Limitations and Indications in the Treatment of Cancer of the Thyroid With Radioactive Iodine*†

Rawson, Rulon W.; Rall, J. E.; Peacock, Wendell C.

doi:10.1210/jcem-11-10-1128

Cited by 86 publications

(30 citation statements)

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“…Thyroid stunning reflecting a reduced radioiodine uptake in thyroid remnants after whole-body diagnostic scanning with 131 I has been an elusive phenomenon ever because it was first recognized more than 50 years ago (20). Although most experts in the field agree that it is a real side effect of the diagnostic use of 131 I that needs to be considered in radioiodine therapy (2)(3)(4)(5), the significance and even the existence of stunning have been questioned (21).…”

Section: Discussionmentioning

confidence: 99%

Down-regulation of the Sodium/Iodide Symporter Explains 131I-Induced Thyroid Stunning

Nordén¹,

Larsson²,

Tedelind³

et al. 2007

Cancer Research

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Abstract131 I radiation therapy of differentiated thyroid cancer may be compromised by thyroid stunning (i.e., a paradoxical inhibition of radioiodine uptake caused by radiation from a pretherapeutic diagnostic examination). The stunning mechanism is yet uncharacterized at the molecular level. We therefore investigated whether the expression of the sodium/ iodide symporter (NIS) gene is changed by irradiation using 131 I. Confluent porcine thyroid cells on filter were stimulated with thyroid-stimulating hormone (TSH; 1 milliunit/mL) or insulin-like growth factor-I (IGF-I; 10 ng/mL) and simultaneously exposed to 131 I in the culture medium for 48 h, porcine NIS mRNA was quantified by real-time reverse transcription-PCR using 18S as reference, and transepithelial iodide transport was monitored using 125 I À as tracer. TSH increased the NIS expression >100-fold after 48 h and 5-to 20-fold after prolonged stimulation. IGF-I enhanced the NIS transcription at most 15-fold but not until 5 to 7 days. 131 I irradiation (7.5 Gy) decreased both TSH-stimulated and IGF-I-stimulated NIS transcription by 60% to 90% at all investigated time points. TSH and IGF-I stimulated NIS synergistically 15-to 60-fold after 5 days. NIS expression was reduced by 131 I also in costimulated cells, but the transcription level remained higher than in nonirradiated cells stimulated with TSH alone. Changes in NIS mRNA always correlated with altered 125

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Section: Discussionmentioning

confidence: 99%

Down-regulation of the Sodium/Iodide Symporter Explains 131I-Induced Thyroid Stunning

Nordén¹,

Larsson²,

Tedelind³

et al. 2007

Cancer Research

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“…Rawson et al in 1951 [12] , were the first to describe thyroid stunning as a temporal reduction in the cell's ability to concentrate iodine after exposure to relatively low radioactive iodine-131 for diagnostic images (2-10mCi), but did not kill the cell. Its significance was attributed to suppression the efficacy of radioactive 131I ablative dose [13] .…”

Section: Discussionmentioning

confidence: 99%

Effect of stunning of diagnostic 131-iodine doses on ablative doses for differentiated thyroid cancer patient’s outcome

Elsaban

Al-Sakhri²,

Al-Zahrani³

2013

JST

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Background: Thyroid stunning was defined as transient reduction of thyroid tissue uptake 131I (RAI-131) ablative dose after a diagnostic 131I dose that decreases the final absorbed dose in ablative therapy.Aim of the study: after following the proper precautions compare the response to the ablative dose given to patients with differentiated thyroid cancer with or without diagnostic radioactive iodine 131(RAI-131). Patients and methods:One hundred patients with differentiated thyroid cancer were included and divided into two groups: Group I, ablative dose of RAI-131according to their risk stratification without diagnostic dose and Group II, patients performing diagnostic whole body scan [5mCi] followed by ablative dose. Results:The current study have showed no significant associations between overall response in both groups and the different studied parameters except for the mean ablative dose of P<0.001 and r=0.7, P<0.001 in group I and group II respectively]. Correlation matrix was used in all patients revealed that overall response was highly correlated with risk stratification; cervical nodal status and RAI-131 ablative dose [P values <0.01; <0.01 and <0.01 respectively], while regression proved that the only predictor for response is the mean RAI-131 ablative dose. Conclusion:Following the proper precautions prevent stunning appearance after the diagnostic dose success rate to ablation will not be affected.

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“…The first time this phenomenon was mentioned was in 1951 by Rawson et al [14] without any effect on the routines in nuclear medicine practice. At our Department we first experienced stunning in 1989 when a 12-year-old girl was treated for a large papillary thyroid cancer with massive pulmonary metastasing.…”

Section: Stunningmentioning

confidence: 96%

Radioiodine treatment for malignant thyroid disease

Berg

2006

Acta Oncologica

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Limitations and Indications in the Treatment of Cancer of the Thyroid With Radioactive Iodine*†

Cited by 86 publications

References 0 publications

Down-regulation of the Sodium/Iodide Symporter Explains 131I-Induced Thyroid Stunning

Down-regulation of the Sodium/Iodide Symporter Explains 131I-Induced Thyroid Stunning

Effect of stunning of diagnostic 131-iodine doses on ablative doses for differentiated thyroid cancer patient’s outcome

Radioiodine treatment for malignant thyroid disease

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