nach oben

Erschienen in:

31.12.2018 | Original Article

Thyroid stunning in radioiodine-131 therapy of benign thyroid diseases

verfasst von: Christian Happel, Wolfgang Tilman Kranert, Hanns Ackermann, Ina Binse, Benjamin Bockisch, Daniel Gröner, Ken Herrmann, Frank Grünwald

Erschienen in: Endocrine | Ausgabe 3/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Existence and cause of thyroid stunning was controversially discussed for decades but the underlying mechanism remains unclear. Numerous studies describe thyroid stunning in radioiodine-131 therapy (RIT) of differentiated thyroid carcinoma. However, there are no studies evaluating thyroid stunning in benign thyroid diseases caused by the radioiodine uptake test (RIUT). Therefore, the influence of pre-therapeutic tracer radiation dose on therapeutic iodine-131 uptake was evaluated retrospectively.

Methods

A total of 914 RIT patients were included. Exclusion criteria were anti-thyroid drugs, pre- and/or intra-therapeutic effective half-lives (EHL) beyond 8.04 days and externally performed RIUT or 24 h RIUT. All patients received RIUT 1 week before RIT. Thyroid volume was estimated via ultrasound. Tracer radiation dose to the thyroid was calculated retrospectively. The dependence of changes in the pre-therapeutic to the therapeutic extrapolated-maximum-¹³¹I-uptake (EMU) from the dose in RIUT was evaluated statistically.

Results

EMU in RIUT ranged from 0.10 to 0.82 (median: 0.35) and EMU in RIT ranged from 0.10 to 0.74 (median: 0.33). Averaged over the whole cohort the therapeutic EMU decreased significantly (2.3% per Gray intra-thyroidal tracer radiation dose). A disease-specific evaluation showed dose-dependent thyroid stunning from 1.2% per Gray in solitary toxic nodules (n = 327) to 21% per Gray in goiters (n = 135) which was significant for the subgroups of disseminated autonomies (n = 114), multifocal autonomies (n = 178) and goiters (p < 0.05) but not for Graves’ diseases (n = 160) and solitary toxic nodules (p > 0.05).

Conclusions

The presented data indicate for the first time a significant dependence of pre-therapeutic radiation dose on thyroid stunning in goiter and disseminated and multifocal autonomy. To achieve the desired intra-thyroidal radiation dose, RIT activity should be adapted depending on the dose in RIUT.

R. Lorenz, A. Buck, C. Reiners, In-patient nuclear medicine therapy in Germany from 2010 to 2012 – analysis of structured quality reports. Nuklearmedizin 54, 61–68 (2015)CrossRefPubMed

M. Freesmeyer, F. Gühne, C. Kühnel, T. Opfermann, T. Winkens, A. Werner Determination of effective half-life of ¹³¹I in patients with differentiated thyroid carcinoma: comparison of cystatin C and creatinine-based estimation of renal function. Endocrine (2018). https://doi.org/10.1007/s12020-018-1800-4

O. Dohan, A. de la Vieja, V. Paroder, C. Riedel, M. Artani, M. Reed, C.S. Ginter, N. Carrasco, The sodium/iodine symporter (NIS): characterization, regulation, and medical significance. Endocr. Rev. 24, 48–77 (2003)CrossRefPubMed

E. Bell, F. Grünwald. Radiojodtherapie bei Benignen und Malignen Schilddrüsenerkrankungen (Springer-Verlag Berlin Heidelberg, New York, 1999).

R.W. Rawson, J.E. Rall, W. Peacock, Limitations in the treatment of cancer of the thyroid with radioactive iodine. Trans. Assoc. Am. Physicians 64, 179–198 (1951)PubMed

W. Brenner, Is thyroid stunning a real phenomenon or just fiction? J. Nucl. Med. 43, 835–836 (2002)PubMed

A.J. Coakley, Thyroid stunning. Eur. J. Nucl. Med. 25, 203–204 (1998)CrossRefPubMed

H.Q. Dam, S.M. Kim, H.C. Lin, C.M. Intenzo, ¹³¹I therapeutic efficacy is not influenced by stunning after diagnostic whole-body scanning. Radiology 232, 527–533 (2004)CrossRefPubMed

I.R. McDougall, A. Iagaru, Thyroid stunning: fact or fiction? Semin. Nucl. Med. 41, 105–112 (2011)CrossRefPubMed

10.

S.P. Cholewinski, K.S. Yoo, P.S. Klieger, R.E. O’Mara, Absence of thyroid stunning after diagnostic whole-body scanning with 185 MBq ¹³¹I. J. Nucl. Med. 41, 1198–1202 (2000)PubMed

11.

M. Filesi, M. Colandrea, T. Montesano, R. D’Apollo, G. Ronga, Thyroid stunning in clinical practice: is it a real problem? Minerva Endocrinol. 34, 29–36 (2009)PubMed

12.

J.M. Woolfenden, Thyroid stunning revisited. J. Nucl. Med. 47, 1403–1404 (2006)PubMed

13.

J.E. Kalinyak, I.R. McDougall, Whole-body scanning with radionuclides of iodine, and the controversy of “thyroid stunning“. Nucl. Med. Commun. 25, 883–889 (2004)CrossRefPubMed

14.

S. Walrand, M. Hesse, F. Jamar, Statistical and radiobiological analysis of the so-called thyroid stunning. EJNMMI Res. 5, 67 (2015)CrossRefPubMedPubMedCentral

15.

M. Lassmann, M. Luster, H. Hänscheid, C. Reiners, Impact of ¹³¹I diagnostic activities on the biokinetics of thyroid remnants. J. Nucl. Med. 45, 619–625 (2004)PubMed

16.

L.F. Morris, A.D. Waxman, G.D. Braunstein, Thyroid stunning. Thyroid 13, 333–340 (2003).CrossRefPubMed

17.

J.P. Muratet, A. Daver, J.F. Minier, F. Larra, Influence of scanning doses of iodine-131 on subsequent first ablative treatment outcome in patients operated on for differentiated thyroid carcinoma. J. Nucl. Med. 39, 1546–1550 (1998)PubMed

18.

P. Postgård, J. Himmelman, U. Lindencrona, N. Bhogal, D. Wiberg, G. Berg, S. Jansson, E. Nyström, E. Forssell-Aronsson, M. Nilsson, Stunning of iodide transport by ¹³¹I irradiation in cultured thyroid epithelial cells. J. Nucl. Med. 43, 828–834 (2002)PubMed

19.

M.M. Nordén, F. Larsson, S. Tedelind, T. Carlsson, C. Lundh, E. Forssell-Aronsson, M. Nilsson, Down-regulation of the sodium/iodide symporter explains ¹³¹I-induced thyroid stunning. Cancer Res. 67, 7512–7517 (2007)CrossRefPubMed

20.

B. Meller, E. Gaspas, W. Deisting, B. Czarnocka, M. Baehre, B.E. Wenzel, Decreased radioiodine uptake of FRTL-5 cells after ¹³¹I incubation in vitro: molecular biological investigations indicate a cell cycle-dependent pathway. Eur. J. Nucl. Med. Mol. Imaging 35, 1204–1212 (2008)CrossRefPubMed

21.

C. Lundh, M.M. Nordén, M. Nilsson, E. Forssell-Aronsson, Reduced iodine transport (stunning) and DNA synthesis in thyrocytes exposed to low absorbed doses from ¹³¹I in vitro. J. Nucl. Med. 48, 481–486 (2007)PubMed

22.

C. Lundh, U. Lindencrona, P. Postgård, T. Carlsson, M. Nilsson, E. Forssell-Aronsson, Radiation-induced thyroid stunning: differential effects of ¹²³I, ¹³¹I, ^99mTc and ²¹¹At on iodide transport and NIS mRNA expression in cultured thyroid cells. J. Nucl. Med. 50, 1161–1167 (2009)CrossRefPubMed

23.

F.A. Verburg, R.B. Verkooijen, M.P. Stokkel, J.W. van Isselt, The success of ¹³¹I ablation in thyroid cancer patients is significantly reduced after a diagnostic activity of 40 MBq ¹³¹I. Nuklearmedizin 48, 138–142 (2009)CrossRefPubMed

24.

J.C. Sisson, A.M. Avram, S.A. Lawson, P.G. Gauger, G.M. Doherty, The so-called stunning of thyroid tissue. J. Nucl. Med. 47, 1406–1412 (2006)PubMed

25.

Y. Yin, Q. Mao, S. Chen, N. Li, X. Li, Y. Li, A quantitative study about thyroid stunning after diagnostic whole-body scanning with 74 MBq ¹³¹I in patients with differentiated thyroid carcinoma. Q. J. Nucl. Med. Mol. Imaging 59, 455–461 (2015)PubMed

26.

T. Krohn, P.T. Meyer, C. Ocklenburg, D. Knollmann, B. Nowak, W.M. Schaefer, Stunning in radioiodine therapy of benign thyroid disease. Quantification and therapeutic relevance. Nuklearmedizin 47, 248–254 (2008)CrossRefPubMed

27.

O. Sabri, M. Zimny, M. Schreckenberger, A. Meyer-Oelmann, P. Reinartz, U. Buell, Does thyroid stunning exist? A model with benign thyroid disease. Eur. J. Nucl. Med. 27, 1591–1597 (2000)CrossRefPubMed

28.

E. Wudel, K. Koppenhagen, The stunned thyroid? Veränderte Radiojodkinetik der NACH-THERAPIE bei benignen Schilddrüsenerkrankungen. Nuklearmedizin 34, A166 (1995). (Abstract)

29.

M. Dietlein, J. Dressler, W. Eschner, M. Lassmann, B. Leisner, C. Reiners, H. Schicha, Procedure guideline for radioiodine test (version 3). Nuklearmedizin 46, 198–202 (2007)CrossRefPubMed

30.

M. Dietlein, J. Dressler, F. Grünwald, B. Leisner, E. Moser, C. Reiners, H. Schicha, P. Schneider, O. Schober, Guideline for radioiodine therapy for benign thyroid disease (version 4). Nuklearmedizin 46, 220–223 (2007)CrossRefPubMed

31.

L.D. Marinelli, Dosage determination in the use of radioactive isotopes. J. Clin. Invest. 28, 1271–1280 (1949)CrossRefPubMedPubMedCentral

32.

F.A. Leger, M. Izembart, F. Dagousset, L. Barritault, G. Baillet, A. Chevalier, J. Clerc, Decreased uptake of therapeutic doses of iodine-131 after 185-MBq iodine-131 diagnostic imaging for thyroid remnants in differentiated thyroid carcinoma. Eur. J. Nucl. Med. 25, 242–246 (1998)CrossRefPubMed

33.

H.M. Park, Y.H. Park, X.H. Zhou, Detection of thyroid remnant/metastasis without stunning: an ongoing dilemma. Thyroid 7, 277–280 (1997)CrossRefPubMed

34.

T.E. Hilditch, M.F. Dempsey, A.A. Bolster, R.M. McMenemin, N.S. Reed, Self-stunning in thyroid ablation: evidence from comparative studies of diagnostic ¹³¹I and ¹²³I. Eur. J. Nucl. Med. 29, 783–788 (2002)CrossRef

35.

H.M. Park, O.W. Perkins, J.W. Edmondson, R.B. Schnute, A. Manatunga, Influence of diagnostic radioiodine on the uptake of ablative dose of iodine-131. Thyroid 4, 49–54 (1994)CrossRefPubMed

36.

H.S. Wu, H.H. Hseu, W.Y. Lin, S.J. Wang, Y.C. Liu, Decreased uptake after fractionated ablative doses of iodine-131. Eur. J. Nucl. Med. Mol. Imaging 32, 167–173 (2005)CrossRefPubMed

37.

H.W. Yeung, J.L. Humm, S.M. Larson, Radioiodine uptake in thyroid remnants during therapy after tracer dosimetry. J. Nucl. Med. 41, 1082–1085 (2000)PubMed

38.

J.C. Reynolds, J. Robbins, The changing role of radioiodine in the management of differentiated thyroid cancer. Semin. Nucl. Med. 27, 153–164 (1997)CrossRef

39.

E.C.S.C. Etchebehere, A.O. Santor, P.S. Matos, L.V.M. Assumpçāo, Lima MCVL, M.C.L. Lima, L.S. Ward, Is thyroid stunning clinically relevant? A retrospective analysis of 208 patients. Arq. Bras. Endocrinol. Metab. 58, 292–300 (2014)CrossRef

40.

T. Bajén, S. Mañé, A. Muñoz, J.R. García, Effect of a diagnostic dose of 185 MBq ¹³¹I on postsurgical thyroid remnants. J. Nucl. Med. 41, 2038–2042 (2000)PubMed

41.

I.R. McDougall, 74 MBq radioiodine ¹³¹I does not prevent uptake of therapeutic doses of ¹³¹I (i.e. it does not cause stunning) in differentiated thyroid cancer. Nucl. Med. Commun. 18, 505–512 (1997)CrossRefPubMed

42.

E.B. Silberstein, Comparison of outcomes after (123)I versus (131)I pre-ablation imaging before radioiodine ablation in differentiated thyroid carcinoma. J. Nucl. Med. 48, 1043–1046 (2007)CrossRefPubMed

43.

N.A. Damle, C. Bal, S. Ballal, Stunning in post (131)I therapy scans after low-dose (131)I diagnostic whole body scans with differentiated thyroid cancer in the Indian patient population: critical importance of interval between the two scans. Indian J. Endocrinol. Metab. 16, 477–478 (2012)CrossRefPubMedPubMedCentral

44.

R.K. Jeevanram, D.H. Shah, S.M. Sharma, R.D. Ganatra, Influence of initial large dose on subsequent uptake of therapeutic radioiodine in thyroid cancer patients. Int. J. Rad. Appl. Instrum. B. 13, 277–279 (1986)CrossRefPubMed

45.

M. Medvedec, Thyroid stunning in vivo and in vitro. Nucl. Med. Commun. 26, 731–735 (2005)CrossRefPubMed

46.

J. Halstenberg, W.T. Kranert, H. Korkusuz, A. Mayer, H. Ackermann, F. Grünwald, C. Happel, Influence of glucocorticoid therapy on intratherapeutic biodistribution of ¹³¹I radioiodine therapy in Graves’ disease. Nuklearmedizin 57, 43–49 (2018)CrossRefPubMed

47.

M.K. Chen, M. Yasrebi, J. Samii, L.H. Staib, I. Doddamane, D.W. Cheng, The utility of I-123 pretherapy scan in I-131 radioiodine therapy for thyroid cancer. Thyroid 22, 304–309 (2012)CrossRefPubMed

48.

A. Siddiqi, R.R. Foley, K.E. Britton, A. Sibtain, P.N. Plowman, A.B. Grossman, J.P. Monson, G.M. Besser, The role of ¹²³I-diagnostic imaging in the follow-up of patients with differentiated thyroid carcinoma as compared to ¹³¹I-scanning: avoidance of negative therapeutic uptake due to stunning. Clin. Endocrinol. (Oxf.). 55, 515–521 (2001)CrossRefPubMed

49.

M. Ruhlmann, W. Sonnenschein, J. Nagarajah, I. Binse, K. Herrmann, W. Jentzen, Pretherapeutic ¹²⁴I dosimetry reliably predicts intratherapeutic blood kinetics of ¹³¹I in patients with differentiated thyroid carcinoma receiving high therapeutic activities. Nucl. Med. Commun. 39, 457–464 (2018)CrossRefPubMed

50.

P. Szumowski, M. Mojsak, S. Abdelrazek, M. Sykała, A. Amelian-Fiłonowicz, D. Jurgilewicz, J. Myśliwiec, Calculation of therapeutic activity of radioiodine in Graves’ disease by means of Marinelli’s formula, using technetium (^99mTc) scintigraphy. Endocrine 54, 751–756 (2016)CrossRefPubMedPubMedCentral

51.

K. Watanabe, T. Igarashi, H. Ashida, S. Ogiwara, T. Ohta, M. Uchiyama, H. Ojiri. Diagnostic value of ultrasound and Tl-201/Tc-99m dual scintigraphy in differentiating between benign and malignant thyroid nodules. Endocrine (2018). https://doi.org/10.1007/s12020-018-1768-0

Titel: Thyroid stunning in radioiodine-131 therapy of benign thyroid diseases
verfasst von: Christian Happel
Wolfgang Tilman Kranert
Hanns Ackermann
Ina Binse
Benjamin Bockisch
Daniel Gröner
Ken Herrmann
Frank Grünwald
Publikationsdatum: 31.12.2018
Verlag: Springer US
Erschienen in: Endocrine / Ausgabe 3/2019
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-018-01833-5

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren.

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Die „Zehn Gebote“ des Endokarditis-Managements

30.04.2024 Endokarditis Leitlinie kompakt

Worauf kommt es beim Management von Personen mit infektiöser Endokarditis an? Eine Kardiologin und ein Kardiologe fassen die zehn wichtigsten Punkte der neuen ESC-Leitlinie zusammen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2019

Determination of effective half-life of 131I in patients with differentiated thyroid carcinoma: comparison of cystatin C and creatinine-based estimation of renal function

Human telomerase reverse transcriptase in papillary thyroid cancer: gene expression, effects of silencing and regulation by BET inhibitors in thyroid cancer cells

Effects of growth hormone on hepatic insulin sensitivity and glucose effectiveness in healthy older adults

Clinical perspectives in congenital adrenal hyperplasia due to 3β-hydroxysteroid dehydrogenase type 2 deficiency

Long-term control of Paget’s disease of bone with low-dose, once-weekly, oral bisphosphonate preparations, in a “real world” setting