Factors affecting discharge time of well differentiated thyroid cancer patients receiving 131I therapy: Five years’ experience

Document Type : Original Article

Authors

Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Khyber Pakhtunkhwa, Pakistan

Abstract

Introduction:The post-surgical management of patients with differentiated thyroid cancer include ablation of remnant local and distant metastatic tissues with 131I therapy, which accentuates isolation of the patient in order to avoid unnecessary radiation exposure to the care givers, general public and the environment. The duration of isolation is subject to the reduction of exposure to the safe limit as defined by the regulatory bodies. 
Methods:This study presents the correlation of isolation period of the radioiodine treated patients with administered activity, surgical endeavors and the disease extent. The study was conducted on 222 patients at the Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan from 2008-2012.
Results: The number of patients in the four groups on the basis of 131I administered activity were, 131I administration while 27.03%, 24.32%, 10.81%, 6.31%, and 0.90% patients were kept in isolation for 72, 96, 120, 144 and 168 hours, respectively.
Conclusion: The isolation period of radioactive 131I treated patients is directly related to the 131I activity administered, size of the remnant, and extent of the disease.

Keywords


  1. Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol. 2013;2013:965212.
  2. Jegerlehner S, Bulliard JL, Aujesky D, Rodondi N, Germann S, Konzelmann I, Chiolero A; NICER Working Group. Overdiagnosis and overtreatment of thyroid cancer: A population-based temporal trend study. PLoS One. 2017 Jun 14;12(6):e0179387.  
  3. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009 Nov;19(11):1167-214.  
  4. Haymart MR, Banerjee M, Yang D, Stewart AK, Doherty GM, Koenig RJ, Griggs JJ. The relationship between extent of thyroid cancer surgery and use of radioactive iodine. Ann Surg. 2013 Aug;258(2):354-8.
  5. Mazzaferri EL. Empirically treating high serum thyroglobulin levels. J Nucl Med. 2005 Jul;46(7):1079-88.
  6. Hewamanna R, Loganathan N and Perera DKA. Releasing thyroid cancer patients from the hospital based on dose rate measurement after 131I activity administration. J Natl Sci Found Sri. 2014;42 (2):137-141.
  7. Lassmann M, Reiners C, Luster M. Dosimetry and thyroid cancer: the individual dosage of radioiodine. Endocr Relat Cancer. 2010 Jun 3;17(3):R161-72.
  8. Zhang H, Jiao L, Cui S, Wang L, Tan J, Zhang G, He Y, Ruan S, Fan S, Zhang W. The study of external dose rate and retained body activity of patients receiving 131I therapy for differentiated thyroid carcinoma. Int J Environ Res Public Health. 2014 Oct 21;11(10):10991-1003.
  9. Shah AS, Hameedullah, Saeed F, Shah KA, Khan AU, Khattak MR. Radiation doses from 131I treated hyperthyroidism patients versus life style: - a survey.  Int J Radiat Res. 2015;13(1): 67-72.
  10. Ahmadi Jeshvaghane N, Paydar R, Fasaei B, Pakneyat A, Karamloo A, Deevband MR, Khosravi HR. Criteria for patient release according to external dose rate and residual activity in patients treated with 131I-sodium iodide in Iran. Radiat Prot Dosimetry. 2011 Sep;147(1-2):264-6.
  11. Demir M, Parlak Y, Cavdar I, Yeyin N, Tanyildizi H, Gümüser G, Sayit E, Erees S, Sayman H. The evaluation of urine activity and external dose rate from patients receiving radioiodine therapy for thyroid cancer. Radiat. Radiat Prot Dosimetry. 2013;156(1):25-9.
  12. Pakistan Nuclear Regularity Authority. Guidance level for maximum activity for patients in therapy on discharge from hospital. Regulations on Radiation Protection (PAK-904) Government of Pakistan, 2004.
  13. National Council of Radiation Protection and Measurement (NCRP). Management of radionuclide therapy patients. NCRP report No. 155. USA; NCRP, 2006.
  14. International Commission of Radiation Protection (ICRP). The 2007 Recommendations of the International Commission on Radiation Protection, ICRP Publication 103. Ann ICRP. 2007; 37(2- 4):1-332.
  15. Alevizaki C, Molfetas M, Samartzis A, Vlassopoulou B, Vassilopoulos C, Rondogianni P, Kottou S, Hadjiconstantinou V, Alevizaki M. Iodine 131 treatment for differentiated thyroid carcinoma in patients with end stage renal failure: dosimetric, radiation safety, and practical considerations. Hormones (Athens). 2006 Oct-Dec;5(4):276-87.
  16. Jhummon NP, Tohooloo B, Qu S. Iodine-131 induced hepatotoxicity in previously healthy patients with Grave's disease. Thyroid Res. 2013 Mar 16;6:4.
  17. Muhammad W, Faaruq S, Matiullah, Hussain A, Khan AA. Release criteria from hospitals of 131I thyrotoxicosis therapy patients in developing countries--case study. Radiat Prot Dosimetry. 2006;121(2):136-9.
  18. Khan SA, Khan MS, Arif M, Durr-e-Sabih, Rahim MK, Ahmad I. Radiation Dose-rate Reduction Pattern in Well-differentiated Thyroid Cancer Treated with I-131. J Coll Physicians Surg Pak. 2015 Jul;25(7):510-3.
  19. Oh JR, Ahn BC. False-positive uptake on radioiodine whole-body scintigraphy: physiologic and pathologic variants unrelated to thyroid cancer. Am J Nucl Med Mol Imaging. 2012;2(3):362-85.
  20. de Carvalho JW, Sapienza M, Ono C, Watanabe T, Guimarães MI, Gutterres R, Marechal MH, Buchpiguel C. Could the treatment of differentiated thyroid carcinoma with 3.7 and 5.55 GBq of (131I)NaI, on an outpatient basis, be safe? Nucl Med Commun. 2009 Jul;30(7):533-41.
  21. Van Dyke M, Punja M, Hall MJ, Kazzi Z. Evaluation of toxicological hazards from medical radioiodine administration. J Med Toxicol. 2015 Mar;11(1):96-101.
  22. Paschke R, Lincke T, Müller SP, Kreissl MC, Dralle H, Fassnacht M. The treatment of well-differentiated thyroid carcinoma. Dtsch Arztebl Int. 2015 Jun 26;112(26):452-8.
  23. Carballo M, Quiros RM.  To treat or not to treat: the role of adjuvant radioiodine therapy in thyroid cancer patients. J Oncol. 2012;2012:707156.