Abstract:Context
No consensus exists about the optimal duration of the low iodine diet (LID) in preparation of 131I therapy in differentiated thyroid cancer (DTC) patients.
Objective
This work aimed to investigate if a LID of four days is enough to achieve adequate iodine depletion in preparation for 131I therapy. In addition, the nutritional status of the LID was evaluated.
Methods
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“…A second cornerstone of preparation for I-131 treatment generally consists of a low-iodine diet for a period of 1–2 weeks before administration; however, a recent study showed that a 4-day low-iodine diet seems to be sufficient in areas with iodine-sufficient intake ( 40 , 114 , 115 ). Although in use for many years, its effect on therapy outcome is not uniformly accepted; here, local iodine sufficiency status might also play a role.…”
“…Although its merit is still subject to some scientific debate, a low-iodine diet before I-131 therapy may favorably influence the uptake of I-131 in DTC during therapy and will do no harm. Therefore, the expert panel agreed to recommend a low-iodine diet for at least 4 days before the administration of I-131 treatment ( 115 ). Recommendation 16A: We recommend that TSH stimulation (>30 mI/L) is induced before I-131 therapy in order to facilitate I-131 uptake (4S).…”
“…Although its merit is still subject to some scientific debate, a low-iodine diet before I-131 therapy may favorably influence the uptake of I-131 in DTC during therapy and will do no harm. Therefore, the expert panel agreed to recommend a low-iodine diet for at least four days before administration of I-131 treatment [118].…”
At present no European recommendations for the management of pediatric thyroid nodules and differentiated thyroid carcinoma (DTC) exist. Differences in clinical, molecular, and pathological characteristics between pediatric and adult DTC emphasize the need for specific recommendations for the pediatric population. An expert panel was instituted by the executive committee of the European Thyroid Association (ETA) including an international community of experts from a variety of disciplines including pediatric and adult endocrinology, pathology, endocrine surgery, nuclear medicine, clinical genetics, and oncology. The American Thyroid Association (ATA) pediatric guideline 2015 was used as framework for the present guideline. Areas of discordance were identified, and clinical questions were formulated. The expert panel members discussed the evidence and formulated recommendations based upon the latest evidence and expert opinion. Children with a thyroid nodule or DTC require expert care in an experienced center. The present guideline provides guidance for healthcare professionals to make well-considered decisions together with patients and parents regarding diagnostics, treatment and follow-up of pediatric thyroid nodules and DTC.
“…A second cornerstone of preparation for I-131 treatment generally consists of a low-iodine diet for a period of 1–2 weeks before administration; however, a recent study showed that a 4-day low-iodine diet seems to be sufficient in areas with iodine-sufficient intake ( 40 , 114 , 115 ). Although in use for many years, its effect on therapy outcome is not uniformly accepted; here, local iodine sufficiency status might also play a role.…”
“…Although its merit is still subject to some scientific debate, a low-iodine diet before I-131 therapy may favorably influence the uptake of I-131 in DTC during therapy and will do no harm. Therefore, the expert panel agreed to recommend a low-iodine diet for at least 4 days before the administration of I-131 treatment ( 115 ). Recommendation 16A: We recommend that TSH stimulation (>30 mI/L) is induced before I-131 therapy in order to facilitate I-131 uptake (4S).…”
“…Although its merit is still subject to some scientific debate, a low-iodine diet before I-131 therapy may favorably influence the uptake of I-131 in DTC during therapy and will do no harm. Therefore, the expert panel agreed to recommend a low-iodine diet for at least four days before administration of I-131 treatment [118].…”
At present no European recommendations for the management of pediatric thyroid nodules and differentiated thyroid carcinoma (DTC) exist. Differences in clinical, molecular, and pathological characteristics between pediatric and adult DTC emphasize the need for specific recommendations for the pediatric population. An expert panel was instituted by the executive committee of the European Thyroid Association (ETA) including an international community of experts from a variety of disciplines including pediatric and adult endocrinology, pathology, endocrine surgery, nuclear medicine, clinical genetics, and oncology. The American Thyroid Association (ATA) pediatric guideline 2015 was used as framework for the present guideline. Areas of discordance were identified, and clinical questions were formulated. The expert panel members discussed the evidence and formulated recommendations based upon the latest evidence and expert opinion. Children with a thyroid nodule or DTC require expert care in an experienced center. The present guideline provides guidance for healthcare professionals to make well-considered decisions together with patients and parents regarding diagnostics, treatment and follow-up of pediatric thyroid nodules and DTC.
“…While the American Thyroid Association [8], British Thyroid Association [9], and Italian Society of Endocrinology [10] recommend 1-2 weeks, the 2022 European Thyroid Association supports a low-iodine diet but does not specify the duration [11]. South Korean researchers have advocated a strict low-iodine diet for 1 week before 131 I treatment [12,13], while a Dutch study suggested that a 4-day low-iodine diet may be su cient [14]. The Guidelines for Radioiodine Therapy of Differentiated Thyroid Cancer (2014 edition) propose 1-2 weeks, extended to 2-4 weeks in the 2021 edition [6], but these recommendations lack high-quality supporting evidence.…”
Objective: To explore the implementation of low-iodine diets among medical staff caring for patients with differentiated thyroid carcinoma prior to 131I therapy across 58 hospitals, and offer valuable insights for the development of guidelines on low-iodine diets.
Methods: Convenience sampling was utilized to conduct a survey among 163 medical staff members working in nuclear medicine departments across 58 tertiary hospitals using a self-designed questionnaire.
Results: Concerning the duration of the low-iodine diet prior to treatment, the medical staff's recommendations were as follows: 58.28% suggested 2–4 weeks, 31.29% recommended more than 4 weeks, 9.2% opted for 7–13 days, and 1.23% favored less than 1 week. Regarding the timing of resuming a normal diet, the respondents' recommendations ranged from immediately after treatment (1.84%) to 3 months post-treatment (8.58%), with intermediate recommendations of 2 hours (8.58%), 24–48 hours (14.11%), post-discharge (12.26%), and 1 month (42.94%).Furthermore, the surveyed medical staff unanimously recommended abstaining from seafood, with 90.8% also advising against the consumption of iodized salt, 91.41% recommending avoidance of iodine-containing medications, and 71.17% advising caution with moderately high-iodine foods. Notably, 75.46% of the medical staff evaluated patient compliance with the low-iodine diet. When patients failed to adhere to the diet preparation, 33.74% of healthcare workers chose to proceed with treatment. In terms of guidance sources, 96.93% of respondents relied on relevant guidelines, 66.26% referred to the literature, and 49.69% drew upon their clinical experience. During hospitalization, 58.28% of the medical staff continued to guide patients on the low-iodine diet, while only 8.59% provided such guidance after discharge. Notably, only 20.25% of the staff considered consulting the nutrition department.
Discussion: This study underscored substantial variations in the duration and selection criteria for low-iodine diets, which were linked to a scarcity of standardized evaluations. Consequently, there is an urgent need for further research to establish detailed, practical, accessible, comprehensive, and dependable implementation programs for low-iodine diets.
“…Adequate patient preparation for RAI [low-iodine diet and thyroid stimulating hormone (TSH) stimulation] is essential to ensure sufficient therapeutic uptake. A recent study shows that a low-iodine diet for 4 days provides equivalent thyroid stimulating hormone (TSH) stimulation to 7 days [42], which may improve patient compliance. RAI should also be delayed at least four weeks following computed tomography with iodinated contrast [43].…”
Section: Radioactive Iodine Imaging Therapy and Dosimetrymentioning
Purpose of reviewThyroid cancers are endocrine neoplasms with diverse gene expression and behavior, for which constantly evolving anatomic and functional imaging/theranostic agents have an essential role for diagnosis, staging, and treatment.
Recent findingsTo achieve definitive diagnosis, neck ultrasound and associated risk stratification systems, notably Thyroid Imaging Reporting and Data System (TI-RADS), allow improved thyroid nodule characterization and management guidance. Radioactive iodine-131 (RAI) has long played a role in management of differentiated thyroid cancer (DTC), with recent literature emphasizing its effectiveness for intermediate-high risk cancers, exploring use of dosimetry for personalized medicine, and potential for retreatment with RAI following tumor redifferentiation. Iodine-124 positron emission tomography/computed tomography (PET/ CT) has promising application for DTC staging and dosimetry. F18-fluorodeoxyglucose (FDG) PET/CT is used for staging of high risk DTC and identification of noniodine-avid disease recurrences, with metabolic uptake consistently portending poor prognosis. Poorly differentiated and anaplastic thyroid cancers are best assessed with anatomic imaging and F18-FDG PET/ CT, though recent studies show a potential theranostic role for Ga68/Lu177-prostate-specific membrane antigen. Medullary thyroid cancers are evaluated with ultrasound, CT, magnetic resonance imaging, and various positron-emitting radiotracers for PET imaging (F18-DOPA, F18-FDG, and recently Ga68-1,4,7,10-tetraazacyclododecane-1,4,7,10tetraacetic acid (DOTA)--octreotate (DOTATATE)); the latter may enable treatment with Lu177-DOTATATE.
SummaryMultidisciplinary collaboration is essential to streamline appropriate management, given the wide array of available imaging and new therapies for metabolic and genetically complex cancers.
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