyroiditis in
addition to factitious thyroid disease
Pregnancy and lactation: Absolute C/I
25. What dose of radioiodine is
used?
• Dosimeteric approach
• Emperical treatment
Regardless of method for dose selection routine
RAIU is useful for confirming hyperfunctioning
gland prior to therapy.
RAIU can also help exclude a hyperfunctioning
gland with blocked uptake
26. Factors affecting the dose
given
• Gland size
• Maximal uptake
• Biological/ effective half life of I-131
27. RAI therapy: Concepts
• 80-200 microcurie per gram of thyroid tissue
assuming a biological half life of 4-6 days delivers a
dose of 50 to 100 Gray to thyroid
• Higher dose required for retreatment (typically 3 to
6 months after initial treatment)
• Previous RAI tr failure does not lessen the chance of
successful retreatment
• Treatment based on calculations appear efficacious
but have not been proven superior to empirical
treatment
28. RAI therapy: Concepts
• Capsule vs Liquid formulations (I-131)
• Liquid formulations require extra measures
to minimize radiation contamination at the
time of administration
• Equivalent in efficacy
32. Treatment outcome
• Expected response rate in about 80% pt.
• 20-40% pt. hypo 1 year after RAI
Side effects: Mild, infrequent and self limiting; thyroid
tenderness salivary gland swelling and nausea
34. A New Dimension………
Keston et al in 1942 :
Demonstrated
concentration of I-131
in theThyroid Cancer
35. Guidelines in literature
•American Association of Clinical
Endocrinologists
•American Association of Endocrine
Surgeons
•British Thyroid Association
•Royal College of Physicians
•National Comprehensive Cancer
Network
36. Problems in guidelines…?
•Provide conflicting recommendations
because of lack of high quality evidence from
Randomized Control Trials
•‘American Thyroid Association guidelines’
–For management of patients of thyroid nodules
and carcinoma
–Used strategy similar to NIH
–Thyroid Vol. 16 No.2, 2006
39. Ref: AJCC Cancer staging manual 6th
edition (2002)
Radioiodine ablation recommended for pt. with:
Stage III & IV dis.
Stage II, >= 45 yr
Stage I (selected pt.): Multifocal, nodal mets,
aggressive histopath, ETE, vasc. Inv.
40.
41. No uptake
No treatment**
F/U after 6 months
**Provided that
1Iodide interference is
ruled out
2Histopathology not
aggressive (follicular
carcinoma, aggressive
variants papillary
carcinoma)
Remnant thyroidal bed uptake
Treat
F/U after 6 months for large
dose scan with 3-5 mCi of I-
131
•Off Eltroxin 4-6 Weeks
•TSH, Tg, Sr. Ca, US neck
•Chest and neck X-ray
No abnormal uptake
F/U after 1 yr on Eltroxin
•Tg and USG neck
RMC Protocol following total thyroidectomy
100uCi I-131 uptake and scan with radioiodine With metastasis
Treat
F/U after 6 months for
large dose scan with 3-5
mCi of I-131
•Off Eltroxin 4-6 Weeks
•TSH, Tg, Sr. Carcinoma
•Chest and neck X-ray
Abnormal concentration
Treat
F/U after 1 year for large
dose scan
•Off Eltroxin
•TSH, Tg, Sr. Ca
•Chest and neck X-ray
Off thyroxine for 4-6 wks, No iodine containing drugs, food, Measure TSH & Tg,
Chest & neck X-ray, pathology review.
43. Post-operative Radio-iodine
Scan
To determine residual thyroid tissue
To determine metastatic disease
To determine the suitability for Radio-
iodine therapy
45. Radioiodine treatment
•Outcome of I-131 therapy: Related to the
effective radiation dose delivered to thyroid
cancer tissue
•Most of the radiation dose is delivered by
beta particles that do not penetrate deep
into the tissue (2 mm in depth at the most)
46. Radioiodine therapy
•Emperical therapy
•Dosimetric approach
In pts in whom RRA is planned there has been a trend
towards reduction in dose of I-131 administered: 30-50
mCi in present decade as compared to 150-250 mCi
with no difference in therapy outcome. As a result there
has been lesser undesirable radiation exposure and
reduction in stay in the isolation ward
47. Radioiodine therapy is unique
since it requires attention to
radiation safety procedures
necessitating hospitalization and
isolation of patient in radiation
ward
48. Patient is discharged when whole body retention of radioactivity is
less than 555 MBq (AERB) a limit ensured and established by patient
monitoring using a portable ionization chamber based radiation
survey meter
49. I 131 scan
Initial scan
following surgery
Follow up scan following residual
remnant ablation (RRA)
No clinical evidence of tumor
No imaging evidence of tumor (no uptake outside
thyroid bed on initial post treatment scan, on a
recent diag. scan, or neck US)
Undetectable serum TG (tumor marker)
50. 87% vs 49% after 10 years Thyroid cancer related survival
93% vs 78% after 10 years
51. Comparison of cumulative deaths in in pts with PCT: Surgery alone vs
Surgery and thyroid hormone vs thyroidectomy and RRA
52. Two negative annual successive
whole body scans have very
good predictive value for a lack
of future recurrence
Follow up strategy (post
surgery & RRA)
53. CARCINOMA THYROID WITH EXTENSIVE METS
Gaurav Malhotra et.al. Metastatic parotid tumor: A rare presentation for
papillary carcinoma of thyroid. Clin Nucl Med. 2007 Jun;32(6):488-90.
54. 52 yr male a known case of follicular carcinoma of thyroid was
administered 182 mCi of radioiodine a month after total
thyroidectomy.
Post therapy scan: Radioiodine uptake in apex of left lung
55. CT guided biopsy of mass revealed mucinous BAC. Surgery was ruled out so he was
given chemotherapy without benefit. Since the lesion continued to show I-131 uptake a
high dose radioiodine therapy was given with 209 mCi I-131. Follow up CT scan
showed 1 cm all round reduction of the mass suggesting a possibility of this therapeutic
option in non thyroidal tumors that may concentrate radioiodine
56. 30 yr male underwent total
thyroidectomy followed by RAI
therapy for PTC.
Presented 2 decades later with
LBA. MRI s/o multiple vertebral
mets. WB RAI scan showed
extensive mets and suspicious
abdominal foci.
57.
58. CT guided biopsy from left adrenal focus confirmed
metastasis from carcinoma of thyroid.
Metastases to both renal and adrenal have been
rarely reported from carcinoma of thyroid and to the
best of our knowledge this the second such case.
59. Pertinent questions
1. Multicentre retrospective cohort study examined
cancer mortality in >35,000 patients after 3
treatment modalities for hyperthyroidism: Total
cancer deaths not increased for this group. RAI not
associated with excess total cancer deaths
2. Incidence of thyroid ca in RAI treated patients
over 27 year period was not significantly
different from general population incidence
Does radioiodine treatment cause cancer?
60. Pertinent questions
• I-131 delivers a dose of 0.01-0.03 Gy to ovaries
mostly from excreted iodine in bladder
• No adverse outcome in subsequent pregnancies
has been seen
• Avoid pregnancy for atleast 6 months following
therapy
Does radioiodine treatment have adverse genetic
effects on offsprings?
61. Pertinent questions
• Sleep alone for a few days
• >3 feet distance from others in first 72 hrs
• Avoid contact with children and pregnant
women
• Hydration/ toilet/ Clothes/ utensils
What precautions does the patient have to follow
after receiving RAI?
62. Pertinent questions
• What is the best time to assess the response of RAI
therapy?
•For thyrotoxicosis pts: Assessment of treatment
response is more reliable at 12 to 14 weeks of
therapy although it may be possible to identify
non-optimal responder at 6 to 8 weeks
63. Thyroid cancer with all its
peculiarities in biological and
histological criteria should be
treated as any other cancer: get rid
of the tumor and do everything to
avoid recurrence or mets; treat
mets as well and as long as you can
64. "Anyone who stops learning is old,
whether at 20 or 80.
Anyone who keeps learning stays young.
The greatest thing in life is
to keep your mind young„
Henry Ford