The Evolving Use of Radioiodine Therapy in Differentiated Thyroid Cancer

Mayson, Sarah E.; Yoo, Don C.; Gopalakrishnan, Geetha

doi:10.1159/000369496

Cited by 10 publications

(10 citation statements)

References 57 publications

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“…Iodine-131 ablation therapy after the surgical procedure of total or near-total thyroidectomy is standard management for thyroid cancer [ 1 ]. Iodine-131 is generally considered able to ablate thyroid cells without affecting healthy tissues in the body because of their levothyroxine (T4) and triiodothyronine (T3) contents.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of differentiated thyroid cancer (DTC) has increased globally over the last several decades, and iodine-131 is routinely used to treat DTC after total or near-total thyroidectomy to ablate the remnant thyroid tissue and enable physicians to detect tumor recurrence or distant metastasis more easily [ 1 ]. Iodine-131 is also used to treat benign thyroid conditions such as Grave’s disease and benign nodular goiter [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Drug-induced liver injury caused by iodine-131

Kim

Park

et al. 2016

Clin Mol Hepatol

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Iodine-131 is a radioisotope that is routinely used for the treatment of differentiated thyroid cancer after total or near-total thyroidectomy. However, there is some evidence that iodine-131 can induce liver injury . Here we report a rare case of drug-induced liver injury (DILI) caused by iodine-131 in a patient with regional lymph node metastasis after total thyroidectomy. A 47-year-old woman was admitted with elevated liver enzymes and symptoms of general weakness and nausea. Ten weeks earlier she had undergone a total thyroidectomy for papillary thyroid carcinoma and had subsequently been prescribed levothyroxine to reduce the level of thyroid-stimulating hormone. Eight weeks after surgery she underwent iodine-131 ablative therapy at a dose of 100 millicuries, and subsequently presented with acute hepatitis after 10 days. To rule out all possible causative factors, abdominal ultrasonography, endoscopic ultrasonography (on the biliary tree and gall bladder), and a liver biopsy were performed. DILI caused by iodine-131 was suspected. Oral prednisolone was started at 30 mg/day, to which the patient responded well.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Drug-induced liver injury caused by iodine-131

Kim

Park

et al. 2016

Clin Mol Hepatol

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“…This mechanism stands in stark contrast to non-incorporated beta-emitting radioisotopes, where only a small fraction of emitted electrons travel in the precise orientation necessary to strike one strand plus its opposite strand and cause a double-strand DNA break [ 30 , 31 ]. With 32 P, the extreme proximity of the contralateral target strand to the decay-produced electron makes this double-strand breakage much more likely to occur [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Phosphorus-32, a Clinically Available Drug, Inhibits Cancer Growth by Inducing DNA Double-Strand Breakage

et al. 2015

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Radioisotopes that emit electrons (beta particles), such as radioiodine, can effectively kill target cells, including cancer cells. Aqueous 32P[PO4] is a pure beta-emitter that has been used for several decades to treat non-malignant human myeloproliferative diseases. 32P[PO4] was directly compared to a more powerful pure beta-emitter, the clinically important 90Y isotope. In vitro, 32P[PO4] was more effective at killing cells than was the more powerful isotope 90Y (P ≤ 0.001) and also caused substantially more double-stranded DNA breaks than did 90Y. In vivo, a single low-dose intravenous dose of aqueous elemental 32P significantly inhibited tumor growth in the syngeneic murine cancer model (P ≤ 0.001). This effect is exerted by direct incorporation into nascent DNA chains, resulting in double-stranded breakage, a unique mechanism not duplicatable by other, more powerful electron-emitting radioisotopes. 32P[PO4] should be considered for human clinical trials as a potential novel anti-cancer drug.

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“… 14 High-dose radioiodine therapy is also helpful for advanced disease at presentation, local recurrence that is not amenable to surgery alone, and distant metastatic disease. 15 …”

Section: Current Applicationsmentioning

confidence: 99%

Targeted Radionuclide Therapy: Practical Applications and Future Prospects

et al. 2016

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In recent years, there has been a proliferation in the development of targeted radionuclide cancer therapy. It is now possible to use baseline clinical and imaging assessments to determine the most effective therapy and to tailor this therapy during the course of treatment based on radiation dosimetry and tumor response. Although this personalized approach to medicine has the advantage of maximizing therapeutic effect while limiting toxicity, it can be challenging to implement and expensive. Further, in order to use targeted radionuclide therapy effectively, there is a need for multidisciplinary awareness, education, and collaboration across the scientific, industrial, and medical communities. Even more important, there is a growing understanding that combining radiopharmaceuticals with conventional treatment such as chemotherapy and external beam radiotherapy may limit patient morbidity while improving survival. Developments in radiopharmaceuticals as biomarkers capable of predicting therapeutic response and targeting disease are playing a central role in medical research. Adoption of a practical approach to manufacturing and delivering radiopharmaceuticals, assessing patient eligibility, optimizing post-therapy follow-up, and addressing reimbursement issues will be essential for their success.

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The Evolving Use of Radioiodine Therapy in Differentiated Thyroid Cancer

Cited by 10 publications

References 57 publications

Drug-induced liver injury caused by iodine-131

Drug-induced liver injury caused by iodine-131

Phosphorus-32, a Clinically Available Drug, Inhibits Cancer Growth by Inducing DNA Double-Strand Breakage

Targeted Radionuclide Therapy: Practical Applications and Future Prospects

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