Efficiency and Safety of Radioactive Iodine I-131 in Treatment of Thyroid Disease

Abstract

Thyroid gland is the largest endocrine gland in the body. The thyroid gland produces hormones that regulate the metabolism rate, affect the growth and many functions of various organ systems. Nuclear medicine technique is very useful diagnostic tool in detecting thyroid disease. Thyroid scintigraphy can reveal functional and anatomic information of thyroid gland. A variety of radiopharmaceuticals and methodologies have been used over the years in nuclear medicine. Iodine-131 has been used to image the thyroid several decades. Radioactive Iodine I-131 is useful for the treatment of hyperthyroidism and thyroid cancer. There were 100 participants included in the study who were treated with I-131. The participants were checked 6 months and 12 months after the beginning of the treatment. The results show normalization of the laboratory parameters and hormonal status at the control examinations after 6 months and 12 months therapy with I-131. The side effects did not appear in any of the patients, which demonstrates safe application.

Efficiency and Safety of Radioactive Iodine I-131 in Treatment of Thyroid Disease

Efficiency and Safety of Radioactive Iodine I-131 in Treatment of Thyroid Disease

Rubina Alimanovic-Alagic, Elma Kucukalic-Selimovic, Mevludin MekicClinic for Nuclear Medicine, Clinical Center of Sarajevo University, BiHClinic doe Hearth and Rheumatic Diseases, Clinical Center of Sarajevo University, BiH

PROFESSIONAL PAPER SUMMARY

Thyroid gland is the largest endocrine gland in the body. The thyroid gland produces hormones that regulate the metabolism rate, aect the growth and many functions of various organ systems. Nuclear medicine technique is very useful diagnostic tool in detecting thyroid disease. Thyroid scintigraphy can reveal functional and anatomic information of thyroid gland. A variety of radiopharmaceuticals and methodologies have been used over the years in nuclear medicine. Iodine-131 has been used to image the thyroid several decades. Radioactive Iodine I-131 is useful for the treatment of hyperthyroidism and thyroid cancer. There were 100 participants included in the study who were treated with I-131. The participants were checked 6 months and 12 months aer the beginning of the treatment. The results show normalization of the laboratory parameters and hormonal status at the control examinations aer 6 months and 12 months therapy with I-131. The side eects did not appear in any of the patients, which demonstrates safe application.

Keywords: thyroid gland, nuclear medicine, thyroid disease, therapy I-131, efficiency, certainty

1. INTRODUCTION

Thyroid disease belongs in the group of endocrinological diseases, or glands with internal secretion (1,2,3,4,5). Over the hormone produced thyroid gland inuence on almost all metabolic processes in the body. Usually thyroid problems include irregular hormone production by the thyroid gland. Hormones actions can be divided into three basic functions: growth, maintenance of homeostasis of the body and reproduction (6,7,8). Given the incidence of thyroid diseases they have wide consequences on the population. Thyroid gland is a buttery shaped gland located in the bottom of the neck, with both sides. Thyroid gland consists of two lobes, tied in the middle with isthmus. In healthy adults, the weight or volume of each isthmus lobe together should not exceed 15-25 grams in adults. According to the level where the disorder occurred disorders of thyroid gland could be: primary-damaged thyroid gland, secondary-disturbance is at the level of adenohypophisis and tertiary- disorder is at the hypothalamus level. Thyroid diseases can be divided according to morphological criteria in the tumor and non-tumor-benign, and according to the functional state

of the gland it may be: euthyroid (normal function), hyperthyroid (increased function) and hypothyroid (reduced thyroid function). Thyroid cancers can be: papillary, follicular, medullar and anaplastic (9,10,11).

2. NUCLEAR MEDICINE

Today, the nuclear medicine is clinically complete eld. For the diagnosis of thyroid gland state performed are laboratory analysis in-vitro, and then scintigraphy analysis, and ultrasound of the thyroid gland. In the diagnosis is still irreplaceable and still present the combination of numerous in vivo and in vitro methods, using radioactive isotopes for diagnostic and therapeutic purposes.

By measuring the radioactivity of individual points at the thyroid gland in one moment and at the same time presenting all points of radioactivity in the form of images is called scintigram or scan. Thyroid scintigraphy is an important and common procedure in nuclear medicine. Thyroid scintigraphy is multifunctional visualization of the thyroid gland after administration of the diagnostic dose of different radioactive isotopes. Ultrasound of the thyroid gland is also used as a guide for focused punction of the thyroid gland (FNA). To set the correct diagnosis of the patient also can be used computerized tomography (CT) and magnetic resonance imaging (MRI).

In vitro analysis: Thyroid stimulating hormoneTSH, thyroxineT4, ThreeiodinethyronineT3, Free thyroxinFT4, Free

threeiodinethyronineFT 3, thyroglobulinTG, ThyreocacitonineTCT rarely TBG, TGL, ATGL and AbTPO.

Radioactive isotopes that are commonly used for diagnostic purposes for scintigraphy are: Tc-99m, 123 I, 131 I, 201 TL. Machines for visualization in scintigraphy are scanner or gamma camera with the appropriate collimator.

Thyroid diseases can be treated: with medications for hyper or hypothyroidism, with iodine tablets, administration of radioactive iodine I-131, with surgical treatment of thyroid gland, broad-spectrum antibiotics are commonly given for acute inammation of the thyroid gland, radiation and chemotherapy.

Treatment with radioactive iodine in addition to surgery and treatment thyreostatics is one of the radical forms of treatment in case of Based disease, in case of thyroid gland autonomy and the cancer. For the treatment is used radioactive iodine I-131 and I-125. Both isotopes are gamma and beta emitters.

3. GOAL

To determine the therapeutic eect of radioactive iodine-I-131 in the treatment of thyroid gland diseases.

4. MATERIALS AND

METHODOLOGY

The study is retrospective and it included 100 patients treated with radioactive iodine I-131. The study included all patients with benign thyroid diseases for which treatment is indicated and the treatment with radioactive iodine I-131 is administered.

All patients are normally treated at the Clinic for Nuclear Medicine, Clinical Center of Sarajevo University. Parameters that are monitored are: age, sex, hormonal status of patients before treatment, 6 months after the therapy, 12 months after therapy and thyroid scintigraphy after the treatment.

5. RESULTS

Shown in tables and gures (Table 1 and Figures 1 to 11).

6. DISCUSSION AND CONCLUSIONS

The study was conducted at the Clinic of Nuclear Medicine, Clinical Center of Sarajevo University. The study included 100 patients, of whom 96 (96%) were female patients and 4 (4%) male. All patients

Diagnosis AGE GROUP

20-35 35-55 55-75 75 + Total Hyperthireosis 2 20 26 6 54 Hypothireosis 10 8 8 2 28 Unifocal autonomy 0 6 9 3 18

TOTAL 10 36 43 11 100

Table 1. Frequency of diseases according to patients age and diagnosis

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5. RESULTS

Figure 1. Gender structure of the sample

96

18

16

Efficiency and Safety of Radioactive Iodine I-131 in Treatment of Thyroid Disease

14

12

7,7

11,2 10,3 10,7

9

120

10 7,1 7,7

000000000000

8

8

6,1 5,4

18

6

5,6 5,3 5

6,3

16

4

9

14

2

12

0

7,7

9 BEFOR

000000000000

8

E TREATMENT

8

10 7,1 7,7 6,1 5,4

6

5,6 5,3 5

6,3

11,2 10,3 10,7

4

9

2

0

BEFORE TREATMENT

age group 35-55 years. Thyroid disease in younger patients 20 to 35 years of age was present in 21 cases.

Out of all the most common thyroid disease is hyperthyroidism in 54 (54%) cases, while unifocal autonomy is reported by 18 (18%) patients and in 28 patients hypothyreosis.

Hypothyreosis occurred in10 cases at age 20-35 years, and in 8 patients in groups between 35-55 and 55-75 years of age, and the least in the age group over 75 years. Hyperthyreosis was present in 36 cases in the age group 35-55 years, and in the age group 55-75 years in 43 patients. Unifocal autonomy is most common in the 9 cases in people aged 55-75 years of life, and in 6 patients in group 35-55 years. Therapy with radioactive iodine I-131 in the treatment of thyroid diseases has proved to be eective, without adverse eects.

REFERENCES

1. Vrhovec B. Interna medicina. Medicinska biblioteka. Naklada Naprijed.d.d. Zagreb, 2003: 1240-53.

2. Borota R, Stefanosvi LJ. Nuklearna medicina. Novi Sad, Medicinski fakultet, 1992.

3. Goodman and Gilmans .The Pharmacological Basis of Therapeutics, 2005: 1563-96.

4. Alimanovi-Alagi R, Brkovi A, Kuukali-Selimovi E, Skopljak-Beganovi A.Scintigraja titne lijezde kao dijagnostika metoda u evaluaciji oboljenja titne lijezde.. Medicinski Arhiv, 2008; 62(2): 114-6.

5. Ivanevi D, Dodig D, Kusi Z. Klinika nuklearna medicina. Medicinska naklada Zagreb, 1999.

6. Safa AM, Schumacher OP, Rodriguez-Antunez A. Long-term follow-up results in children and adolescents treated with radioactive iodine-131 for hyperthyreoidism. N Engl J Med, 1975; 292: 167-71.7. Salanci BV, Kiratli PO, Gunay EC. Role of scintigraphy in congenital thyroid anomalies. Turk J Pediatr, 2005; 47(4): 364-8.

8. Bojarska-Szmygin A, Janicki K, Pietura R, Janicka L. The usefulness of thyroid size and TSH receptor antibody (TRAb) determinations in predicting the eectiveness of tiamazole and l-131 treatment for Graves-Basedows disease. Ann Univ Mariae Curie Skodowska (Med), 2003; 58 (1): 242-7.

9. Meller B, von Hof K, Genina E, Deisting W, Meller J. Diagnostic 123I and 131I activites and radioiodine therapy. Eects on urinary iodine extrection in patients with dierentiated thyroid carcinoma. Nuklearmedizin, 2005; 44(6): 243-8.

10. Corstens F, Huysmans D, Kloppenborg P. Thallium-201 scintigraphy of the suppresed thyroid: an alternative for iodine-123 scanning after TSH stimualtion. J Nucl Med, 1998; 29: 1360-3.

11. http://www.cancer.gov I-131 Radioactive I-131 from Fallout. National Cancer Institute. Retrieved on 2007.

Corresponding author: Rubina Alimanovi-Alagi, Mr.Sci.Dr.med. Institute for Nuclear medicine, KCU, Sarajevo, Bolnicka 25. B&H. Tel:

[phone]. Mob: [phone]. E-mail: [email protected]

Diagnosis

AGE GROUP

100

80

20-35

35-55 55-75 75 + Total

60

20 26 6 54 Hypothireosis 10

8 8 2 28 Unifocal

autonomy

Hyperthireosis 2

40

20

0

6 9 3 18

TOTAL 10 36 43 11 100

Figure 2. Frequency of diseases according to patients age and diagnosis

0

4

Figure 8. FT3 values in case of hyperthyreosis one year after treatment with I-131

Figure 9. TSH values in case of unifocal autonomy before treatment, after 6 and 12 months

in treatment with I-131

Female Male

Figure 7. FT3 values in case of hyperthyreosis before treatment

Figure 1. Gender structure of the sample

Figure 8. FT3 values in case of hyperthyreosis one year after treatment with I-131

Figure 9. TSH values in case of unifocal autonomy before treatment, after 6 and 12 months

in treatment with I-131

30

Table 1. Frequency of diseases according to patients age and diagnosis

25

20

26

20-35

35-55

55-75

75+

20

15

10

9

6

10

6

5

2

3

Figure 3. TSH values in case of hyperthyreosis before treatment

0

0

0

0

Figure 8. FT3 values in case of hyperthyreosis one year aer treatment with I-131

0

8 8 2

Figure 3. TSH values in case of hyperthyreosis before treatment

0

Figure 2. Frequency of diseases according to patients age and diagnosis

14

2,5

14

12

2

12

10

10

2,5

1,5

8

8

2

1

6

6

1,5

0,5

4

4

2

2

1

1 3 5 7 9 11 13 15 17 19 21 23 25 27

BEFORE TREATMENT

0 0 Before treatment After 6 months After 1 yearTSH IN UNIFOCAL AUTONOMY

Figure 10. FT4 values in case of unifocal autonomy before treatment, after 6 and 12 months

in treatment with I-131

0,5

1 3 5 7 9 11 13 15 17 19 21 23 25 27BEFORE TREATMENT

Before treatment After 6 months After 1 year

TSH IN UNIFOCAL AUTONOMY

Figure 10. FT4 values in case of unifocal autonomy before treatment, after 6 and 12 months

in treatment with I-131

Figure 9. TSH values in case of unifocal autonomy before treatment, aer 6 and 12 months in treatment with I-131

Figure 4. TSH values in case of hyperthyreosis one year after treatment with I-131

0

Figure 3. TSH values in case of hyperthyreosis before treatment

30

30

10

25

25

Figure 4. TSH values in case of hyperthyreosis one year after treatment with I-131

0

9

8

20

20

7

15

6

15

10

5

10

10

9

4

8

3

5

5

7

2

6

1

5

1 3 5 7 9 11 13 15 17 19 21 23 25 27

AFTER ONE YEAR

Before treatment After 6 month After 1 year

FT4 IN UNIFOCAL AUTONOMY

0 0 Before treatment After 6 month After 1 yearFT4 IN UNIFOCAL AUTONOMY

4

1

3 Figure 4. TSH values in case of hyperthyreosis one year aer treatment with I-131

18,3

Figure 10. FT4 values in case of unifocal autonomy before treatment, aer 6 and 12 months in treatment with I-131

2

Figure 11. FT3 values in case of unifocal autonomy before treatment, after 6 and 12 months

in treatment with I-131

Figure 11. FT3 values in case of unifocal autonomy before treatment, after 6 and 12 months

in treatment with I-131

Figure 5. FT4 values in case of hyperthyreosis before tretment

1 3 5 7 9 11 13 15 17 19 21 23 25 27

AFTER ONE YEAR

50

50

16

14

12

10

8

6

4

2

0

Before treatment After 6 months After 1 year

FT3 IN UNIFOCAL AUTONOMY

45

45

40

40

35

35

28

28

30

30

Figure 5. FT4

25

25

23,9

47,5

values in case of hyperthyreosis before tretment

21,5

14,2 14,7

17,4

35,7

21,5

14,2 14,7

17,4

35,7

23,9

47,5

20 20 15,7

28

15,7

28

000000000000

000000000000

15

15

11,2

15,1

21,7

18,1

11,2

15,1

21,7

18,1

10

10

18,3

5

5

0

0

BEFORE TREATMENT

Figure 6. FT4 values in case of hyperthyreosis one year after treatment with I-131

BEFORE TREATMENT

Figure 6. FT4 values in case of hyperthyreosis one year after treatment with I-131

Figure 5. FT4 values in case of hyperthyreosis before tretment

Figure 11. FT3 values in case of unifocal autonomy before treatment, aer 6 and 12 months in treatment with I-131

25

25

20

20

15

15

10

10

5

5

0

0

AFTER ONE YEAR

AFTER ONE YEAR

Figure 6. FT4 values in case of hyperthyreosis one year aer treatment with I-131

Figure 7. FT3 values in case of hyperthyreosis before treatment

Figure 7. FT3 values in case of hyperthyreosis before treatment

had control of hormonal status before treatment, after 6 months and 12 months of treatment with I-131.

Determined is the therapeutic eect of radioactive iodine I-131 use in the treatment of thyroid diseases. Efficiency is dened in terms of regulation of hormonal status: TSH, FT4 and FT3, after 6 and after 12 months of using radioactive iodine I-131 in the treatment of thyroid diseases.

The largest number of respondents was in the age group 55-75 years or 43 (43%), while 36 (36%) of respondents were in the

300

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