Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2005; 44(06): 243-248
DOI: 10.1055/s-0038-1625321

Original Articles

Schattauer GmbH

Diagnostic ¹²³I and ¹³¹I activities and radioiodine therapy

Effects on urinary iodine excretion in patients with differentiated thyroid CarcinomaDiagnostische ¹²³I- und ¹³¹I-Aktivitäten sowie RadioiodtherapieAuswirkungen auf die Uriniodausscheidung von Patienten mit differenziertem Schilddrüsenkarzinom

B. Meller

¹Department of Radiotherapy and Nuclear Medicine, University of Lübeck

,

K. von Hof

¹Department of Radiotherapy and Nuclear Medicine, University of Lübeck

,

E. Genina

¹Department of Radiotherapy and Nuclear Medicine, University of Lübeck

,

W. Deisting

¹Department of Radiotherapy and Nuclear Medicine, University of Lübeck

,

J. Meller

²Department of Nuclear Medicine, Georg-August-University, Göttingen, Germany

,

E. Richter

¹Department of Radiotherapy and Nuclear Medicine, University of Lübeck

,

M. Baehre

¹Department of Radiotherapy and Nuclear Medicine, University of Lübeck

› Institutsangaben

Summary

Aim: Urinary iodine excretion (UIE) provides information about iodine supply and release. In the present study we investigated effects of the application of different radioiodine isotopes on UIE in patients with differentiated thyroid carcinoma (DTC). Patients, methods: In 91 consecutive patients with DTC UIE, measured as iodine/creatinine ratio, was determined before and after application of ¹²³I and ¹³¹I for diagnostic or therapeutic purposes. Additionally, remnant volume (V) was determined prior to therapy. Group A consisted of 33 patients with supposed successful ablation of DTC. These patients received 370 MBq ¹³¹I for diagnostic use and served as controls. 58 patients (group B) with remnants, relapses and metastases received 370 MBq ¹²³I for diagnostics prior to therapy with 1.5-22.2 GBq ¹³¹I. Factors influencing individual changes in urinary iodine excretion (ΔUIE) were investigated by using non-parametric tests. Results: In group A UIE did not change significantly after application of ¹³¹I. As well, UIE remained unchanged after diagnostic application of ¹²³I in group B. In contrast, UIE increased significantly already 24 h after therapeutic application of ¹³¹I in this group. In patients with small remnants (V < 2.5 ml) a significant but only moderate increase of UIE could be observed (average increase: 47 μg I/g crea). In patients with larger remnants, with relapses or metastases increase of UIE values was significant and more pronounced. Conclusions: It was confirmed that UIE increased significantly during radioiodine therapy in patients with DTC and radioiodine-accumulating tissue. The increase of UIE after therapeutic administration of radioiodine can be explained by the disintegrated thyroid follicles in thyroid remnants. The radioiodine-induced iodine release may be one reason for thyroid “stunning” even after application of diagnostic amounts of ¹³¹I.

Zusammenfassung

Ziel: Die Uriniodausscheidung (UIA) liefert Informationen über die Iodversorgung und -freisetzung. In dieser Studie untersuchten wir Auswirkungen der Applikation unterschiedlicher Radioiodisotope auf die UIA von Patienten mit differenzierten Schilddrüsenkarzinomen (DSD-Ca). Patienten, Methoden: Bei 91 konsekutiven Patienten mit DSD-Ca wurde die UIA, gemessen als Iod/Kreatinin-Quotient, vor und nach Applikation von ¹²³I und ¹³¹I für diagnostische oder therapeutische Zwecke bestimmt. Zusätzlich wurde vor Therapie das Volumen des Schilddrüsenrestes ermittelt. Gruppe A bestand aus 33 Patienten, bei denen bereits eine erfolgreiche Ablation des DSD-Ca anzunehmen war. Diese Patienten erhielten 370 MBq ¹³¹I zur Diagnostik und dienten als Kontrolle. 58 Patienten (Gruppe B) mit Schilddrüsenresten, Rezidiven und Metastasen erhielten 370 MBq ¹²³I für die Diagnostik vor der Therapie mit 1,5-22,2 GBq ¹³¹I. Einflussfaktoren auf die individuellen Änderungen der Uriniodausscheidung (ΔUIA) wurden mittels nichtparametrischer Tests untersucht. Ergebnisse: In Gruppe A änderte sich die UIA nach ¹³¹I-Applikation nicht signifikant. Nach diagnostischer Applikation von ¹²³I blieb die UIA der Gruppe B ebenfalls unverändert. Im Gegensatz hierzu stieg die UIA dieser Gruppe bereits 24 h nach therapeutischer Applikation von ¹³¹I signifikant an. Bei Patienten mit kleinen Schilddrüsenresten (V < 2,5 ml) konnte ein signifikanter, aber nur leichter Anstieg der UIA festgestellt werden (mittlerer Anstieg: 47 μg I/g crea). Bei Patienten mit größeren Resten, Rezidiven oder Metastasen konnte ein signifikanter, stärker ausgeprägter Anstieg der UIA nachgewiesen werden. Schlussfolgerungen: Es wurde bestätigt, dass die UIA bei Patienten mit DSD-Ca und iodspeicherndem Gewebe bei der Radioiodtherapie signifikant ansteigt. Der Anstieg der UIA nach der therapeutischen Gabe von Radioiod kann durch die Auflösung der thyroidalen Follikel in den Schilddrüsenresten erklärt werden. Die Radioiod-induzierte Iodfreisetzung könnte eine Ursache für das thyroidale „Stunning“ selbst nach der Applikation diagnostischer Mengen ¹³¹I sein.

Keywords

Keywords

Thyroid carcinoma - radioiodine scintigraphy - radioiodine therapy - urinary iodine excretion

Schlüsselwörter

Schlüsselwörter

Schilddrüsenkarzinom - Radioiod-Szintigraphie - Radioiodtherapie - Uriniodausscheidung

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