Document Detail


Association between excessive urinary iodine excretion and failure of radioactive iodine thyroid ablation in patients with papillary thyroid cancer.
MedLine Citation:
PMID:  23205883     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: A low-iodine diet (LID) is usually recommended for a week or two before radioactive iodine (RAI) ablation therapy in papillary thyroid cancer (PTC) patients after total thyroidectomy. However, it is still controversial whether an LID affects ablation outcomes. We therefore evaluated the association between urinary iodine excretion and the rate of successful ablation and investigated the determinants of successful RAI ablation outcomes.
METHODS: We retrospectively reviewed the records of 295 consecutive patients with PTC who received 1110 MBq RAI remnant ablation therapy with thyroid hormone withdrawal after total thyroidectomy. Successful ablation was defined as either no visible or faint uptake on a follow-up scan (definition 1), or no visible or faint uptake on a follow-up scan and a stimulated thyroglobulin level <2 ng/mL (definition 2).
RESULTS: The proportion of patients with appropriate LID status (defined as a urinary iodine concentration [UIC] <66.2 μg iodine/g creatinine [μg/gCr]) was significantly higher in the successfully ablated group (81% vs. 67%, p=0.03). Based on definition 1, 80.3% (237/295) of patients were successfully ablated. The ablation rate was significantly lower in patients who had a UIC >250 μg/gCr at the time of RAI ablation (p<0.05). In multivariate analysis, a UIC >250 μg/gCr was the only significant variable associated with ablation failure (p=0.002, odds ratio [OR] 4.74 [95% confidence interval (CI) 1.78-12.63]). Based on definition 2, 74.9% (221/295) of patients were successfully ablated. A UIC >250 μg/gCr at RAI administration showed a significant association with ablation failure (p<0.05). The OR of a UIC >250 μg/gCr for ablation failure was 3.88 [CI 1.42-10.57] (p=0.008).
CONCLUSION: Excessive iodine intake (UIC >250 μg/gCr) was associated with poor RAI ablation outcomes. Because this amount of iodine is very high, we propose that the level of strictness of the LID protocol should be modified according to the region that the patient is from and the food that the patient is accustomed to eating. Even in those areas where iodine intake is high, overly strict compliance with an LID protocol is not necessary and simple recommendations to avoid iodine-rich foods would be appropriate.
Authors:
Seo Young Sohn; Joon Young Choi; Hye Won Jang; Hye Jeong Kim; Sang Man Jin; Se Won Kim; Sunghwan Suh; Kyu Yeon Hur; Jae Hyeon Kim; Jae Hoon Chung; Sun Wook Kim
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  23     ISSN:  1557-9077     ISO Abbreviation:  Thyroid     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-06-07     Completed Date:  2014-01-28     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  United States    
Other Details:
Languages:  eng     Pagination:  741-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Carcinoma / pathology,  radiotherapy,  surgery
Carcinoma, Papillary / pathology,  radiotherapy*,  surgery,  urine
Diet / adverse effects*
Female
Humans
Iodine / adverse effects*,  urine
Iodine Radioisotopes / therapeutic use*
Male
Middle Aged
Radiopharmaceuticals / therapeutic use*
Radiotherapy, Adjuvant
Republic of Korea
Retrospective Studies
Tertiary Care Centers
Thyroid Neoplasms / pathology,  radiotherapy*,  surgery,  urine
Thyroidectomy
Treatment Failure
Tumor Burden
Up-Regulation*
Chemical
Reg. No./Substance:
0/Iodine Radioisotopes; 0/Radiopharmaceuticals; 9679TC07X4/Iodine
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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