RAI Treatment of Distant Metastasis of Thyroid Cancer

Wook Kang Keon

doi:10.11106/jkta2013.6.1.49

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Keon: RAI Treatment of Distant Metastasis of Thyroid Cancer

Original Article

J Korean Thyroid Assoc 2013;6(1):49-55.

Published online: 3 May 2013

DOI: https://doi.org/10.11106/jkta2013.6.1.49

RAI Treatment of Distant Metastasis of Thyroid Cancer

Wook Kang Keon

¹Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea

²Cancer Research Institute, Seoul National University, Seoul, Korea

Address reprint requests to Keon Wook Kang, MD, PhD, Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2803, Fax: 82-2-745-7690, E-mail: kangkw@snu.ac.kr

Received 2 April 2013 Accepted 2 April 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

For the distant metastasis of differentiated thyroid cancers, such as papillary thyroid carcinoma, follicular thyroid carcinoma, and Hürthle cell carcinoma, radioiodine therapy is one of the standard treatment methods after total thyroidectomy. Radioiodine is accumulated in thyroid cells and thyroid cancer cells through sodium iodide symporter which is located in the membrane of cells. This molecular target specific therapy renders a better prognosis and less adverse effects. Radioiodine ¹³¹I emits gamma ray for imaging and beta ray for treatment at the same time, we can monitor patients’ specific distribution of radioiodine, which let us know unexpected metastasis lesions or differentiated status of thyroid cancer cells. In this article, I reviewed practical points of view about radioiodine therapy for distant metastasis of thyroid cancers such as methods for administration of radioiodine, patients’ preparation before radioiodine treatment, follow up of patients, adverse effects, and radiation safety issues.

Keywords: Thyroid cancer, Radioiodine, Metastasis

References

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2. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology.Thyroid Carcinoma. V.2:2012.

3. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006; 16(2):109–42.

4. Roh JH, Kim BI, Ha JS, Chang SJ, Shin HY, Choi JH, et al. Comparison of urine iodine/creatinine ratio between patients following stringent and less stringent low iodine diet for radioiodine remnant ablation of thyroid cancer. Nucl Med Mol Imaging. 2006; 40(6):322–6.

5. Kim WB, Kim TY, Kwon HS, Moon WJ, Lee JB, Choi YS, et al. Management guidelines for patients with thyroid nodules and thyroid cancer. J Korean Soc Endocrinol. 2007; 22(3):157–87.

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Fig. 1.

Whole body scans after serial radioiodine therapies in a patient with papillary thyroid cancer. Initial whole body scan after 1.1 GBq (30 mCi) of radioiodine therapy showed remnant thyroid and mediastinal lymph node metastasis. New lesions were revealed in right supraclavicular lymph nodes on whole body scan after 7.4 GBq (200 mCi) high dose radioiodine therapy about 4 months later. Multiple metastatic lesions were not visualized in initial scan due to higher affinity of radioiodine in normal thyroid tissue than thyroid cancer. After repeated 7.4 GBq of radioiodine therapies, metastatic lesions decreased and finally disappeared.

Table 1.

Empirical dose of radioiodine therapy in differentiated thyroid cancer

Status	Dose
Status	GBq	mCi
Cervical lymph node metastasis Distant metastasis	5.5–6.5 7.4	150–175 200

Table 2.

Low-Iodine diet food list for radioiodine scan or therapy

Food allowed	Food not allowed
Rice, wheat, corn Potato and sweet potato without skin Beef, pork, chicken, lamb, beans, tofu Vegetables: cabbage, onion, carrot, cucumber, radish, spinach, lettuce, mushroom Fruits, unsalted nuts Egg whites Refined salt, non-iodized salt Sugar, jam, honey, ketchup, vegetable oil, coffee Seasoning: sesame, vinegar, ginger, garlic, pepper, red pepper, wasabi, mustard	Seaweeds and related product: kelp, nori, udon, ramen, soups containing seaweeds Seafood: fish, crab, shrimp, clams, oysters Whole egg, egg yolk Milk products: milk, cheese, yogurt, ice cream, butter, milk chocolate Artificial red dye: ham, sausage, drinks, cough syrup Sea salt, iodized salt and related food: Kimchi, soy bean paste, hot pepper paste

Fig. 2.

¹³¹I scan versus ¹²³I scan. ¹²³I scan (B) is clearer than ¹³¹I scan (A) and reveals small lesions.

Fig. 3.

Diagnostic radioiodine scan (A) versus scan after radioiodine therapy (B). Diffuse lung metastasis was found out on a scan after radioiodine therapy which was not visualized on a small dose of diagnostic scan.

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