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OBJECTIVES This study aimed to indicate the risk factors of atrial fibrillation (AF) in thyrotoxic patients receiving radioactive iodine (RAI) therapy after antithyroid drug and other medication. METHODS This study was a retrospective cohort study. Thyrotoxic patients were divided into two groups, with or without AF. Clinical features were retrospectively analyzed. Univariate and multivariate analyses of data from thyrotoxic patients were performed to evaluate the probability of AF. RESULTS The following clinical factors were found to be correlated with AF: age, gender, duration of hyperthyroidism, coronary artery disease, hypertension, and levels of platelets, creatinine, uric acid (UA), and certain liver enzymes. According to the multiple logistic regression model, age and levels of UA, direct bilirubin (DBIL), and gamma-glutamyl transpeptidase (GGT) were important risk factors for predicting AF. ROC analysis showed that DBIL levels were predictive of AF, with a specificity of 0.813, a sensitivity of 0.767, and an area under the curve of 0.8515 (P < 0.001). CONCLUSION Older age and levels of UA, DBIL, and GGT influenced the occurrence of AF in thyrotoxic patients receiving RAI. DBIL level was an important factor in predicting AF in patients with hyperthyroidism. Thus, thyrotoxic patients who have the above-mentioned risk factors should undergo routine pulse palpation should be considered for active antithyroid drug therapy.

Objective Remnant thyroid ablation is crucial in the management of patients with differentiated thyroid cancer. However, the optimal dose of radioactive I for ablation is still controversial. This study aimed to compare the success rate of different activities of I for postoperative remnant ablation in randomized controlled trials (RCTs) and to determine the optimal dose. Patients and methods Sources were retrieved from the Cochrane Library, Medline, Embase, Scopus, and Google Scholar until March 2014. All RCTs that assessed the efficacy of different doses of I for ablation were selected. After data extraction, statistics were performed by Review Manager 5.2 software. Results Seventeen RCTs were considered eligible, involving 3737 patients. The overall methodological quality of the studies was good. The rate of successful remnant ablation of low versus moderate I activities (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.80-1.00; P = 0.06) and moderate versus high I activities (RR, 0.94; 95% CI, 0.89-1.00; P = 0.05) showed no significant differences. However, high I activities had 11% higher successful ablation rate than low activities with an RR of 0.89 (95% CI, 0.81-0.97; P = 0.008), which was significant. Conclusions We summarized all available randomized evidence to demonstrate that high dose of I was significantly better than low dose to achieve successful remnant thyroid ablation.

The purpose of this study was to systematically provide a database for estimating radiation dose of individuals nearby (131)I-treated hyperthyroid patients. External dose rates were measured on 48 hyperthyroid patients using a survey meter in front of patients' thyroid glands. The initial measurement was recorded within 30 min post radioiodine administration at 0.3 m, 0.6 m, 1 m, and 2 m. Follow-up measurements were carried out up to 12 d post radioiodine administration. In addition, ambient dose rates of different locations such as wards, patients' washrooms, medical staffs' workplaces, and corridors were also measured. The Na131I treatment dose administered in this study ranged from 74-555 MBq. Significant positive correlation between dose rate at 1 m and the administered dose was found in this study. The normalized external dose rates at 0.3 m were 0.234 µSv h(-1) MBq(-1) at 0.5 h, 0.325 µSv h(-1) MBq(-1) at 4 h, 0.308 µSv h(-1) MBq(-1) at 6 h, 0.301 µSv h(-1) MBq(-1) at 24 h, 0.259 µSv h(-1) MBq(-1) at 48 h, 0.234 µSv h(-1) MBq(-1) at 72 h, 0.224 µSv h(-1) MBq(-1) at 96 h, 0.186 µSv h(-1) MBq(-1) at 120 h, and 0.158 µSv h(-1) MBq(-1) at 144 h, respectively. With these results, the authors estimated radioactive radiation dose for the public and medical staffs near (131)I-treated hyperthyroid patients. This study is beneficial for radiation safety decision-making.

Iodine-131 (I-131) treatment and subsequent whole body iodine-131 scans (WBSs) are important in the management of differentiated thyroid carcinoma (DTC). Nevertheless, false positive benign lesions in WBS should be interpreted with reliable anatomic imaging methodologies to differentiate from true metastases. We report a DTC case with a concurrent thyroglossal duct cyst (TDC), which is relatively uncommon compared with an accompanying lingual thyroid. After thyroid remnant ablation, subsequent posttherapeutic WBS showed a stable I-131 avid lesion in the neck despite cumulative dosage of 346 mCi I-131. Low level of thyroglobulin indicated that the lesion should be from thyroid origin, yet only a small amount of thyroid remnant should be contained. Magnetic resonance imaging and computed tomography were performed and revealed a dumbbell-shaped TDC. Part of the lesion was behind the hyoid bone, part of it protruded to the anterior surface of the thyroid cartilage, and the isthmus penetrated through the thyrohyoid membrane. Although the shape of this TDC reflects the route of the thyroglossal duct in embryological perspective, its coincidence with DTC is rarely documented. Our case also proved that the possibility of concurrent TDC should be considered as the cause of residual thyroglobulin for an I-131 avid lesion in the midline anterior cervical area, which could show great resistance to I-131 therapy.

To assess the efficacy of radioiodine therapy (RIT) and investigate the prognostic factors for patients with pulmonary metastasis secondary to differentiated thyroid carcinoma (DTC) through a retrospective study. A total of 80 patients with radioactive iodine-131 (131I)-avid pulmonary metastasis from DTC treated with 131I from 2007 to 2014 at our institution entered the study. Treatment response was mainly measured by two parameters: serum thyroglobulin (Tg) levels and post-therapeutic 131I whole-body scan (WBS). Treatment variables were assessed for statistical significance using the univariate and multivariate analyses. A receiver-operating characteristic (ROC) curve was also plotted to verify the accuracy of predictors. Of these 80 patients, the overall effective rate was 72.5% (58/80), the rates for complete response (CR), partial response (PR), and no response (NR) were 20.0%, 52.5%, and 27.5%, respectively. Univariate analysis showed that gender, pulmonary nodule size, absence or presence of extrapulmonary distant metastases, age, and Tg level at diagnosis were significantly associated with 131I therapy efficacy. Binary logistic regression analysis revealed that older patients (odds ratio [OR]:1.481, 95% confidence interval [CI]: 1.457–2.091, P = .020), subjects with higher Tg levels at diagnosis (OR: 1.046, 95% CI: 1.016–1.119, P = .014), and those with extrapulmonary distant metastases (OR: 1.185, 95%CI: 1.025–1.463, P = .020) had a higher probability of poor prognosis. The optimal cutoffs for age and Tg level to predict 131I therapy efficacy for DTC with lung metastases were 46 years old and 55.50 ng/mL, respectively, based on ROC analysis. This study indicated that most DTC patients with pulmonary metastases can obtain partial or complete remission after RIT, while older patients with higher Tg levels at diagnosis and extrapulmonary distant metastases more likely show poor prognosis.

Hepatic dysfunction is often observed in patients with Graves’ hyperthyroidism. The aims of this study were to investigate the risk factors for hepatic dysfunction and to analyze the efficacy of 131I (radioactive iodine-131) treatment. In total, 2385 patients with Graves’ hyperthyroidism (478 males, 1907 females; age 42.8 ± 13.5 years) were involved in our study. Of these, 1552 cases with hepatic dysfunction received 131I treatment. All clinical data were retrospectively reviewed to explore the risk factors associated with hepatic dysfunction using logistic regression analysis. Furthermore, we observed thyroid and liver function indices for the 1552 subjects at 3, 6 and 12 months after 131I treatment, in order to evaluate efficacy. Overall, 65% patients were affected by hepatic dysfunction. The most common abnormality was elevated alkaline phosphatase (ALP), of which the prevalence was 52.3%. The percentages of hepatocellular injury type, bile stasis, and mixed type were 45.8%, 32.4%, and 21.8%, respectively. Both univariate and multivariate analyses demonstrated that age, duration of Graves hyperthyroidism, free triiodothyronine (FT3)level, and thyrotrophin receptor antibody (TRAb) concentration were the most significant risk factors predicting hepatic dysfunction. Additionally, the patients with mild hepatic dysfunction, or hepatocellular injury type were more likely to attain normal liver function after 131I treatment. Furthermore, after 131I treatment, liver function was more likely to return to normal in the cured group of patients compared with the uncured group. Older patients and cases with a longer history of Graves’ hyperthyroidism, higher FT3 or TRAb concentration were more likely to be associated with hepatic dysfunction, and the prognosis of hepatic dysfunction was closely associated with the outcomes of Graves’ hyperthyroidism after 131I treatment.