Download PDF
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
1   Department of Radiotherapy and Nuclear Medicine, University of Lübeck
,
K. von Hof
1   Department of Radiotherapy and Nuclear Medicine, University of Lübeck
,
E. Genina
1   Department of Radiotherapy and Nuclear Medicine, University of Lübeck
,
W. Deisting
1   Department of Radiotherapy and Nuclear Medicine, University of Lübeck
,
J. Meller
2   Department of Nuclear Medicine, Georg-August-University, Göttingen, Germany
,
E. Richter
1   Department of Radiotherapy and Nuclear Medicine, University of Lübeck
,
M. Baehre
1   Department of Radiotherapy and Nuclear Medicine, University of Lübeck
› Author Affiliations
Further Information

Publication History

Received: 04 April 2005

19 April 2005

Publication Date:
11 January 2018 (online)

Also available at
    Permissions and Reprints

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

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

Schlüsselwörter

Schilddrüsenkarzinom - Radioiod-Szintigraphie - Radioiodtherapie - Uriniodausscheidung
 

  • References

  • 1 Caillou B, Troalen F, Baudin E. et al. Na1/I2 symporter distribution in human thyroid tissues: an immunohistochemical study. J Clin Endocrinol Metab 1998; 83: 4102-6.
    PubMedSearch in Google Scholar
  • 2 Cholewinski SP, Yoo KS, Klieger PS. et al. Absence of thyroid stunning after diagnostic wholebody scanning with 185 MBq 131I. J Nucl Med 2000; 41: 1198-202.
    PubMedSearch in Google Scholar
  • 3 De La Vieja A, Dohan O, Levy O. et al. Molecular analysis of the sodium/iodide symporter: impact on thyroid and extrathyroid pathophysiology. Physiol Rev 2000; 80: 1083-105.
    CrossrefPubMedSearch in Google Scholar
  • 4 Dietlein M, Dressler J, Eschner W. et al. Procedure guideline for thyroid scintigraphy (version 2). Nuklearmedizin 2003; 42: 120-2.
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Dietlein M, Dressler J, Farahati J. et al. Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 2). Nuklearmedizin 2004; 43: 115-20.
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Dietlein M, Dressler J, Eschner W. et al. Procedure guideline for iodine-131 whole-body scintigraphy for differentiated thyroid cancer (version 2). Nuklearmedizin 2003; 42: 123-5.
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Dietlein M, Schober O, Schicha H. Overtherapy or undertherapy for papillary thyroid microcarcinoma? Therapeutic considerations for radioiodine ablation. Nuklearmedizin 2004; 43: 107-14.
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Eng PH, Cardona GR, Fang SL. et al. Escape from the acute Wolff-Chaikoff effect is associated with a decrease in thyroid sodium/iodide symporter messenger ribonucleic acid and protein. Endocrinology 1999; 140: 3404-10.
    CrossrefPubMedSearch in Google Scholar
  • 9 Eng PH, Cardona GR, Previti MC. et al. Regulation of the sodium iodide symporter by iodide in FRTL-5 cells. Eur J Endocrinol 2001; 144: 139-44.
    CrossrefPubMedSearch in Google Scholar
  • 10 Eskandari S, Loo DD, Dai G. et al. Thyroid Na+/Isymporter. Mechanism, stoichiometry, and specificity. J Biol Chem 1999; 272: 27230-8.
    Search in Google Scholar
  • 11 Furudate S, Nishimaki T, Muto T. 125I uptake competing with iodine absorption by the thyroid gland following povidone-iodine skin application. Exp Anim 1997; 46: 197-202.
    CrossrefPubMedSearch in Google Scholar
  • 12 Haugen BR. Redifferentiation therapy in advanced thyroid cancer. Curr Drug Targets Immune Endocr Metabol Disord 2004; 4: 175-80.
    CrossrefPubMedSearch in Google Scholar
  • 13 Hilditch TE, Dempsey MF, Bolster AA. et al. Selfstunning in thyroid ablation: evidence from comparative studies of diagnostic 131I and 123I. Eur J Nucl Med Mol Imaging 2002; 29: 783-8.
    CrossrefPubMedSearch in Google Scholar
  • 14 Jhiang SM, Cho J, Ryu KY. et al. An immunohistochemical study of Na1/I2 symporter in human thyroid tissues and salivary gland tissues. Endocrinology 1998; 139: 4416-9.
    CrossrefPubMedSearch in Google Scholar
  • 15 Kao CH, Yen TC. Stunning effects after a diagnostic dose of iodine-131. Nuklearmedizin 1998; 37: 23-5.
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Kapucu LO, Azizoglu F, Ayvaz G. et al. Effects of diuretics on iodine uptake in non-toxic goitre: comparison with low-iodine diet. Eur J Nucl Med Mol Imaging 2003; 30: 1270-2.
    CrossrefPubMedSearch in Google Scholar
  • 17 Koch W, Knesewitsch P, Tatsch K. et al. Stunning effects in radioiodine therapy of thyroid carcinoma: existence, clinical effects and ways out. Nuklearmedizin 2003; 42: 10-4.
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Lassmann M, Luster M, Hanscheid H. et al. Impact of 131I diagnostic activities on the biokinetics of thyroid remnants. J Nucl Med 2004; 45: 619-25.
    PubMedSearch in Google Scholar
  • 19 Leger FA, Izembart M, Dagousset F. et al. Decreased uptake of therapeutic doses of iodine-131 after 185-MBq iodine-131 diagnostic imaging for thyroid remnants in differentiated thyroid carcinoma. Eur J Nucl Med 1998; 25: 242-6.
    CrossrefPubMedSearch in Google Scholar
  • 20 Löffler M, Weckesser M, Franzius C. et al. Iodine excretion during stimulation with rhTSH in differentiated thyroid carcinoma. Nuklearmedizin 2003; 42: 240-3.
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Meller B, Lauer I, Baehre M. et al. Influence of radioiodine therapy on urinary iodine excretion. Nuklearmedizin 1998; 37: 107-12.
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Meller B, Haase A, Seyfarth M. et al. Reduced radioiodine uptake at increased iodine intake and 131I-induced release of “cold” iodine stored in the thyroid. Nuklearmedizin. in press.
  • 23 Muratet JP, Daver A, Minier JF. et al. Influence of scanning doses of iodine-131 on subsequent first ablative treatment outcome in patients operated on for differentiated thyroid carcinoma. J Nucl Med 1998; 39: 1546-50.
    PubMedSearch in Google Scholar
  • 24 Park 2nd JT, Hennessey JV. Two-week low iodine diet is necessary for adequate outpatient preparation for radioiodine rhTSH scanning in patients taking levothyroxine. Thyroid 2004; 14: 57-63.
    CrossrefPubMedSearch in Google Scholar
  • 25 Petrich T, Knapp W-H, Potter E. Functional activity of human sodium/iodide symporter in tumor cell lines. Nuklearmedizin 2003; 42: 15-8.
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Pluijmen MJ, Eustatia-Rutten C, Goslings BM. et al. Effects of low-iodide diet on postsurgical radioiodide ablation therapy in patients with differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2003; 58: 428-35.
    CrossrefPubMedSearch in Google Scholar
  • 27 Postgard P, Himmelman J, Lindencrona U. et al. Stunning of iodide transport by 131I irradiation in cultured thyroid epithelial cells. J Nucl Med 2002; 43: 828-34.
    PubMedSearch in Google Scholar
  • 28 Reynolds JC, Robbins J. The changing role of radioiodine in the management of differentiated thyroid cancer. Semin Nucl Med 1997; 27: 152-64.
    CrossrefPubMedSearch in Google Scholar
  • 29 Saito T, Endo T, Kawaguchi A. et al. Increased expression of the sodium/iodide symporter in papillary thyroid carcinomas. J Clin Invest 1998; 101: 1296-300.
    CrossrefPubMedSearch in Google Scholar
  • 30 Schomäcker K, Wellner U, Scheidhauer K. et al. Relationship between properties of 131I therapy and radioiodine kinetics. Nuklearmedizin 1996; 35: 175-80.
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Sherman SI. Thyroid carcinoma. Lancet 2003; 361: 501-11.
    CrossrefPubMedSearch in Google Scholar
  • 32 Spitzweg C, Joba W, Morris JC. et al. Regulation of sodium iodide symporter gene expression in FRTL-5 rat thyroid cells. Thyroid 1999; 9: 821-30.
    CrossrefPubMedSearch in Google Scholar
  • 33 Taylor T, Specker B, Robbins J. et al. Outcome after treatment of high-risk papillary and non- Hurthle-cell follicular thyroid carcinoma. Ann Intern Med 1998; 129: 622-7.
    CrossrefPubMedSearch in Google Scholar
  • 34 Tsang RW, Brierley JD, Simpson WJ. et al. The effects of surgery, radioiodine, and external radiation therapy on the clinical outcome of patients with differentiated thyroid carcinoma. Cancer 1998; 55: 2062-71.
    Search in Google Scholar
  • 35 Wawschinek O, Eber O, Petek W. et al. Bestimmung der Harniodausscheidung mittels einer modifizierten Cer-Arsenitmethode. Berichte der ÖGKC 1985; 8: 13-5.
    Search in Google Scholar
  • 36 Weber K, Wellner U, Voth E. et al. Influence of stable iodine on the uptake of the thyroid-model versus experiment. Nuklearmedizin 2001; 40: 31-7.
    Thieme ConnectPubMedSearch in Google Scholar
  • 37 Wellner U, Alef K, Schicha H. Influence of physiological and pharmacological amounts of iodine on the 131I uptake of the thyroid gland--a model calculation. Nuklearmedizin 1996; 35: 251-63.
    Thieme ConnectPubMedSearch in Google Scholar