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  1. Fulltext The use of SPECT-CT improves accuracy of post-radioiodine therapy imaging and changes the management strategy in a case of advanced follicular thyroid carcinoma
    Wong TH, Amir Hassan SZ
    Med J Malaysia, 2015 Dec;70(6):356-7.
    PMID: 26988209
    This is a case of follicular thyroid carcinoma with extensive lung, bone and brain metastases. Multi-modality treatments including total thyroidectomy, modified radical neck dissection, cranial radiotherapy and Iodine-131 (RAI) therapy were instituted. Post RAI therapy planar whole body scan showed RAI avid metastases in the skull, cervical spine, bilateral lungs and abdomen. With the use of SPECTCT imaging, rare adrenal metastasis and additional rib metastasis were identified. Besides, management strategy was altered due to detection of non-RAI avid brain and lung metastatic lesions.
    Matched MeSH terms: Iodine Radioisotopes
  2. Incidental Finding of Endometrioid Adenocarcinoma of the Ovary on 131I Whole-Body Scan
    Mohd Rohani MF, Amir Hassan SZ
    Clin Nucl Med, 2022 Jan 01;47(1):e20-e22.
    PMID: 34028418 DOI: 10.1097/RLU.0000000000003698
    A 57-year-old woman was referred for radioactive iodine therapy 12 weeks after completion thyroidectomy and left modified radical neck dissection for pT2N1Mx follicular variant papillary thyroid carcinoma. After 4 weeks of l-thyroxine withdrawal, stimulated serum thyroglobulin level was less than 0.1 ng/mL with positive thyroglobulin antibody. Posttherapy 131I scintigraphy with SPECT/CT of the head and abdominopelvic region showed thyroid residual in the neck, occipital bone metastasis, and heterogenous tracer uptake in a large peritoneal mass, likely arising from the left ovary. Left salpingo-oophorectomy was performed, and histopathologic examination revealed endometrioid carcinoma of left ovary.
    Matched MeSH terms: Iodine Radioisotopes
  3. Concurrent Benign Iodine-Avid Thymic and Liver Cysts Mimicking Metastatic Disease on 131I Whole-Body Scintigraphy
    Kamarulzaman K, Mohd Rohani MF, Mat Nawi N, Amir Hassan SZ
    Clin Nucl Med, 2024 Mar 01;49(3):250-252.
    PMID: 38306377 DOI: 10.1097/RLU.0000000000005037
    A 57-year-old woman received radioiodine therapy post total thyroidectomy for pT3aNxMx follicular thyroid carcinoma. Posttherapy 131I whole-body scan showed 131I concentration in the chest, mediastinum, and left upper thigh with stimulated thyroglobulin (Tg) of 89 μg/L. Subsequent radioiodine therapies showed persistent 131I accumulation in the anterior mediastinal soft tissue lesions and a hypodense segment VII liver lesion visualized on SPECT/CT, suggestive of iodine-avid metastatic disease despite the undetectable serum Tg (<1.0 μg/L) with no Tg antibody interference. Biopsy of the liver lesion revealed liver cyst, and consequent removal of the mediastinal lesions showed benign thymic cysts.
    Matched MeSH terms: Iodine Radioisotopes/therapeutic use
  4. 2021 Asia-Pacific Graves' Disease Consortium Survey of Clinical Practice Patterns in the Management of Graves' Disease
    Parameswaran R, de Jong MC, Kit JLW, Sek K, Nam TQ, Thang TV, et al.
    Endocrine, 2023 Jan;79(1):135-142.
    PMID: 36129592 DOI: 10.1007/s12020-022-03193-7
    AIM: Although Graves' disease (GD) is common in endocrine practices worldwide, global differences in diagnosis and management remain. We sought to assess the current practices for GD in countries across Asia and the Pacific (APAC), and to compare these with previously published surveys from North America and Europe.

    METHODS: A web-based survey on GD management was conducted on practicing clinicians. Responses from 542 clinicians were received and subsequently analysed and compared to outcomes from similar surveys from other regions.

    RESULTS: A total of 542 respondents participated in the survey, 515 (95%) of whom completed all sections. Of these, 86% were medical specialists, 11% surgeons, and 3% nuclear medicine physicians. In addition to serum thyroid-stimulating hormone (TSH) and free thyroxine assays, most respondents would request TSH-receptor autoantibody (TRAb) measurement (68%) during initial work-up. Thyroid ultrasound is requested by about half of respondents (53%), while the use of nuclear medicine scans is limited. The preferred first-line treatment is anti-thyroid drug (ATD) therapy (79%) with methimazole (MMI) or carbimazole (CBZ), followed by radioiodine (RAI; 19%) and surgery (2%). In case of surgery, one-third of respondents would opt for a subtotal rather than a total thyroidectomy. In case of mild Graves orbitopathy (GO), ATDs (67%) remains the preferred treatment, but a larger proportion of clinicians prefer surgery (20%). For a patient with intention to conceive, the preferred treatment pattern remained unchanged, although propylthiouracil (PTU) became the preferred ATD-agent during the first trimester. In comparison to European and American practices, marked differences were noted in the relatively infrequent usage of nuclear medicine scans and the overall higher use of a ATDs and β-blockers and adjunctive ATD-treatment during RAI in the APAC-group.

    CONCLUSION: Although regional differences regarding the diagnosis and management of GD are apparent in this first pan-Asia-Pacific survey, this study reveals the overall approach to the management of this disease in Asia-Pacific generally tends to fall between the trends appreciated in the American and European cohorts.

    Matched MeSH terms: Iodine Radioisotopes/therapeutic use
  5. Staff and ambient radiation dose resulting from therapeutic nuclear medicine procedures
    Alkhorayef M, Sulieman A, Mohamed-Ahmed M, Al-Mohammed HI, Alkhomashi N, Sam AK, et al.
    Appl Radiat Isot, 2018 Nov;141:270-274.
    PMID: 30145016 DOI: 10.1016/j.apradiso.2018.07.014
    With associated cure rates in excess of 90%, targeted 131I radioactive iodine therapy has clearly improved thyroid cancer survival. Thus said, potential radiation risks to staff represent a particular concern, current study seeking to determine the radiation exposure of staff from 131I patients during hospitalization, also estimating accumulated dose and related risk to staff during preparation of the radioactive iodine. In present study made over the three-month period 1st February to 1st May 2017, a total of 69 patient treatments were investigated (comprising a cohort of 46 females and 23 males), this being a patient treatment load typically reflective of the workload at the particular centre for such treatments. The patients were administered sodium iodide 131I, retained in capsules containing activities ranging from 370 to 5550 MBq at the time of calibration, radioiodine activity depends on many factors such as gender, clinical indication, body mass index and age. The staff radiation dose arising from each patient treatment was measured on three consecutive days subsequent to capsule administration. In units of µSv, the mean and dose-rates range at distances from the patients of 5 cm, 1 m and 2 m were 209 ± 73 (165-294), 6.8 ± 2 (5.3-9.5) and 0.9 ± 0.3 (0.7-1.2). The annual dose (also measured in units of µSv), based on annual records of doses, for medical physicists, technologists and nurses were 604, 680 and 1000 µSv respectively. In regard to current practice and workload, staff exposures were all found to be below the annual dose limit for radiation workers.
    Matched MeSH terms: Iodine Radioisotopes
  6. Fulltext Occupational exposure and radiobiological risk from thyroid radioiodine therapy in Saudi Arabia
    Al-Mohammed HI, Sulieman A, Mayhoub FH, Salah H, Lagarde C, Alkhorayef M, et al.
    Sci Rep, 2021 Jul 15;11(1):14557.
    PMID: 34267237 DOI: 10.1038/s41598-021-93342-1
    Worldwide, thyroid cancer accounts for some 10% of total cancer incidence, most markedly for females. Thyroid cancer radiotherapy, typically using 131I (T1/2 8.02 days; β- max energy 606 keV, branching ratio 89.9%), is widely adopted as an adjunct to surgery or to treat inoperable cancer and hyperthyroidism. With staff potentially receiving significant doses during source preparation and administration, radiation protection and safety assessment are required in ensuring practice complies with international guidelines. The present study, concerning a total of 206 patient radioiodine therapies carried out at King Faisal Specialist Hospital and Research Center over a 6-month period, seeks to evaluate patient and occupational exposures during hospitalization, measuring ambient doses and estimating radiation risk. Using calibrated survey meters, patient exposure dose-rate estimates were obtained at a distance of 30-, 100- and 300 cm from the neck region of each patient. Occupational and ambient doses were measured using calibrated thermoluminescent dosimeters. The mean and range of administered activity (AA, in MBq) for the thyroid cancer and hyperthyroidism treatment groups were 4244 ± 2021 (1669-8066), 1507.9 ± 324.1 (977.9-1836.9), respectively. The mean annual occupational doses were 1.2 mSv, that for ambient doses outside of the isolation room corridors were found to be 0.2 mSv, while ambient doses at the nursing station were below the lower limit of detection. Exposures to staff from patients being treated for thyroid cancer were less compared to hyperthyroidism patients. With a well-defined protocol, also complying with international safety requirements, occupational exposures were found to be relatively high, greater than most reported in previous studies.
    Matched MeSH terms: Iodine Radioisotopes/administration & dosage; Iodine Radioisotopes/adverse effects*; Iodine Radioisotopes/therapeutic use*
  7. Fulltext Transient hypothyroidism following I131 treatment for thyrotoxicosis
    Zaini A, Ngan A, Paramsothy M, Khoo BH, Ch'ng SL
    Med J Malaysia, 1983 Dec;38(4):331-3.
    PMID: 6599994
    Matched MeSH terms: Iodine Radioisotopes/adverse effects*; Iodine Radioisotopes/therapeutic use
  8. A rare case of minimally invasive follicular thyroid cancer with intraluminal superior vena cava and right atrium metastases
    Khoo ACH, Chen SL
    World J Nucl Med, 2019 9 14;18(3):301-303.
    PMID: 31516376 DOI: 10.4103/wjnm.WJNM_43_18
    Follicular thyroid cancers are known to spread hematogenously to the bones and lungs and rarely presenting with massive angioinvasion. We report a case of a middle-aged female who had undergone total thyroidectomy for minimally invasive follicular thyroid cancer with angioinvasion in 2014. She was noted to have a large tumor thrombus extending from the superior vena cava to the right atrium on whole body scan post-Iodine-131 (131I) remnant ablation therapy. We discuss the various imaging modalities, treatment options, and difficulties in managing such massive angioinvasion in patients with well-differentiated thyroid cancers.
    Matched MeSH terms: Iodine Radioisotopes
  9. Fulltext Radiation doses to patient's relatives following radioiodine therapy
    Sulaiman BT, Clarke SE
    Med J Malaysia, 1996 Mar;51(1):131-3.
    PMID: 10967992
    A total of 10 volunteers were monitored for radiation doses, whose spouses were given radio-iodine (131I) orally. Nine of the spouses were given radio-iodine for Graves' disease and one for thyroid carcinoma. It was found that the highest radiation dose received by the volunteer was only 13.5% of the annual dose limit for individual members of the public. Hence, patients treated with radio-iodine do not pose a significant radiation hazard to the public.
    Matched MeSH terms: Iodine Radioisotopes/therapeutic use*
  10. Pre-ablative diagnostic whole-body scan following total thyroidectomy for well-differentiated thyroid cancer: is it necessary?
    Teoh CM, Rohaizak M, Chan KY, Jasmi AY, Fuad I
    Asian J Surg, 2005 Apr;28(2):90-6.
    PMID: 15851360
    This study reviewed the incidence of positive pre-ablative diagnostic scan after total thyroidectomy and the efficacy of the current ablative dose. The predictive factors for outcome using a standard ablative dose and postoperative complications of total thyroidectomy were also examined.
    Matched MeSH terms: Iodine Radioisotopes/therapeutic use
  11. Fulltext The minimum amount of fluids needed to achieve the fastest time to reach permissible level for release in well-differentiated thyroid patients undergoing high-dose I-131 therapy
    Cheen Hoe AK, Fong LY, Halim FNA, Fatt QK, Hamzah F
    World J Nucl Med, 2018 7 24;17(3):182-187.
    PMID: 30034283 DOI: 10.4103/wjnm.WJNM_59_17
    Radioiodine (131I) therapy is the mainstay of treatment for patients who had undergone total thyroidectomy for well differentiated thyroid carcinoma. Increased fluid intake has always been encouraged to minimize the risk of non-target organ exposure to I-131radiation. This study aimed to determine the minimum amount of fluids needed for patients to have the fastest time to achieve permissible level for release after high dose I-131therapy.

    METHODOLOGY: All the patients who were treated with high dose I-131from 18th January 2016 till 31st December 2016 in Hospital Pulau Pinang, Malaysia were recruited. The data from 126 patients on thyroxine hormone withdrawal (THW) group and 18 patients on recombinant human thyroid stimulating hormone (rhTSH) group were analysed. There is no change in patient management in terms of preparation, dose or post therapy whole-body scan. Fluid intake of patients were monitored strictly and whole-body retention of I-131are measured using ionizing chamber meter immediately after ingestion of I-131then at 1 hour, 24 hours, 48 hours, 72 hours and 96 hours.

    RESULTS: The median time to achieve permissible release limit (50 μSV/hr at 1 meter) was 21.6 hours and 22.1 hours post-ingestion of I-131in the THW and rhTSH group respectively. The minimum amount of fluid needed to reach permissible release limit in the fastest time was 2,103 ml and 2,148ml for the THW and TSH respectively.

    CONCLUSION: Clinicians would be able to evidently advise their patient on the amount of fluid to consume and utilize their isolation wards faster to treat more patients.

    Matched MeSH terms: Iodine Radioisotopes
  12. Fulltext Understanding issues in preparing patients for radioactive iodine treatment of thyroid disorders
    Zanial AZ, Hamzah F
    The Malaysian Journal of Nursing, 2015;7(1):3-6.
    MyJurnal
    Thyroid disorders could be broadly categorised into benign and malignant diseases. Approaches for the
    management of benign and malignant thyroid disorders have been well documented including the treatment
    using radioactive iodine (RAI). RAI has long been used to treat hyperthyroidism and well differentiated
    thyroid cancer. Nevertheless, there are various factors that may influence the outcome of RAI treatment
    including matters related to patient preparations. Thus, healthcare personnel play an important role in
    assisting patients to make the necessary preparations. This article aims to give nurses and clinicians of
    various specialities an insight into the overview of RAI treatment for thyroid disorders particularly in
    Malaysia and further discusses the issues related to preparations of patients.
    Matched MeSH terms: Iodine Radioisotopes
  13. Fulltext Primary thyroid lymphoma: A rare malignancy in the head and neck
    Mohd Shaiful Nizam Mamat Nasir, Bathma Dhevi Susibalan, Muhammad Nasri Abu Bakar, Suhaimi Yusof, Arfahiza Selimin, Kahairi Abdullah, et al.
    Archives of Orofacial Sciences, 2018;13(2):1-4.
    MyJurnal
    Primary thyroid lymphoma is a relatively uncommon pathology of the thyroid gland that mainly occurs in elderly females. We describe a rare case of B-cell thyroid lymphoma in a young healthy male. It is an important diagnosis to be considered in patients presenting with a rapidly enlarging neck mass as its management is different from other differentiated thyroid carcinoma which require total thyroidectomy plus adjuvant radioactive iodine ablation. Our report emphasizes the need for clinical awareness leading to early detection, followed by early multidisciplinary management.
    Matched MeSH terms: Iodine Radioisotopes
  14. Fulltext Results of long-term follow-up after compensated fixed-dose therapy for thyrotoxicosis
    Zaini A, Khir A, Doi SA, Chan SP, Paramsothy M, Khoo BH
    J Int Med Res, 1992 Jun;20(3):279-88.
    PMID: 1397673
    To evaluate the effects of simple compensated fixed-dose iodine-131 therapy for thyrotoxicosis, the long-term results for 74 patients treated with a fixed dose of iodine-131 ranging from 5 to 12 mCi (185 to 444 MBq) were evaluated in the first 2 years of a trial. The dose selected was loosely based on the gross size of the thyroid gland. Routine antithyroid drug therapy was given for a minimum of 3 months after iodine-131 therapy. The mean (+/- SD) duration of follow-up was 74.5 +/- 42 months. The results indicated that roughly 25% of patients treated in this way will become hypothyroid after 5 years and that 85% are cured (need no further therapy during the follow-up period) using a single dose of iodine-131. Of those cured using a single iodine-131 dose, 81% were no longer receiving drugs after 6 months and 85% after 1 year. Such a regimen seems currently to be among the best available where prolonged periods of medication-free euthyroidism after therapy are sought.
    Matched MeSH terms: Iodine Radioisotopes/therapeutic use*
  15. Features of post-radioiodine whole body scan in non-invasive Follicular Thyroid Neoplasm with papillary-like nuclear features (NIFTP)
    Wong TH, Tan TH, Chin SC, Lee BN
    Med J Malaysia, 2018 06;73(3):181-182.
    PMID: 29962506
    Recently, encapsulated follicular variant of papillary thyroid carcinoma has been reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) to emphasize the benign nature of this entity. In our institution, we have assessed 455 patients treated with radioiodine ablation for differentiated thyroid carcinoma and 20 of them were retrospectively found to fulfill the new NIFTP criteria. There was no evidence of metastasis on post radioiodine whole body scans for NIFTP cases and these patients were in remission subsequently. The benign features of these patients' whole body scans and good clinical outcome following treatment further support NIFTP as a low risk thyroid neoplasm.
    Matched MeSH terms: Iodine Radioisotopes
  16. Fulltext Papillary Thyroid Carcinoma Presenting with Chronic Cough and Hemoptysis in Primary Care: A Case Report
    Abd Hamid MF, Abdul Razak S, Azraai AM, Miptah HN
    Am J Case Rep, 2023 Nov 10;24:e941089.
    PMID: 37946402 DOI: 10.12659/AJCR.941089
    BACKGROUND The article discusses an unusual case of papillary thyroid carcinoma in which chronic cough and hemoptysis were the predominant symptoms. While the more common causes of hemoptysis are pulmonary in origin, extrapulmonary etiologies have been reported, including thyroid carcinoma. The clinical presentation of thyroid malignancy in this case mimics many other common disorders, such as pulmonary tuberculosis, bronchogenic carcinoma, bronchiectasis, and chronic obstructive pulmonary disease. Hence, making it challenging to suspect early when patients present to primary care. CASE REPORT A 54-year-old woman presented with a chronic cough and hemoptysis in our Primary Care Medicine Clinic. While initial assessments in the primary care medicine clinic yielded no remarkable findings, a subsequent high-resolution computed tomography scan of the thorax uncovered a thyroid lesion. Subsequent evaluation in the hospital setting included an ultrasound examination, revealing multiple thyroid nodules, and fine needle aspiration that confirmed papillary thyroid carcinoma. She underwent total thyroidectomy with central and left lateral neck dissection, complicated by left vocal cord palsy. She received 2 cycles of periodic radioactive iodine therapy and injection laryngoplasty postoperatively. There was no evidence of iodin avid disease and recurrence of hemoptysis after surgery. CONCLUSIONS This case report emphasizes the significance of considering papillary thyroid carcinoma when assessing hemoptysis in the primary care setting, as early detection and treatment of it would result in a better outcome.
    Matched MeSH terms: Iodine Radioisotopes
  17. Fulltext Radioiodine I-131 for the therapy of graves' disease
    Mumtaz M, Lim SL, Khaw CH, Mohd Khir AS
    Malays J Med Sci, 2009 Jan;16(1):25-33.
    PMID: 22589645
    Graves' disease is a common cause of hyperthyroidism. Treatment options for Graves' disease include antithyroid medication, surgery or radioactive iodine (I-31) or RAI. This review will focus on the approach to RAI therapy; discussing dose selection, patient preparation, and consideration before and after administering RAI, examining aspects of pre-treatment with antithyroid medication as well as discussing possible adverse events including hypothyroidism and possible worsening of thyroid-associated opthalmopathy. Follow-up is lifelong with the aim of ensuring the patient remains euthyroid or on replacement therapy if there is evidence of hypothyroidism. While there are controversies in treatment of thyrotoxicosis with RAI, with appropriate patient selection and regular follow-up, radioiodine is a safe and effective modality in achieving high cure rates.
    Matched MeSH terms: Iodine Radioisotopes*
  18. Fulltext Future Prospective of Radiopharmaceuticals from Natural Compounds Using Iodine Radioisotopes as Theranostic Agents
    Nurhidayah W, Setyawati LU, Daruwati I, Gazzali AM, Subroto T, Muchtaridi M
    Molecules, 2022 Nov 18;27(22).
    PMID: 36432107 DOI: 10.3390/molecules27228009
    Natural compounds provide precursors with various pharmacological activities and play an important role in discovering new chemical entities, including radiopharmaceuticals. In the development of new radiopharmaceuticals, iodine radioisotopes are widely used and interact with complex compounds including natural products. However, the development of radiopharmaceuticals from natural compounds with iodine radioisotopes has not been widely explored. This review summarizes the development of radiopharmaceuticals from natural compounds using iodine radioisotopes in the last 10 years, as well as discusses the challenges and strategies to improve future discovery of radiopharmaceuticals from natural resources. Literature research was conducted via PubMed, from which 32 research articles related to the development of natural compounds labeled with iodine radioisotopes were reported. From the literature, the challenges in developing radiopharmaceuticals from natural compounds were the purity and biodistribution. Despite the challenges, the development of radiopharmaceuticals from natural compounds is a golden opportunity for nuclear medicine advancement.
    Matched MeSH terms: Iodine Radioisotopes*
  19. Fulltext Radiosynthesis, Stability, Lipophilicity, and Cellular Uptake Evaluations of [131I]Iodine-α-Mangostin for Breast Cancer Diagnosis and Therapy
    Nurhidayah W, Widyasari EM, Daruwati I, Mahendra I, Subroto T, Khairul Ikram NK, et al.
    Int J Mol Sci, 2023 May 12;24(10).
    PMID: 37240025 DOI: 10.3390/ijms24108678
    The high rate of incidence and mortality caused by breast cancer encourage urgent research to immediately develop new diagnostic and therapeutic agents for breast cancer. Alpha mangostin (AM) is a natural compound reported to have anti-breast cancer properties. Its electron-donating groups structure allows it to be labeled with an iodine-131 radioisotope to develop a candidate of a diagnostic and therapeutic agent for breast cancer. This study aims to prepare the [131I]Iodine-α-mangostin ([131I]I-AM) and evaluate its stability, lipophilicity, and cellular uptake in breast cancer cell lines. The [131I]I-AM was prepared by direct radiosynthesis with Chloramine-T method in two conditions (A: AM dissolved in NaOH, B: AM dissolved in ethanol). Reaction time, pH, and mass of the oxidizing agent were optimized as crucial parameters that affected the radiosynthesis reaction. Further analysis was conducted using the radiosynthesis conditions with the highest radiochemical purity (RCP). Stability tests were carried out at three storage conditions, including -20, 2, and 25 °C. A cellular uptake study was performed in T47D (breast cancer cell line) and Vero cells (noncancerous cell line) at various incubation times. The results show that the RCP values of [131I]I-AM under conditions A and B were 90.63 ± 0.44 and 95.17 ± 0.80% (n = 3), respectively. In the stability test, [131I]I-AM has an RCP above 90% after three days of storage at -20 °C. A significant difference was obtained between [131I]I-AM uptake in T47D and Vero cells. Based on these results, [131I]I-AM has been prepared with high RCP, stable at -20 °C, and specifically uptaken by breast cancer cell lines. Biodistribution evaluations in animals are recommended as further research in developing [131I]I-AM as a diagnostic and therapeutic agent for breast cancer.
    Matched MeSH terms: Iodine Radioisotopes/chemistry
  20. Clinical determinants of fluorodeoxyglucose positron emission tomography/computed tomography in differentiated thyroid cancer patients with elevated thyroglobulin and negative (131)iodine whole body scans after (131)iodine therapy
    Shamim SE, Nang LB, Shuaib IL, Muhamad NA
    Malays J Med Sci, 2014 May;21(3):38-46.
    PMID: 25246834
    A cross-sectional prospective study has been conducted on differentiated thyroid cancer (DTC) patients using negative (131)Iodine ((131)I) whole body scans and elevated thyroglobulin (Tg) levels. The main objective of this research was to determine the prevalence of the conversion of differentiated to dedifferentiated thyroid cancer patients during follow up at the Hospital Kuala Lumpur. It has been demonstrated that fluorodeoxyglucose (FDG) uptake is inversely proportional to the iodine concentration and to differentiation of the cells.
    Matched MeSH terms: Iodine Radioisotopes
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