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Nuklearmedizin 2007; 46(05): 224-231
DOI: 10.1160/nukmed-0288
131I-Lipiodol dosimetry
Schattauer GmbH

Procedure guideline for radioiodine therapy and 131iodine whole-body scintigraphy in paediatric patients with differentiated thyroid cancer

Verfahrensanweisung zur Radioiodtherapie und 131I-Ganzkörperszintigraphie bei differenzierten Schilddrüsenkarzinomen im Kindes- und Jugendalter
C. Franzius
1   Kliniken und Polikliniken für Nuklearmedizin, Universitätsklinika Münster
,
M. Dietlein
,
M. Biermann
3   Nuclear Medicine and PET-Center, Department of Radiology, Haukeland University Hospital and Section for Radiology, Department of Surgical Sciences, University of Bergen, Norway
,
M. Frühwald
4   Klinik und Poliklinik für Kinderheilkunde, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Münster
,
T. Linden
4   Klinik und Poliklinik für Kinderheilkunde, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Münster
,
P. Bucsky
5   Hämatologie, Onkologie und Immunologie der Klinik für Kinder- und Jugendmedizin der Universität zu Lübeck
,
C. Reiners
,
O. Schober
1   Kliniken und Polikliniken für Nuklearmedizin, Universitätsklinika Münster
› Author Affiliations
Further Information

Publication History

Eingegangen: 12 July 2007

Publication Date:
29 December 2017 (online)

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Summary

The procedure guideline for radioiodine (131I) therapy and 131I whole-body scintigraphy of differentiated thyroid cancer in paediatric patients is the counterpart to the procedure guidelines (version 3) for adult patients and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Characteristics of thyroid cancer in children are the higher aggressiveness of papillary thyroid cancer, the higher frequency of extrathyroidal extension and of disseminated pulmonary metastases as well as the high risk of local recurrences. Radioiodine therapy is generally recommended in children, the 131I activity depends on the children's body weight. Radioiodine ablation in children with small papillary cancer (≤1 cm) should be considered. TSH stimulation is reached two weeks (children) or three weeks (adolescents) after withdrawal of thyroid hormones. Anti-emetic drugs are highly recommended. CT of the chest and examination of pulmonary function are clearly indicated if there is any suspicion on metastases. 3–6 months after 131I ablation, the 131I whole-body scintigraphy is highly recommended as lymph node metastases are frequently detected in paediatric patients. Follow-up care should be arranged in shorter intervals than in adults to test the compliance and to adapt dosage of thyroid hormones to the children's body weight. Reference values of fT3 are higher in children than in adults. Evidence is insufficient to describe in which constellation the TSH may be kept within the low normal level. Therefore, TSH suppression is generally recommended.

Zusammenfassung

Die Verfahrensanweisung zur Radioiodtherapie (RIT) und zur 131I-Ganzkörperszintigraphie beim differenzierten Schilddrüsenkarzinom im Kindes- und Jugendalter reiht sich thematisch neben die entsprechenden Verfahrensanweisungen (Version 3), die für erwachsene Patienten verfasst sind, und konkretisiert die interdisziplinäre Leitlinie der Deutschen Krebsgesellschaft um die nuklearmedizinischen Aspekte. Besonderheiten im Kindes- und Jugendalter sind die höhere Aggressivität des papillären Schilddrüsenkarzinoms, die Häufigkeit eines organüberschreitenden Tumorwachstums und einer disseminierten pulmonalen Metastasierung sowie die hohe lokale Rezidivrate. Die TNM-Klassifikation wird aufgrund der geringen Ausdehnung der normalen kindlichen Schilddrüse der Risikostratifikation nicht gerecht. Grundsätzlich besteht auch bei Kindern die Empfehlung zur Radioiodtherapie, wobei die 131I-Aktivität gewichtsabhängig appliziert wird. Bei kleinen papillären Schilddrüsenkarzinomen (≤1 cm) ist die Indikation zu einer ablativen Radioiodtherapie eher großzügig zu stellen. Nach Hormonentzug wird die TSH-Stimulation bereits nach zwei Wochen (Kinder) bzw. drei Wochen (Jugendliche) erreicht. Antiemetika werden großzügig verordnet. Die Indikation zur CT des Thorax und zur Lungenfunktionsuntersuchung ist bei Metastasenverdacht großzügig zu stellen. Auf die diagnostische 131I-Ganzkörperszintigraphie drei bis sechs Monate nach ablativer Radioiodtherapie sollte wegen der Häufigkeit einer lymphogenen Metastasierung nicht verzichtet werden. Nachsorgeintervalle sind eher kürzer zu wählen, um eine unzureichende Compliance bei Kindern frühzeitig zu erfassen und um die Hormondosis gewichtsbezogen anzupassen. Der höhere Normbereich von fT3 für Kinder ist zu beachten. Es liegt keine ausreichende Evidenz vor, ob und wann eine nicht-suppressive Einstellung der Schilddrüsenfunktion sinnvoll ist. Daher ist die TSHSuppression grundsätzlich anzustreben.

Keywords

Procedure guidelines - differentiated thyroid cancer - radioiodine therapy - paediatric patients - children - adolescents

Schlüsselwörter

Verfahrensanweisung - differenziertes Schilddrüsenkarzinom - Radioiodtherapie - Kindesalter - Jugendalter - Pädiatrie
 

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