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Outpatient Thyroid Remnant Ablation Using Repeated Low 131-Iodine Activities (740 MBq/20 mCi x 2) in Patients with Low-Risk Differentiated Thyroid Cancer.
MedLine Citation:
PMID:  22238400     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Context:In low-risk differentiated thyroid cancer (DTC), postoperative (131)I remnant ablation should employ a minimum effective activity; reports increasingly suggest efficacy of low activities, e.g. 1110 MBq/30 mCi.Objectives, Design, Patients, and Interventions:We retrospectively studied the ablation capability and diagnostic utility of the Minidose protocol, two 740-MBq/20 mCi outpatient administrations, 6-18 months apart, plus related diagnostic procedures, in 160 consecutive (near-) totally thyroidectomized low-risk DTC (pT1/N0-Nx) patients. Successful ablation comprised negative 740-MBq whole-body scintigraphy with cervical uptake below 0.1%, negative stimulated thyroglobulin (STg) (<1 ng/ml, negative thyroglobulin antibodies), and negative Doppler ultrasonography (performed around Minidose 2).Setting:The study took place at a referral center.Results:Minidose imaging found unsuspected nodal or distant metastases in nine of 160 patients (5.6%). Ablation success rates after one (two) 740-MBq activity (activites) were 75.9% (90.2%) in 145 (132) evaluable imaging-negative patients. Compared with thyroid hormone withdrawal, recombinant human TSH stimulation was associated with higher urinary iodine excretion/creatinine, lower cervical uptake, and more frequent ablation success after the first 740 MBq; success rates no longer differed significantly after both administrations. Patients with STg below 10 ng/ml at Minidose 1 were oftener ablated at Minidose 2 (odds ratio = 13.9, 95% confidence interval = 2.5-76.4, P < 0.003), attaining 92.0% final ablation success after recombinant human TSH preparation, suggesting that one 740-MBq activity should suffice in this subgroup. All 81 evaluable patients with prolonged follow-up (mean 41.8 ± 21.9 months after Minidose 1) had no evidence of disease at the last visit.Conclusions:The Minidose outpatient ablation protocol is effective and diagnostically useful in low-risk DTC.
Authors:
Jérôme Clerc; Marie Bienvenu-Perrard; Caroline Pichard de Malleray; Françoise Dagousset; Thierry Delbot; Marc Dreyfuss; Lionel Groussin; Robert J Marlowe; Françoise Aubène Leger; Alain Chevalier
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-11
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  -     ISSN:  1945-7197     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Departments of Nuclear Medicine (J.C., M.B.-P., C.P.M., F.D., T.D., F.A.L., A.C.) and Endocrinology (C.P.M., F.D., L.G.), Université René Descartes Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, 75679 Paris, France; and Spencer-Fontayne Corporation (R.J.M.), Jersey City, New Jersey.
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