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Background: Radioiodine (RI) ablation following thyroid-stimulating hormone suppression is an effective treatment for papillary thyroid cancer (PTC), typically leading to favorable outcomes. However, RI-refractory tumors exhibit aggressive behavior and poor prognoses. Recent studies highlight the role of genetic abnormalities in PTC signaling pathways, including the activation of telomerase reverse transcriptase (TERT), and the correlation of mutations with adverse outcomes., Methods: This study analyzed mutations in BRAF V600E and the TERT-promoter genes, comparing clinicopathological features between RI-refractory and RI-responsive PTCs. Among 82 RI-refractory patients, formalin-fixed, paraffin-embedded tissues from initial surgeries were available for 26. Another 89 without distant metastasis over 5 years formed a matched RI-responsive control group., Results: Histopathologically, RI-refractory PTCs showed increased frequencies of small tumor clusters without fibrovascular cores, hobnail features, and a high height-to-width ratio of tumor cells. These tumors were more likely to exhibit necrosis, mitosis, lymph node metastasis, extrathyroidal extension, and involvement of resection margins. TERT-promoter mutations were statistically significantly associated with these aggressive clinicopathologic features. Immunohistochemically, decreased expression of sodium iodide symporter and thyroglobulin stimulating hormone receptor proteins was common in RI-refractory PTCs, along with lower levels of oncogenic proteins such as vascular endothelial cell growth factor, vascular endothelial cell growth factor receptor 2, and nuclear factor kappa-light-chain-enhancer of activated B cells. Total loss of PTEN expression was occasionally observed. In contrast, all cases tested positive for cytoplasmic β-catenin., Conclusions: RI-refractory PTCs are linked to TERT mutations and exhibit specific aggressive histopathologic features, particularly in tumor centers.

Objective: To provide a narrative review of challenges and opportunities in the care of thyroid cancer survivors., Methods: A literature search for full-text articles pertaining to quality of life and survivorship in thyroid cancer was performed and supplemented with personal experience of the authors., Results: Despite usually favorable prognosis for most thyroid cancer survivors, health-related quality of life (HRQOL) can be as poor or even worse than that in more aggressive cancers. Worry of cancer recurrence and long-term effects from cancer treatment adversely affects HRQOL in addition to other factors. Disparities and financial hardships among thyroid cancer survivors further affect HRQOL. In addition to monitoring for cancer recurrence and managing hypothyroidism, long-term effects from cancer treatment, including surgical complications, effects from radioactive iodine therapy, a small but increased risk of second primary malignancies, and aging-related health conditions (bone, cardiac, and fertility), need to be monitored for and addressed during survivorship care., Conclusion: Survivorship care models can vary depending on the specifics of the population served; however, a team-based survivor-centered approach provides the best care to thyroid cancer survivors., Competing Interests: Disclosure The authors have no conflicts of interest to disclose., (Copyright © 2024 AACE. Published by Elsevier Inc. All rights reserved.)

By combining dark-field optical microscopy with an in situ thermochemical aqueous solution system, we report a single-particle imaging strategy to investigate the host-guest interactions between covalent organic framework-300 (COF-300) as a representative COF host and a series of linear-chain fatty amines. The thermodynamic parameters, such as dissociation constant, Gibbs free energy changes, enthalpy changes, and entropy changes for the binding events within COF-300 are quantified. Correlation between the hydrophobicity of various amines and other data suggests that the mechanism of the host-guest bindings arises from the entropy-driven noncovalent interactions such as hydrogen bonds and van der Waals forces. These mechanistic insights allow for the rational design and preparation of COF-300-encapsulated n -octylamine with enhanced trapping performance of radioactive 131 I - . This study not only provides thermodynamic insights into the host-guest interactions within the COF framework but also establishes a structure-property relationship between fatty amines and energetic magnitude information.

Background: Noise, an unwanted variability in judgment, is ubiquitous in medicine, including in the prescription of radioactive iodine (RAI). Building upon our recently developed predictive risk model, we created an online clinical support tool to facilitate the translation of our model into clinical practice. The aim of this study is to assess the utility of an online clinical support tool to reduce noise in the treatment for patients with differentiated thyroid cancer (DTC)., Methods: The tool was accessible via weblink or a QR code. Activity recommendations were applied to the calculator's four risk categories: 0 GBq for very low risk, 1 GBq for low risk, 4 GBq for intermediate risk, and 6 GBq for high risk. The tool was applied prospectively to 103 patients who received RAI at Royal North Shore Hospital between 2021 and 2022 and retrospectively to 393 patients treated with RAI between 2017 and 2021., Results: A significant difference was observed in administered activity between the 2021-2022 and 2017-2021 cohorts in patients stratified as intermediate risk (median activity 3.95 GBq, interquartile range 2.03-4.04 vs 4 GBq, 4-4) and high risk (4.07 GBq, 3.95-5.7 vs 6 GBq, 6-6) with P-values of 0.01 and <0.01, respectively. No difference was seen in low-risk patients (2.01 GBq, 1.03-3.98 vs 1 GBq, 1-4, P = 0.30). Additionally, no clinically significant recurrence was observed between the two cohorts (6.6% vs 4.5%; P = 0.628)., Conclusion: Optimal risk classification and activity recommendation continue to be established. Our data suggest that providing risk stratification and activity recommendation in an easy-to-access online tool can reduce noise and variability in activity prescription for patients with DTC.

Objective: Radioactive iodine (RAI) therapy may cause hematologic abnormalities. The aim of this study is to evaluate long-term hematologic effects in differentiated thyroid cancer (DTC) patients after RAI therapy. Materials and Methods: A total of 1389 patients with DTC who were treated with RAI were retrospectively evaluated. Complete blood cell counts before RAI therapy and at last follow-up and hematologic malignancy development were obtained from the electronic records. Results: In the long-term analysis, thrombocytopenia and lymphopenia were observed significantly in patients over 60 years of age. Thrombocytopenia was observed more frequently in men. Leukopenia, thrombocytopenia, and lymphopenia were observed significantly with doses of >175 mCi. Thrombocytopenia and lymphopenia were observed significantly with multiple dose administration. Higher frequencies of anemia, thrombocytopenia, leukopenia, neutropenia, and lymphopenia were found in patients with advanced-stage disease. However, patients with advanced-stage disease had higher doses and more multiple doses than patients with early-stage disease. The rate of hematologic malignancy was found to be higher than in the general population. Conclusion: We suggest that cytopenia be surveyed more carefully in patients older than 60 years of age. The most important risk factor for lower platelets after RAI therapy is male gender. Clinically, the most important predictor for cytopenia is advanced disease stage, which is related to the combined effects of applied high dose activity, multiple dose applications, and high tumor burden.

Abstract Purpose The study was designed to elucidate the predictive value of the number of lymph node metastases (LNMs) and lymph node ratio (LNR) for response to therapy restratification system (RTRS). Methods From December 2015 to December 2019, 1228 patients who accepted radioactive iodine (RAI) were collected in the study. After 6–8 months, response to RAI was evaluated as complete response (excellent response) and incomplete response (indeterminate, biochemical, and structural incomplete response). The study developed classification tree to determine the optimum LNMs and LNR that predicted response to RAI. Multivariate logistic regression analyses were further analyzed to find independent factors of response to RAI. Result The mean age of patients was 44 ± 12 and 71.09% (873/1228) were females. The best cutoff value of LNMs to affect RAI treatment response determined by classification tree was 5. Further in 388 patients with LNMs >5, the best cutoff value of LNR to affect RAI treatment response determined by classification tree was 0.30. With multivariate analysis, the study found that LNMs (>5), gender, lymph node dissection, and American Thyroid Association (ATA) risk classification were independent predictors of response to RAI for all 1228 patients; and LNR (>0.30), gender, and ATA risk classification for 388 patients with LNMs >5. The sensitivity analysis indicated that whether patients with LNM or not were included, the multivariate logistic regression model was kept stable. On subgroup analysis, no significant interactions were observed between the effect of LNMs/LNR and gender, N stage, ATA risk classification, lymph node dissection, or T stage. Conclusions With classification tree, the study found that LNMs and LNR could predict initial response to RAI, and their optimal cutoff values were 5 and 0.30, separately.

PICO question In clinically hyperthyroid cats, is iodine-131 (I-131) treatment superior to unilateral or bilateral thyroidectomy in normalising serum thyroxine (T4) levels? Clinical bottom line Category of research question Treatment. The number and type of study designs reviewed 35 papers were critically reviewed. These were mostly retrospective studies with a small proportion of prospective cohort studies. Strength of evidence Moderate. Outcomes reported More papers were available evaluating the effect of radioiodine therapy on T4 levels compared to thyroidectomy. Long-term follow-up of T4 is a relatively new component of study designs. Most papers suggested between 40–87% cats had normal T4 6 months after treatment. 19–47% cats receiving unilateral or bilateral thyroidectomy, and 100% cats receiving radioiodine therapy were in long-term remission in one study. Conclusion In view of the evidence and outcomes from the studies, there is moderate evidence that I-131 treatment is superior to unilateral or bilateral thyroidectomy. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Objective: A low-iodine diet (LID) of <50μ iodine/day is recommended as preparation for radioactive iodine (RAI) therapy in patients with differentiated thyroid cancer (DTC). The 24-h urinary iodine excretion (UIE) is utilized to evaluate the iodine-depleted status. The aim of this study was to test the association between UIE and progression-free survival (PFS). Patients and methods: In total, 70 patients with intermediate- or high-risk DTC, post-total thyroidectomy, adhered to 2 weeks of LID and had UIE measured before RAI therapy. A Cox regression model was performed to study the contribution of UIE to PFS. Results: The study group consisted of 68% (48/70) of women, aged 41.5 [IQR 31.0, 54.0] years, with tumor size 2.8 [IQR 1.8-4.5] cm, and presence of distant metastases in 22.9% (16/70) of patients. Patients were treated with 1-5 RAI dosages with the median cumulative activity of 150 [IQR 102-314] mCi (5.5 [IQR 3.8-11.6] GBq). During the follow-up of 3.7 [IQR 1.5-6.5] years, 21.4% (15/70) of patients had disease progression. The risk of progression was significantly higher in patients with UIE ≥200 µg/day at the time of RAI administration than in those with UIE <200 µg/day (HR 3.35, 95% CI 1.09-10.34, and p = 0.02). However, the multivariate Cox proportional hazards regression analysis adjusted for age, tumor size, and presence of distant metastases suggested that only distant metastases were independently significantly associated with the risk of progression (HR 5.80 (1.17-28.67), p = 0.03). Conclusions: Although UIE ≥200 µg/day might be associated with worse PFS in RAI-treated DTC patients, the presence of distant metastases is a strong independent predictor of progression. Less stringent LID might be sufficient to achieve a UIE of <200 µg/day. [ABSTRACT FROM AUTHOR]

Introduction: Malignant struma ovarii (MSO) is a rare thyroid cancer arising within an ovarian teratoma. While surgical excision of the primary tumor is widely accepted as standard of care, recommendations for adjuvant treatment of MSO—whether or not to administer radioactive iodine (RAI)—are based largely on case reports and remain debated. In this study, we aimed to propose a risk stratification and analyze RAI utilization patterns in MSO cases. Methods: The National Cancer Database (NCDB) was queried for patients with MSO between 2004 and 2016. Demographic, oncological, and clinicopathologic data were compared between groups using Fisher's exact test. Kaplan–Meier curves were used to estimate overall survival (OS), and variables associated with OS were assessed via univariate Cox regression. We adapted the 2015 American Thyroid Association risk guidelines for MSO patients. We stratified patients into low-, intermediate-, and high-risk groups using metastasis, extraovarian extension, lymphovascular invasion, lymph node status, surgical margins, tumor size, and grade. Risk stratification, demographic, oncological, and clinicopathologic data were compared between the groups receiving and not receiving RAI therapy. We then queried the Surveillance, Epidemiology, and End Results (SEER) 18 registry for patients with MSO between 2000 and 2018 to confirm our risk stratification analysis. Results: In the NCDB analysis, a total of 158 patients were identified, and 19 received RAI. RAI therapy was associated with distant metastasis (p = 0.005) and lymph node status (p = 0.012). Twenty-one NCDB patients were stratified as high risk, and 30% of high-risk patients received RAI. High-risk stratification was associated with decreased OS via univariate Cox regression (hazard ratio = 4.0 [95% confidence interval 1.11–14.26], p = 0.034). In our subsequent analysis using the SEER registry, there were 95 MSO patients, and 18 received RAI. Again, the majority of high-risk patients did not receive RAI, with only 41% of high-risk patients receiving RAI. Conclusions: MSO is a rare malignancy with apparently variable and inconsistent patterns of postoperative RAI administration. The risk stratification described here provides a framework to identify patients potentially at risk for mortality, and utilization of RAI in this group should be studied further. [ABSTRACT FROM AUTHOR]

Patients with differentiated thyroid cancer (DTC) usually have good prognosis, while those with advanced disease have poor clinical outcomes. This study aimed to investigate the antitumor effects of combination therapy with lenvatinib and 131I (CTLI) using three different types of DTC cell lines with different profiling of sodium iodide symporter (NIS) status. The radioiodine accumulation study revealed a significantly increased radioiodine uptake in K1-NIS cells after lenvatinib treatment, while there was almost no uptake in K1 and FTC-133 cells. However, lenvatinib administration before radioiodine treatment decreased radioiodine uptake of K1-NIS xenograft tumor in the in vivo imaging study. CTLI synergistically inhibited colony formation and DTC cell migration, especially in K1-NIS cells. Finally, 131I treatment followed by lenvatinib administration significantly inhibited tumor growth of the NIS-expressing thyroid cancer xenograft model. These results provide important clinical implications for the combined therapy that lenvatinib should be administered after 131I treatment to maximize the treatment efficacy. Our synergistic treatment effects by CTLI suggested its effectiveness for RAI-avid thyroid cancer, which retains NIS function. This potential combination therapy suggests a powerful and tolerable new therapeutic strategy for advanced thyroid cancer. [ABSTRACT FROM AUTHOR]

Introduction: Salivary gland dysfunction (e.g., sialadenitis and xerostomia) is the most common complication of radioactive iodine (RAI) therapy for differentiated thyroid cancer (DTC). Several methods have been used to reduce/prevent this adverse effect. We aimed to systematically review the effectiveness of non-pharmacological and pharmacological interventions in preventing RAI-induced salivary gland dysfunction in patients with DTC. Methods: A systematic review was conducted, according to PRISMA guidelines. The protocol was registered (PROSPERO: CRD42022295229). PubMed, Embase, Scopus, and the Cochrane Library electronic databases were searched from inception to November 2021. Inclusion criteria were randomized controlled trials of DTC patients who were older than 18 years and underwent RAI after thyroidectomy in which at least one studied group received an intervention to prevent salivary gland dysfunction. Results: Twelve studies (a total of 667 participants) were included. Among DTC patients who were treated with RAI, nonpharmacological treatment such as parotid gland massage and aromatherapy ameliorated salivary gland dysfunction. Antioxidants such as vitamin E and selenium demonstrated radioprotective effects on the salivary gland, while other antioxidants did not show radioprotective benefits. Vitamin C showed no significant effects on preventing salivary gland dysfunction. Amifostine had inconsistent outcomes among studies. Among cholinergic agonists, pilocarpine did not demonstrate the radioprotective effect on parotid glands, while bethanechol lowered salivary gland dysfunction. However, the negative results from pilocarpine may be explained by the strong sialorrheic effect of the Cincinnati regimen in both study arms. Conclusion: Among non-pharmacological and pharmacological methods, parotid gland massage, aromatherapy, vitamin E, selenium, amifostine, and bethanechol may have benefits in minimizing RAI-induced salivary gland dysfunction in patients with DTC. The results are limited by a small number of patients and should be confirmed in future larger randomized controlled trials. [ABSTRACT FROM AUTHOR]

It remains controversial whether papillary thyroid cancer (PTC) patients with lowto intermediate-risk disease should receive radioactive iodine (RAI) after total thyroidectomy (TT). We aim to identify those who might benefit from RAI treatment in PTC patients with cervical nodal metastasis after TT. Patients were divided into TT and TT+RAI groups fromthe Surveillance, Epidemiology, and End Results (SEER) database (2004-2018). Overall survival (OS) and cancer-specific survival (CSS) were compared, and propensity score matching (PSM) was performed between groups. A total of 15,179 patients were enrolled, including 3,387 (22.3%) who underwent TT and 11,792 (77.7%) who received TT+RAI. The following characteristics were more likely to present in the TT+RAI group: multifocality, capsular extension, T3, N1b, and more metastatic cervical lymph nodes. RAI was associated with better OS in low- to intermediate-risk PTC patients in themultivariate Cox regression model. The subgroup analysis showed that RAI predicted better OS in patients =55 years, American Joint Committee on Cancer (AJCC) stage II, and capsular extension with a hazard ratio (HR) (95% CI) of 0.57 (0.45-0.72), 0.57 (0.45-0.72), and 0.68 (0.51-0.91), respectively. However, RAI failed to improve the prognoses of patients with age <55 years, AJCC stage I, PTC =1 cm, and capsular invasion. In the PSM cohort with 3,385 paired patients, TT+RAI treatment predicted better OS compared with TT alone. In addition, TT+RAI predicted better OS in patients with metastatic cervical lymph nodes =2, multifocality, extracapsular extension, and American Thyroid Association (ATA) intermediate risk. In conclusion, RAI was associated with better OS in low- to intermediate-risk PTC patients with age =55 years, multifocality, extrathyroidal extension, and ATA intermediate risk. However, the survival benefit from RAI may be limited in patients with AJCC stage I, PTC =1 cm, unifocality, capsular invasion, and ATA low-risk diseases; these patients even showed pathological cervical lymph node metastasis. [ABSTRACT FROM AUTHOR]

Objectives: Although radioiodine (131I) is the treatment of choice for feline hyperthyroidism, 131I-dosing protocols commonly induce iatrogenic hypothyroidism and expose azotaemia. A recently reported patient-specific 131I dosing algorithm minimised the risk of 131I-induced hypothyroidism and azotaemia, while maintaining high cure rates. The aim of the study was to report results of 131I treatment in a European population of hyperthyroid cats using this patient-specific dosing algorithm. Methods: This prospective case series (before-and-after study) evaluated 165 hyperthyroid cats referred for 131I treatment. All cats had serum concentrations of thyroxine (T4), triiodothyronine (T3) and thyroid-stimulating hormone (TSH) measured (off methimazole ⩾1 week). Thyroid volume and percentage uptake of 99mTc-pertechnetate (TcTU) were determined using thyroid scintigraphy. An initial 131I dose was calculated by averaging dose scores for T4/T3 concentrations, thyroid volume and TcTU; 70% of that composite dose was then administered. Twenty-four hours later, percentage 131I uptake was measured, and additional 131I administered as needed to deliver an adequate radiation dose to the thyroid tumour(s). Serum concentrations of T4, TSH and creatinine were determined 6–12 months later. Results: Median calculated 131I dose was 2.15 mCi (range 1.2–7.5), with only 51 (30.9%) receiving ⩾2.5 mCi. Of 165 cats, 124 (75.2%) became euthyroid, seven (4.2%) became overtly hypothyroid, 27 (16.4%) became subclinically hypothyroid and seven (4.2%) remained hyperthyroid. A higher proportion of overtly (85.7%) and subclinically (26.9%) hypothyroid cats developed azotaemia than euthyroid cats (13.6%; P = 0.0002). Hypothyroid cats were older (P = 0.016) and more likely to have detectable TSH concentrations (P = 0.025) and symmetrical bilateral distribution of 99mTc-pertechnetate uptake (P = 0.0002), whereas persistently hyperthyroid cats had higher severity scores (P = 0.012). Conclusions and relevance: Our results confirm that 131I dosing with this new algorithm results in high cure rates, with a lowered prevalence of 131I-induced overt hypothyroidism and azotaemia. Age, serum TSH concentrations, bilateral, symmetrical uptake and severity score help predict outcome. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate the impact of various factors including radioactive iodine (RAI) activity on the therapeutic response according to the range of serum thyroglobulin (Tg) in patients with papillary thyroid carcinoma (PTC). Methods: A total of 2809 patients were retrospectively enrolled from 24 hospitals. They were divided into four subgroups according to their serum Tg (stimulated Tg, sTg) or anti-Tg antibody (TgAb) levels, measured just before RAI therapy: sTg < 2 ng/mL, 2 ≤ sTg < 10 ng/mL, sTg ≥ 10 ng/mL, and TgAb > 100 IU/mL. The clinicopathologic factors for therapeutic responses, which were classified as acceptable response (AR) or non-AR, were compared in each subgroup. Results: Clinical impact of the pN category on therapeutic response was different among subgroups based on sTg levels (subgroups with sTg < 2 ng/mL (P = 0.057), 2 ≤ sTg < 10 ng/mL (P = 0.032), and sTg ≥ 10 ng/mL (P = 0.001)). The pN category was also a significant factor in the subgroup with TgAb > 100 IU/mL (P = 0.006). The pT category was not associated with therapeutic response regardless of the sTg level. High activities of RAI (≥ 3.70 GBq) were associated with favorable therapeutic responses in only the subgroup with sTg ≥ 10 ng/mL (P = 0.044). Conclusion: Risk factors for response prediction could be repositioned based on the serum Tg before RAI therapy. RAI activity should be determined while considering the serum Tg-aided remnant thyroid or malignant tissues as well as conventional factors. [ABSTRACT FROM AUTHOR]

Purpose: Patients undergoing thyroidectomy for differentiated thyroid cancer (DTC) may require 131-radioactive iodine (RAI) administration for remnant ablation or disease treatment. After ingestion, RAI resides within the gastrointestinal tract potentially leading to mucosal damage and abnormalities in the absorption of levothyroxine (LT4). The aim of this study was to evaluate whether serum FT4 peak, induced by a LT4 challenge, changes according to the LT4 formulation (solid or liquid) in both RAI and non-RAI-treated DTC patients. Methods: This was a monocentric controlled clinical trial, with a parallel two-groups (1:1) randomization of sequence of LT4 formulation. Patients received 200 mcg LT4 orally administered at 08:00 h, in both solid and liquid formulation, at one-week interval, at baseline and after 1, 3, and 6 months from RAI administration. At each time-point, circulating FT4 was evaluated both before LT4 assumption as well as after 1 and 3 h. FT4 increments were evaluated as area under the curve response (AUC). Analogous protocol with the same time-intervals was followed for non-RAI patients. Results: The trial included 29 consecutive DTC patients, nineteen of whom were submitted to RAI. In RAI subjects, we observed an overall significant reduction in serum FT4 increments with the most relevant decrease at the 1-month time-point, (FT4 AUC: 4.46 ± 0.72 (M ± SD) vs 4.07 ± 0.63 in baseline vs 1-month, P = 0.001) without any difference between the two LT4 formulations. No difference in serum FT4 AUC was found in non-RAI subjects. Conclusion: LT4-induced serum FT4 responses are reduced following RAI administration in thyroidectomized DTC patients. [ABSTRACT FROM AUTHOR]

Introduction: The initial post-surgical radioactive iodine (RAI) therapy for patients with papillary thyroid cancer (PTC) is postponed due to increased demand as well as the limited number of centers to provide RAI therapy. Hence, our aim was to investigate the role of first RAI administration time following thyroidectomy on the number of incomplete response (IR) during the initial follow up, while considering other prognostic factors. Methods: Two hundred and thirty-five PTC patients who were admitted to our department for RAI therapy were included in this study. They were allocated into two groups with <3 months (early group) and = 3 months (delayed group) time interval after the first RAI therapy, and the total thyroidectomy. Then, based on the response to RAI therapy, patients were categorized as excellent, biochemical incomplete, structural incomplete, or indeterminate responses (ER, BIR, SIR or IDR, respectively). Results: With respect to age, gender, pathologic variables, RAI dose rate and IR (BIR+SIR) rate, significant differences were found between the two groups. The findings identified that early RAI failed to affect the rate of IR (univariate analysis: HR=1.09, 95%CI: 0.69-1.74, P=0.71; Cox model: HR=0.81, 95%CI: 0.46-1.44, P=0.47). However, Cox multivariate analysis found lymph node status and thyroglobulin level (Lymph node status: HR=2.88, 95%CI: 1.07-7.78, P=0 .04) as independent risk factors for IR during the initial follow up. Conclusion: Therefore, timing of the first post-surgery RAI therapy is not a significant prognosticator of the initial response of patients to therapy. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid cancer (PTC) represents most of cases of differentiated thyroid cancers. Thyroidectomy followed by radioactive iodine (RAI) remnant ablation represent the cornerstone management of many intermediate and high-risk patients according to American Thyroid Association (ATA). Objective: This study aimed to evaluate the outcome of different used I131 ablation doses (80, 100 and 120 mCi) in intermediate and high-risk patients in our hospital and to analyze the predictors affecting RAI failure. Besides, survival analysis was conducted as a secondary objective of the study. Patients and Methods: This was a retrospective study conducted on 63 patients diagnosed as PTC at our hospital from January 2015 till February 2020. Our study involved only PTC pathology, mean age of 40.6 ± 13.4 years at diagnosis, and intermediate- and high-risk patients according to ATA initial risk stratification system, 2015. Results: Among the 63 patients included in this study (17 males and 46 females), 41 were classified as intermediate- risk, while 22 were classified as high-risk based on the ATA guideline. Overall RAI ablation success, in both groups, was observed in 43/63 (68.25%) patients. Moreover, it was achieved in 31/41 (75.6%) of intermediate-risk patients and in 12/22 (54.5%) high-risk patients. Pre-ablation stimulated Tg >1ng/ml was statistically significant negative predictor of ablation failure [P-value < 0.001, odd`s ratio 61.5, 95% CI (10.8-51.5)]. Conclusion: There was no statistically significant difference between success rates of I131 doses in intermediate- and high-risk groups. However, the failure rates were more after 120 mCi due to the associated more aggressive underlying disease, especially higher-risk patients so higher RAI activities are recommended for this risk group. [ABSTRACT FROM AUTHOR]

Objective:The objective of this study was to identify the characteristic features of patients with distant metastasis as the only manifestation of well-differentiated thyroid cancers and to analyze the treatment outcomesMethods:A retrospective review of all patients with well-differentiated thyroid cancers and distant metastasis as the sole initial presentation was carried out. Data regarding age, gender, tumor histology, site, symptoms, and treatment outcomes were collected.Results:There were 10 patients who presented with distant metastasis as the only presentation. The mean age was 56.1 years. Eight (80%) patients had osseous metastasis, one (10%) had pulmonary and one (10%) had both. Follicular thyroid carcinoma was more common and seen in six (60%) patients. Seven (77.8%) out of nine patients had demised within five years of initial presentation.Conclusion:Distant metastases without a neck lump as the initial presentation of well-differentiated thyroid cancers are extremely rare. No specific guidelines are available to manage such patients due to lack of relevant data in the literature.

Abstract Background Radioiodine (131I) is the treatment of choice for hyperthyroidism in cats, but current 131I‐dosing protocols can induce iatrogenic hypothyroidism and expose azotemia. Objectives To develop a cat‐specific algorithm to calculate the lowest 131I dose to resolve hyperthyroidism, while minimizing risk of iatrogenic hypothyroidism and subsequent azotemia. Animals One thousand and four hundred hyperthyroid cats treated with 131I. Methods Prospective case series (before‐and‐after study). All cats had serum concentrations of thyroxine (T4), triiodothyronine (T3), and thyroid‐stimulating hormone (TSH) measured (off methimazole ≥1 week). Using thyroid scintigraphy, each cat's thyroid volume and percent uptake of 99mTc‐pertechnatate (TcTU) were determined. An initial 131I dose was calculated by averaging dose scores for T4/T3 concentrations, thyroid volume, and TcTU; 80% of that composite dose was administered. Twenty‐four hours later, percent 131I uptake was measured, and additional 131I administered, as needed, to deliver an adequate radiation dose to the thyroid tumor(s). Serum concentrations of T4, TSH, and creatinine were determined 6 to 12 months later. Results The median calculated 131I dose was 1.9 mCi (range, 1.0‐10.6 mCi); 1380 cats required additional 131I administration on day 2. Of the cats, 1047 (74.8%) became euthyroid, 57 (4.1%) became overtly hypothyroid, 240 (17.1%) became subclinically hypothyroid, and 56 (4%) remained hyperthyroid. More overtly (71.9%) and subclinically (39.6%) hypothyroid cats developed azotemia than euthyroid cats (14.2%; P

Nuclear medicine history has its share of captivating personalities, controversial claims, and forgotten pioneers. Publications and documents that came out relatively recently, provide us with new perspectives on its history. Primary sourced material might contradict some of the long-held beliefs of the reader who only has a casual familiarity with the events, including basics such as who discovered radioactivity.Because of the nature of the specialty, the importance of the contributions of colleagues in related fields, like physics and chemistry, cannot be overstated. Many of the important discoveries were marked by serendipity, but the pioneers must be given credit for having the necessary insights to interpret the new phenomena correctly, sometimes turning perceived “failure” into novel scientific principles. In addition, most of our pioneers had to deal with inadequate facilities and funding, religious and racial discrimination, and even misogynism.The early history of nuclear medicine is presented in this article as a series of its most interesting anecdotes, from the early work on radioactivity, to the conception of the tracer principle, until the development of radioactive iodine therapy.

Synthesized composites of CNM-25 with different bismuth doping amounts for the adsorption of gaseous iodine as well as iodine in cyclohexane solution. [Display omitted] • Bismuth-doped Cu-BTC@g-C 3 N 4 composites (x%Bi-CNM-25) were synthesized by in situ synthesis method. • Melamine sportive Cu-BTC composites capture iodine due to nitrate and CNH bonding both in gaseous and solution form. • The XPS spectrum confirms presence of polyiodides ions (I 3 -, I 5 -)on the surface of adsorbent. • Bismuth doped composites have low SBET (842.76 m2/g) but capturing high iodine, imply chemisorption and mechanism of adsorption was explained. Capturing radioactive iodine effectively is a top priority, but it remains a major challenge. In this manuscript, we report the synthesis of a bismuth-doped Cu-BTC [Cu 3 (BTC) 2 , BTC=1,3,5-benzenetricarboxylate] (%Bi/Cu-BTC) with a graphitic carbon nitride (g-C 3 N 4) (Bi/Cu-BTC@g-C 3 N 4) abbreviated as (x%Bi-CNM-25) via an in-situ, solvothermal method for the highly efficient absorption of iodine. The exceptional iodine capture performance of x%Bi-CNM-25 can be attributed to the strong chemical bonding between bismuth (Bi) and iodine (I 2), the unsaturated metal, and the amine (−N) groups, highlighting the high effectiveness of this interaction. Furthermore, to evaluate Bi-CNM-25 as an effective sorbent, it was characterized via scanning electron microscopy-energy dispersion spectroscopy (SEM-EDS), Fourier-transform infrared spectroscopy (FITR), TGA/DTA, and X-ray powder diffraction (XRD). The BET-specific surface areas (S BET) were reported as 761.0782, 1,132.65, and 424.8015 m2/g for Cu-BTC, CNM-25, and 40 %Bi-CNM-25 and pore volume was 0.338, 0.493, and 0.215 cm3/g with (P/Po = 0.99) respectivily. Through experiments, its elemental composition and vibration before and after iodine adsorption were analyzed via EDS and X-ray photoelectron spectroscopy (XPS). During the capture process, I 2 is reduced to I− by the intercalated Bi3+ via chemical adsorption. The maximum adsorption capacity of the Bi-CNM-25 composite exhibited for vapor iodine reached up to 588 mg/g in the form of an I 2 molecule, which had a surface area, average pore diameter, and pore volume of 842.7342 m2/g, 4.54 nm, and 0.3900 cm3/g, respectively. The iodine absorption was up to 156.41 mg/g in kinetic and 169.32 mg/g for adsorption isotherm. The Langmuir isotherm and pseudo-second-order kinetic model followed the adsorption. To validate the results of model, statistical error validity models, such as Sum square error (SSE), Average relative error (ARE), Sum of absolute error (EABS), Hybrid fractional error function were applied. Moreover, the TGA/DTA results indicate that the adsorption of iodine by the 40 % Bi-CNM-25 was exothermic, spontaneous, and more stable, exhibiting thermal stability (320 °C). As per the previous different adsorbents for iodine adsorption, 40 %Bi-CNM-25 displayed iodine adsorption of approximately two times that of the commercial Ag-exchange zeolite X, and besides, x%Bi-CNM-25 is cost-effective. Therefore, the significant iodine capture by x%Bi-CNM-25 indicates that it is a capable adsorbent composite with great potential as a material for capturing and temporarily storing radioactive iodine. [ABSTRACT FROM AUTHOR]

Effectively removing radioactive iodine from the environment is critical for mitigating the risks associated with nuclear accidents. This research presents a brand-new Fe-Cu-BTC metal-organic framework (MOF) composite that works very well to absorb iodine. We employed a facile one-pot solvothermal method to achieve epitaxial growth of Fe-BTC on a Cu-BTC substrate. A full analysis using SEM, EDS, FTIR, XRD, BET, TEM, XPS, Raman, and TGA/DTA showed that the composite was successfully made while the crystalline structure of the CuBTC was kept. It was amazing how well the Fe-Cu-BTC composite could absorb iodine, reaching maximum capacities of 217.92 mg/g in solution and 623.21 mg/g in vapor phases, respectively, within the time limits given. The material demonstrated remarkable stability and recyclability, retaining its structural integrity and efficiency over five consecutive adsorption-desorption cycles. The high BET surface area of 820.35 m/g, pore volume of 0.328 cm/g, and pore diameter of 2.950 nm of the composite contributes to its superior adsorption performance. The composite exhibits exceptional stability under acidic conditions with a pH of 2>8. Studies of the adsorption isotherm and kinetics showed that the Langmuir and pseudo-second-order models correctly describe how iodine binds, with R² values of 0.995 and 0.994, respectively. XPS and Raman spectroscopy with peak values (72.21, 104.4, and 167.04) cm-1 confirmed the formation of polyiodides (I₃⁻ and I₅⁻) on the MOF surface, suggesting a physical adsorption mechanism. The Fe-Cu-BTC composite has a controlled synthesis, millimeter-scale dimensions, a porous structure, is very stable, and can be recycled easily. It looks like it could be a good way to capture and store iodine from a variety of environmental sources, such as reprocessing plant off-gas streams and liquid effluents. [Display omitted] • Fe-Cu Bimetal MOF was synthesized via the Solvothermal method. • Fe/Cu MOF have a high specific area and pore diameter and maintain the macrospores and mesoporous. • Cu-BTC Structure stability is maintained due to the iron sportive behavior. • The Bimetallic MOF adsorbent adsorbed iodine both in gaseous form and from solution. • The XPS and Raman spectrum confirm the presence of iodine as a polyiodide ion (I 3 -, I 5 -) on the surface of the adsorbent. [ABSTRACT FROM AUTHOR]

IntroductionSalivary gland dysfunction (e.g., sialadenitis and xerostomia) is the most common complication of radioactive iodine (RAI) therapy for differentiated thyroid cancer (DTC). Several methods have been used to reduce/prevent this adverse effect. We aimed to systematically review the effectiveness of non-pharmacological and pharmacological interventions in preventing RAI-induced salivary gland dysfunction in patients with DTC.MethodsA systematic review was conducted, according to PRISMA guidelines. The protocol was registered (PROSPERO: CRD42022295229). PubMed, Embase, Scopus, and the Cochrane Library electronic databases were searched from inception to November 2021. Inclusion criteria were randomized controlled trials of DTC patients who were older than 18 years and underwent RAI after thyroidectomy in which at least one studied group received an intervention to prevent salivary gland dysfunction.ResultsTwelve studies (a total of 667 participants) were included. Among DTC patients who were treated with RAI, nonpharmacological treatment such as parotid gland massage and aromatherapy ameliorated salivary gland dysfunction. Antioxidants such as vitamin E and selenium demonstrated radioprotective effects on the salivary gland, while other antioxidants did not show radioprotective benefits. Vitamin C showed no significant effects on preventing salivary gland dysfunction. Amifostine had inconsistent outcomes among studies. Among cholinergic agonists, pilocarpine did not demonstrate the radioprotective effect on parotid glands, while bethanechol lowered salivary gland dysfunction. However, the negative results from pilocarpine may be explained by the strong sialorrheic effect of the Cincinnati regimen in both study arms.ConclusionAmong non-pharmacological and pharmacological methods, parotid gland massage, aromatherapy, vitamin E, selenium, amifostine, and bethanechol may have benefits in minimizing RAI-induced salivary gland dysfunction in patients with DTC. The results are limited by a small number of patients and should be confirmed in future larger randomized controlled trials.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295229, PROSPERO, identifier CRD42022295229.

We present a 61-year-old Chinese female who had a history of angioinvasive follicular thyroid cancer (FTC) treated with total thyroidectomy 16 years ago, without radioactive iodine (RAI) treatment who now presents with de novo pretibial myxedema (PTM) followed by active severe Graves’ ophthalmopathy (GO) requiring pulse steroids and radiotherapy.

Abstract Background We identified differentiated thyroid cancer (DTC) survivors from SEER registries and performed Poisson regression to calculate the relative risks (RRs) of subsequent malignancies (SMs) by different sites associated with radioactive iodine (RAI) treatment, and the attributable risk proportion of RAI for developing different SMs. Results We identified 4628 of 104,026 DTC patients developing a SM after two years of their DTC diagnosis, with a medium follow-up time of 113 months. The adjusted RRs of developing SM associated with RAI varied from 0.98 (0.58–1.65) for neurologic SMs to 1.37 (1.13–1.66) for hematologic SMs. The RRs of developing all cancer combined SMs generally increased with age at DTC diagnosis and decreased with the latency time. We estimated that the attributable risk proportion of RAI treatment is only 0.9% for all cancer combined SMs and 20% for hematologic SMs, which is the highest among all SMs. The tumor features and mortalities in patients treated with and without RAI are generally comparable. Conclusion With the large population based analyses, we concluded that a low percentage of DTC survivors would develop SMs during their follow-up. Although the adjusted RR of SMs development increased slightly in patients receiving RAI, the attributable risk proportion associated with RAI was low, suggesting the absolute number of SMs induced by RAI in DTC survivors would be low. The attributable risk proportion of RAI treatment is the highest in hematological SMs, but when in consideration of its low incidence among all DTC survivors, the absolute number of hematological SMs was low.

Abstract Background The main purpose is to investigate the effect of LiCO3 as an add-on therapy with radioactive iodine in increasing the cure and decreasing the T4 level compared to radioactive iodine alone. The primary outcome is the cure rate as defined by the number of hyperthyroid patients who became euthyroid or hypothyroid. The secondary outcome is the T4 level. Methods Four databases were searched (PubMed, Scopus, Web of Science, and Cochrane central library). The inclusion criteria were randomized and non-randomized clinical trials of hyperthyroidism patients receiving LiCO3 with radioiodine compared with hyperthyroidism patients receiving radioactive iodine alone. Included studies were appraised with the risk of bias version 2 tool, according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Results Nine studies were eligible for inclusion in the study, six randomized control trials and three non-randomized control trials. There were 477 patients in the intervention group and 451 patients in the control group. The cure rate was not significantly different between the two groups, while it was significantly increased with 5000 to 6500 mg optimized cumulative dose of LiCO3 compared with the control group, P = 0.0001. The T4 level showed no significant difference between the two groups, P = 0.13. Conclusions LiCO3 adjunct to radioactive iodine did not show significant differences compared with radioactive iodine alone in terms of cure rate or decreasing T4 level. However, the dose of 5000 to 6000 mg of LiCO3 may increase the cure rate.

Exploring efficient, cheap and scalable adsorbents to capture the radioactive iodine gas is crucial for the sustainable development of nuclear energy. Herein, novel copper-based carbon (Cu–C) adsorbents were facilely prepared and applied for iodine adsorption. C supports were prepared by a simple sintering method using rice husk as carbon source. Cu–C adsorbents were synthesized by an improved impregnation reduction method. The adsorption behaviors impacted by Cu content and contact time were investigated. The adsorption mechanism was elucidated through XRD, SEM, XPS and TGA analyses. The results demonstrated that the adsorption capacity of 30%Cu–C sample reached up to 1282 mg/g due to the synergistic effect of copper and carbon. In addition, the obtained Cu–C adsorbents and adsorbed iodine exhibited high thermal stability. The dominant mechanism for the adsorption of iodine gas on Cu–C materials were chemical reaction (2Cu + I 2 = 2CuI) and C–I interaction. Thanks to the excellent properties, the obtained Cu–C materials could be added into the list of potential iodine gas adsorbents. • Efficient, cheap and scalable Cu–C iodine gas adsorbents were reported. • Cu–C adsorbents were facilely prepared using rice-husk derived C as supports. • High capture capacity (1282 mg/g) was attributed to synergistic effect of Cu and C. • The obtained Cu–C adsorbents and adsorbed iodine exhibited high thermal stability. • The dominant adsorption mechanism was chemical reaction and C–I interaction. [ABSTRACT FROM AUTHOR]

[Display omitted] • Six types of Cu 2 O nanocrystals with varying exposures of crystal facets and edges are synthesized. • Oxygen vacancies were generated on the surface of Cu 2 O by adding PVP. • {1 0 0}+{1 1 1} co-exposed Cu 2 O exhibited superior adsorption capacity and rate for I−. • The introduction of Oxygen vacancies significantly increased the affinity of Cu 2 O for I−. Radioactive iodine removal continues to pose significant challenges. In this study, the advantages of crystal facet and defect engineering were utilized to synthesize six types of Cu 2 O nanocrystals with varying crystal facet exposed, crystal edge exposed, and abundant oxygen vacancies (O Vs). Compared to pure {1 0 0} and {1 1 1} exposed Cu 2 O, {1 0 0}+{1 1 1} co-exposed Cu 2 O exhibited superior adsorption capacity and adsorption rate for iodide ions (I−), achieving a removal efficiency of 96 % for trace I− (0.1 mg/L). Moreover, O Vs significantly contribute to iodide ion (I−) adsorption. Experimental and density functional theory (DFT) analyses confirmed that the active sites on {1 0 0}/{1 1 1} crystal edges possess the highest affinity for I−. The O Vs disrupts the charge balance of the Cu 2 O surface and increases unsaturated coordination sites of Cu, therefore, it significantly enhanced the affinity for I−. This research offers insights into the design of effective I− adsorption materials using crystal facet and defect engineering strategies. [ABSTRACT FROM AUTHOR]

• Copper tellurite glass is developed for radioactive iodine immobilization. • The maximum iodine retention is approximately 13.79 wt% for the CuI waste form. • The CuI in the glass matrix causes an increase of Cu2+ and bridging oxygen. • All samples satisfy the US regulation of 2 g/m2 for the normalized release. Radioactive iodine-129 can easily diffuse into the environment and possesses a half-life of 1.57 × 107 years. Therefore, durable and stable waste forms are required for the treatment I-129. In this study, CuI·Cu 2 O·TeO 2 glasses were fabricated by incorporating CuI into a copper tellurite glass (0.3Cu 2 O·0.7TeO 2) matrix at different concentrations ranging from 0 to 30 mol%. The X-ray diffraction analysis confirmed the amorphous phase of all prepared samples, and X-ray fluorescence analysis verified iodine volatilization during the melting process. With the addition of 30 mol% CuI, the maximum iodine loading was approximately 13.79 wt%. X-ray photoelectron spectroscopy and Raman spectroscopy were used to understand the structure of the CuI·Cu 2 O·TeO 2 glass waste forms. As the CuI content increased in the glass matrix, there was an increase of +2-valent Cu and O BO. It was further confirmed that there were no significant changes in the structure of Te, which serves as the glass network former. Furthermore, all samples satisfied the US regulation of 2 g/m2 for the normalized release of all elements, as confirmed through the product consistency test. The proposed glass waste forms have cost advantages over previously developed silver-based glasses, making them a promising avenue for further research. [ABSTRACT FROM AUTHOR]

Background: More than a third of thyroid carcinoma (TC) patients require treatment with radioactive iodine (RAI), but the timing of initial RAI therapy after thyroidectomy remains controversial. Methods: We included 1224 differentiated thyroid carcinoma (DTC) patients during 2015–2019, divided them into the early (≤3 months) and the delayed (>3 months) groups based on the interval between surgery and the initial RAI. Clinical outcomes were assessed within 6–8 months of treatment with RAI, including excellent response (ER), indeterminate response (IDR), biochemical incomplete (BIR) and structural incomplete response (SIR). Further transformed them into dichotomous outcomes, we therefore introduced the ordered/binary logistic regression to assess the relation of time interval and quaternary/dichotomous outcomes, respectively. Finally, we conducted a meta‐analysis for cohort study to investigate the effect of timing of RAI therapy on the prognosis of TC. Results: Delay RAI therapy beyond 3 months reduced the IR (BIR + SIR) rate in the present cohort study (RR = 0.67, 95% CI: 0.49–91). Following meta‐analysis including 38,688 DTC patients confirmed these results (RR = 0.77, 95% CI: 0.66–0.91), further revealed the duration of treatment does not influence OS (pooled RR = 1.05, 95% CI: 0.83–1.33). Conclusion: Delayed initial RAI therapy beyond 3 months but no later than 6 months did not impair the prognosis of TC. [ABSTRACT FROM AUTHOR]

The outcome of radioactive iodine (131I) treatment among hyperthyroid patients can be affected by pretreatment with antithyroid drugs (ATD) and they should be discontinued before 131I treatment. This study aims to compare the outcome of 131I treatment among hyperthyroid patients who were off carbimazole for 3-7 days and 8-30 days before the 131I treatment. This prospective cohort study was carried out among 89 hyperthyroid patients referred for 131I treatment at the Nuclear Medicine Unit, Peradeniya (NMU) during August 2018 to February 2020. All these patients received a fixed activity of 10 mCi 131I. Each patient was followed up at a three-month interval for 06 months. The data were collected by directly interviewing the patients, from the clinical records and from the NMU database. Six months after 131I treatment among Graves' disease (GD) patients, 17.9 % had euthyroidism, 59.7 % had hypothyroidism and 22.4 % had hyperthyroidism. The therapeutic success was 77.6 % among them. Of the Toxic Multi Nodular Goitre (TMNG) patients, 36.4 % had euthyroidism, 31.8 % had hypothyroidism and 31.8 % had hyperthyroidism. The overall therapeutic success was 68.2 % among them. Carbimazole discontinuation for 3-7 days and 8-30 days did not show a statistical difference with the 131I treatment outcomes in both GD (Chi-square value = 0.264, p value = 0.876) and TMNG (Chi-square value = 1.743, p value = 0.418). The minimum carbimazole off days among GD was 5 days and 3 days for the TMNG patients. Withholding carbimazole for more than 7 days (8-30 days) before 131I treatment did not influence the therapeutic outcome and discontinuation of carbimazole can be decided on individual basis depending on the comorbid conditions. [ABSTRACT FROM AUTHOR]

Context: Obesity has been reported as a potential risk factor for the aggressiveness of papillary thyroid cancer (PTC), but the data gathered so far are conflicting. Objective: The aim of our study was to evaluate the relationship between body mass index (BMI) and aggressiveness of PTC at the diagnosis and clinical outcome. Methods: A total of 337 patients who underwent radioactive iodine (RAI) therapy between March 2017 and May 2020 were recruited. Patients were divided into four groups: underweight (BMI<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (BMI≥ 30 kg/m2). Treatment and follow-up were defined according to criteria used in the 2015 ATA guidelines. Results: This study included 337 patients with PTC (71.5% women, median age 45.21 ± 13.04 years). The mean BMI was 24.2 ± 3.1 kg/m2. Obese groups had a higher age than the other groups (P = 0.001). Moreover, obese patients had larger tumor sizes and higher T stage, compared to overweight, normal weight, and underweight patients (P = 0.007). After a median follow-up of 32 months, 279 patients (82.7%) had achieved an excellent response (ER) to therapy. The overall ER rates were compared between groups, and they did not differ significantly. Conclusions: We demonstrated that BMI may have an additive effect on the aggressiveness of PTC, but did not have an effect on the response to therapy after high-dose RAI therapy. [ABSTRACT FROM AUTHOR]

Simple Summary: The standard treatment for well-differentiated thyroid cancer is thyroidectomy followed by radioactive iodine (RAI) treatment or active surveillance. Despite adequate documentation of acute gastrointestinal adverse effects after RAI treatment, whether the gastrointestinal exposure causes long-term comorbidity or not remained unclear. We conducted a nationwide, population-based retrospective cohort study using the data from the Taiwan National Health Insurance Research Database (NHIRD) to clarify the association between long-term gastrointestinal disorders (including ulcers, atrophic gastritis, and secondary stomach malignancy) and RAI treatment in thyroid cancer patients. We found that patients with RAI treatment were at a significantly higher risk of developing gastric and duodenal ulcers than those without. In addition, a higher cumulative dose is associated with higher risk. Therefore, follow-ups at gastrointestinal clinics might be of great importance for patients presenting with chronic gastrointestinal discomforts, after receiving a single RAI dose of more than 1.11 GBq, and undergoing repeated treatment due to recurrent or residual thyroid cancer. (1) Background: The study aimed to investigate the association between radioactive iodine (RAI) treatment and long-term gastrointestinal disorders including ulcers, atrophic gastritis, and secondary malignant neoplasm of the stomach in patients with thyroid cancer. (2) Methods: The data of the study were extracted from the National Health Insurance Database (NHIRD) of Taiwan between 2000 to 2015. Patients of ages older than 20 with thyroid cancer after thyroidectomy were included and divided into groups with RAI (study cohort) and without RAI (comparison cohort). Multivariate Cox proportional hazards regression analysis and the Kaplan–Meier method were used for statistical analysis. (3) Results: A total of 7250 (with RAI: 5800, without RAI: 1450) patients were included. The Kaplan-Meier analysis revealed a significantly higher cumulative risk for overall gastrointestinal disorders in the group with RAI (log-rank p = 0.034). The risk for gastrointestinal disorders was higher when receiving a cumulative RAI dose higher than 1.11 GBq in the Cox regression analysis. In the subgroup analysis, the risks of gastric and duodenal ulcers are significantly higher in the group with RAI treatment. (4) Conclusions: This study revealed that RAI was associated with an increased risk for long-term gastrointestinal disorders, specifically gastric and duodenal ulcers, in thyroid cancer, especially when the cumulative dose exceeds 1.11 GBq. [ABSTRACT FROM AUTHOR]

Simple Summary: A higher tumor burden in patients with differentiated thyroid cancer undergoing radioactive iodine (131I) therapy may release into the bloodstream large amounts of 131I with a long residence time. We hypothesized that after the 131I intake, the blood concentration of 131I shows a course in several phases. To our knowledge, this research is the first of its kind. The results of the current study demonstrated a 131I blood concentration biphasic course. The time points to be considered are 46 and 69 h. 131I uptake in the residual thyroid tissue peaked after 46 h. The positive correlation between the neutrophil-to-lymphocyte ratio and administered 131I activity or the blood activity shows that the time interval between 46 and 69 h should be associated with the release of hematological inflammatory mediators, such as neutrophils and lymphocytes, to eradicate tumor cells in response to 131I therapy. Publications investigating the effect of radioactive iodine (131I) therapy on the circulating peripheral blood cells in patients with differentiated thyroid cancer (DTC) are limited to blood samples collected more than 92 h after 131I. Studies conducted on blood samples collected up to 92 h are rare due to the radioactive contamination risk. This research aimed to assess the relationship between the prescribed 131I activity, human whole blood activity, and peripheral blood cells at many time points (6, 22, 46, 69, and 92 h after 131I). The study enrolled 50 female patients with DTC who received a 131I median activity of 90.54 mCi (3.35 GBq). The neutrophil-to-lymphocyte ratio (NLR) was measured as an inflammatory marker. 131I uptake in the residual thyroid tissue peaked after 46 h. Blood activity decreased in the first 46 h and increased 69 h after the 131I intake. Blood activity was associated with the absolute lymphocyte count and the NLR at 69 h (r = −0.49 and r = 0.52, p < 0.001). Our results demonstrate that the time interval between 46 and 69 h should be associated with the release of hematological inflammatory mediators, such as neutrophils and lymphocytes, to eradicate tumor cells in response to 131I therapy. [ABSTRACT FROM AUTHOR]

Microbial iodate (IO3–) reduction is a major component of the iodine biogeochemical reaction network in anaerobic marine basins and radioactive iodine-contaminated subsurface environments. Alternative iodine remediation technologies include microbial reduction of IO3– to iodide (I–) and microbial methylation of I– to volatile gases. The metal reduction pathway is required for anaerobic IO3– respiration by the gammaproteobacterium Shewanella oneidensis. However, the terminal IO3– reductase and additional enzymes involved in the S. oneidensis IO3– electron transport chain have not yet been identified. In this study, gene deletion mutants deficient in four extracellular electron conduits (EECs; Δ mtrA , Δ mtrA -Δ mtrDEF , Δ mtrA -Δ dmsEF , Δ mtr A-ΔSO4360) and DMSO reductase (Δ dmsB) of S. oneidensis were constructed and examined for anaerobic IO3– reduction activity with either 20 mM lactate or formate as an electron donor. IO3– reduction rate experiments were conducted under anaerobic conditions in defined minimal medium amended with 250 μM IO3– as anaerobic electron acceptor. Only the Δ mtrA mutant displayed a severe deficiency in IO3– reduction activity with lactate as the electron donor, which suggested that the EEC-associated decaheme cytochrome was required for lactate-dependent IO3– reduction. The Δ mtrA -Δ dmsEF triple mutant displayed a severe deficiency in IO3– reduction activity with formate as the electron donor, whereas Δ mtrA -Δ mtrDEF and Δ mtr A-ΔSO4360 retained moderate IO3– reduction activity, which suggested that the EEC-associated dimethylsulfoxide (DMSO) reductase membrane-spanning protein DmsE, but not MtrA, was required for formate-dependent IO3– reduction. Furthermore, gene deletion mutant Δ dmsB (deficient in the extracellular terminal DMSO reductase protein DmsB) and wild-type cells grown with tungsten replacing molybdenum (a required co-factor for DmsA catalytic activity) in defined growth medium were unable to reduce IO3– with either lactate or formate as the electron donor, which indicated that the DmsAB complex functions as an extracellular IO3– terminal reductase for both electron donors. Results of this study provide complementary genetic and phenotypic evidence that the extracellular DMSO reductase complex DmsAB of S. oneidensis displays broad substrate specificity and reduces IO3– as an alternate terminal electron acceptor. [ABSTRACT FROM AUTHOR]

Purpose This retrospective study aimed to study the applicability of 2015 adult American Thyroid Association (ATA) differentiated thyroid cancer (DTC) postoperative risk stratification and guidelines in the pediatric population for evaluating the number of metastatic lymph nodes in the postoperative risk stratification and postradioactive iodine (RAI) treatment dynamic risk stratification (DRS) using response to treatment (RTT) reclassification. In addition, the effect of pubertal status and gender was assessed on disease presentation and prognosis. Methods Data of 63 DTC patients aged 20 years or less, stratified into prepubertal, pubertal, and postpubertal age groups, was divided into low, intermediate, and high-risk groups using pediatric ATA recurrence risk stratification. Forty-seven patients were classified as responders (excellent and indeterminate responses) and incomplete responders (biochemical and structurally incomplete responses) by assessing the RTT at 1.5 years follow-up similar to recommendation of 2015 adult DTC ATA guidelines. Results Female-to-male ratio showed a trend of gradual increase with increasing age. Significantly more responders were observed in low- and intermediate-risk groups than in high-risk group (p = 0.0013; p = 0.017, respectively), while prepubertal group had more extensive (N1b) disease. Using DRS at follow-up of 1.5 year, pubertal and postpubertal groups showed significantly better response to RAI. More female than male patients showed response and took significantly less time to respond to RAI (p = 0.003). Conclusion RAI response in pediatric DTC depends on pubertal status, gender, and number of malignant nodes. DRS using RTT classification may be applicable early at 1.5 years after initial therapy in different pubertal age and risk groups. [ABSTRACT FROM AUTHOR]

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The accumulation of 131-iodine is known to occur in the extrathyroidal tissues, such as the salivary glands and the gastrointestinal tract during radioactive iodine therapy. It is considered to be due to the expression of sodium iodide symporter. A 36-year-old lactating female was treated for remnant ablation for papillary thyroid carcinoma (pT1bN1bM0 pStage I) on the condition that she refrained from breastfeeding and was separated from her child and was milked to promote the excretion of 131-iodine until the accumulation disappeared on scintigram imaging. Scintigram showed the decrease and disappearance of the 131-iodine accumulation and the external dose rate was measured and confirmed to have decreased on the day 7 and 14 after the treatment. In conclusion, remnant ablation may be available by milking and separation from the child for 7 to 14 days.

Microbial iodate (IO3–) reduction is a major component of the iodine biogeochemical reaction network in anaerobic marine basins and radioactive iodine-contaminated subsurface environments. Alternative iodine remediation technologies include microbial reduction of IO3– to iodide (I–) and microbial methylation of I– to volatile gases. The metal reduction pathway is required for anaerobic IO3– respiration by the gammaproteobacterium Shewanella oneidensis. However, the terminal IO3– reductase and additional enzymes involved in the S. oneidensis IO3– electron transport chain have not yet been identified. In this study, gene deletion mutants deficient in four extracellular electron conduits (EECs; ΔmtrA, ΔmtrA-ΔmtrDEF, ΔmtrA-ΔdmsEF, ΔmtrA-ΔSO4360) and DMSO reductase (ΔdmsB) of S. oneidensis were constructed and examined for anaerobic IO3– reduction activity with either 20 mM lactate or formate as an electron donor. IO3– reduction rate experiments were conducted under anaerobic conditions in defined minimal medium amended with 250 μM IO3– as anaerobic electron acceptor. Only the ΔmtrA mutant displayed a severe deficiency in IO3– reduction activity with lactate as the electron donor, which suggested that the EEC-associated decaheme cytochrome was required for lactate-dependent IO3– reduction. The ΔmtrA-ΔdmsEF triple mutant displayed a severe deficiency in IO3– reduction activity with formate as the electron donor, whereas ΔmtrA-ΔmtrDEF and ΔmtrA-ΔSO4360 retained moderate IO3– reduction activity, which suggested that the EEC-associated dimethylsulfoxide (DMSO) reductase membrane-spanning protein DmsE, but not MtrA, was required for formate-dependent IO3– reduction. Furthermore, gene deletion mutant ΔdmsB (deficient in the extracellular terminal DMSO reductase protein DmsB) and wild-type cells grown with tungsten replacing molybdenum (a required co-factor for DmsA catalytic activity) in defined growth medium were unable to reduce IO3– with either lactate or formate as the electron donor, which indicated that the DmsAB complex functions as an extracellular IO3– terminal reductase for both electron donors. Results of this study provide complementary genetic and phenotypic evidence that the extracellular DMSO reductase complex DmsAB of S. oneidensis displays broad substrate specificity and reduces IO3– as an alternate terminal electron acceptor.