Radioiodine-131 therapy (RIT) in benign thyroid diseases: Personalized prescription based on objectives with optional use of pharmacological modulators
| Autor: | J. Clerc |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Oncology
endocrine system medicine.medical_specialty endocrine system diseases Radiological and Ultrasound Technology Antithyroid drugs business.industry Functional autonomy medicine.medical_treatment Thyroid Biophysics Planning target volume Radioiodine therapy Disease 030218 nuclear medicine & medical imaging Radiation therapy 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Internal medicine medicine Radiology Nuclear Medicine and imaging Medical prescription business |
| Zdroj: | Médecine Nucléaire. 44:250-260 |
| ISSN: | 0928-1258 |
| DOI: | 10.1016/j.mednuc.2020.08.001 |
| Popis: | 131I therapy (RIT) in benign thyroid diseases is the oldest and most currently used application of internal radiotherapy. With the new molecular 123I-TS images one may identify 15 presentations that can benefit from RIT. With three groups of activity determination corresponding to a dozen approaching protocols, several judgmental criteria (eu-, hypo-, hyperthyroidism, relapses etc.) and varying timeframes to assess the success, a “best method of activity calculation” makes little sense. Four clinical objectives must be first identified (goal): antitoxic (euthyroidism), ablative (hypothyroidism), reductive (to reduce a targeted volume) and preventive (to prevent progression from compensated to overt hyperthyroidism) 131I-RIT. A dose response relationship as regards the target volume reduction is firmly established in the short term (1-year) and explains the clinical outcome in Thyroid Functional Autonomy (TFA). In Grave's disease (GD), other factors may interfere that make the long-term function less predictable. Pharmacological modulators of 131I-RIT such as antithyroid drugs (ATDs) and LT3 must be skillfully handled. ATDs interfere with iodine kinetics, enhance the heterogeneity of the spatial dose deposition and diminish the accuracy of absorbed dose deposition, especially when using poorly controlled dosimetric approaches. Short LT3 administration suppresses TSH that allows direct targeting of the autonomously functioning thyroid tissue. The three main groups and variants of activity calculation are presented in detail. Calculating the activity allows a 50% average reduction in the 131I administered dose. Medical strategy should favour the informed patient's choice, after excluding the rare medical causes prompting discussion of an ablative approach. In TFA, low occurrence of hypothyroidism is the rule provided the treatment be given with a TSH |
| Databáze: | OpenAIRE |
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