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Cervical lymph node metastasis is one of the most common clinical presentations of papillary thyroid carcinoma (PTC). Occult thyroid carcinoma is described as absence of primary tumour or with presence of microcarcinoma in thyroid with cervical lymph node metastasis. Frequency of occult thyroid cancer has decreased due to developments in imaging and improved accuracy of histological examinations. 38 year old male presented to us with complaints of swelling over the left side of neck for the past 2 months. Ultrasonography was suggestive of multiple suspicious enlarged nodes in left level II, III, IV and V and fine needle aspiration cytology showed features of metastatic PTC. He was planned for total thyroidectomy with central compartment clearance and bilateral functional neck dissection. Final histopathology staging was pT0N1b. Radioactive iodine (RAI) screening showed residual functioning thyroid and later therapeutic RAI was administered. He has been on regular follow up and disease free for 1 year post treatment. Occult thyroid carcinoma is a rare diagnosis with multiple treatment plans. Few hypothesis for this entity includes tumor regression, ectopic thyroid carcinoma or missed pathological findings. [ABSTRACT FROM AUTHOR]

Novel Cu2O/Cu@C/SiO2 materials with low cost were conveniently synthesized using C/SiO2 derived from rice-husk as support and used for iodine gas adsorption. The iodine adsorption behaviors affected by Cu content, contact time and temperature were investigated. The adsorption capacity as high as 820 mg/g was achieved benefiting from the synergistic effect between Cu2O/Cu and C/SiO2. The results demonstrated that both Cu2O and Cu changed to CuI after iodine adsorption, indicating that the dominant adsorption mechanism was chemical reaction through formation of CuI. This work revealed that the obtained Cu2O/Cu@C/SiO2 could be included in the list of candidate iodine gas adsorbents. [ABSTRACT FROM AUTHOR]

Background: Pooled data analysis from three phase I/II larotrectinib clinical trials revealed that larotrectinib demonstrated rapid and durable disease control and a favorable safety profile for patients with neurotrophic-tropomyosin receptor kinase (NTRK) fusion positive thyroid carcinoma. Herein, we report the case of a patient with papillary thyroid carcinoma (PTC) and liver metastases who demonstrated a durable response to treatment with larotrectinib. Case presentation: A 50-year-old female with PTC was referred to our hospital for postoperative observation. Computed tomography (CT) scan was performed to screen for distant metastasis, since thyroglobulin concentration increased gradually, and revealed multiple distant metastases, including multiple liver metastases. Radioactive iodine was administered at a dose of 100 mCi. However, uptake was observed only in the thyroid bed, and distant metastases had no avidity. As liver metastases progressed, lenvatinib (24 mg/day) was initiated after confirmation of liver metastases by liver biopsy 9 years and 1 month after the initial referral to our hospital. Since the multiple metastases became refractory for lenvatinib, the OncoGuide™ NCC Oncopanel System was performed, and the SQSTM1–NTRK1 gene fusion was confirmed. Larotrectinib was subsequently administered at a dose of 200 mg/day. The CT before the initiation of larotrectinib showed multiple liver metastases with a maximum diameter of 48 mm. The first CT evaluation at 1 month after the initiation of larotrectinib treatment showed that the tumor volume was reduced by 28% in the RECIST 1.1 criteria. After 3 months of larotrectinib treatment, a 38% reduction in the tumor volume was achieved as the best clinical response. The only side effect was grade 1 myalgia. At 12 months after the initiation of larotrectinib treatment, none of the lesions had progressed. Conclusions: In conclusion, larotrectinib demonstrated effective antitumor activity against liver metastases of PTC, a relatively rare site of distant metastasis. Furthermore, the efficacy of larotrectinib was maintained, even though the patient had a history of multi-tyrosine kinase inhibitor treatment and a relatively infrequent fusion gene, SQSTM1–NTRK1. [ABSTRACT FROM AUTHOR]

Orthognathic surgery has a high incidence of postoperative nausea (PON) and vomiting (POV), delaying mobility initiation and postoperative recovery. Bleeding is another risk associated with this surgical procedure. We aimed to compare total intravenous anesthesia (TIVA) and volatile anesthesia in patients undergoing orthognathic surgery in terms of postoperative nausea and vomiting (PONV) incidence and hemodynamic changes. This retrospective study included 82 patients who underwent bilateral sagittal split ramus osteotomies at Saga University Hospital between April 2016 and April 2021. We compared the effects of TIVA and volatile anesthesia on PONV onset after surgery, acute postoperative hemodynamic changes (blood pressure and heart rate), and factors contributing to PONV. PON was significantly lower in the TIVA group than in the volatile anesthesia group. The total dose of fentanyl contributed to the onset of POV, while the onset of PON was associated with low volumes of fluid infusion and urine in the TIVA and volatile anesthesia groups, respectively. Furthermore, post-extubation hemodynamic change was significantly smaller in the TIVA group than in the volatile anesthesia group. Therefore, TIVA could have a reduced risk of PONV and hemodynamic changes in patients undergoing orthognathic surgery. Employing TIVA could mitigate perioperative complications and enhance patient safety. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop and psychometrically evaluate a patient-reported outcome measure (PROM), SAlivary, LAcrimal, NaSal (SALANS), to document patients' symptoms after radioactive iodine (RAI) treatment for differentiated thyroid cancer (DTC). Methods: We generated and iteratively revised SALANS items based on expert input, focus group discussions and feedback from cognitive testing (n = 17). We administered an initial SALANS measure with 39 items to patients diagnosed with DTC in the past two years (n = 105). Exploratory factor analysis (EFA) examined the factor structure of the SALANS items. We assessed the consistency reliability and related the total and subscale scores of the final SALANS to existing PROMs to assess validity. Results: The final SALANS consisted of 33 items and six subscales (sialadenitis, taste, xerostomia, dry eyes, epiphora, and nasal) with six factors extracted by EFA. The six subscales demonstrated good internal reliability (α range = 0.87—0.92). The SALANS total score showed good convergent validity with the Xerostomia Inventory (r = 0.86) and good discriminant validity with a measure of spirituality (r = − 0.05). The mean SALANS total score was significantly higher (d = 0.5, p < 0.04) among patients who had RAI compared to those who did not have RAI. Conclusion: Preliminary evidence suggests that SALANS is a novel and reliable PROM to assess the type and frequency all symptoms experienced after RAI treatment for DTC. Future work is needed to further validate and develop the scale. [ABSTRACT FROM AUTHOR]

In the current study, a zirconium-containing anion exchange resin was synthesized as an oxidizing resin for iodide adsorption from aqueous solutions. The static adsorption capacity of the oxidizing resin was 612.86 mg/g (obtained from isotherm studies and the Langmuir model). This capacity was 31% higher than the capacity of counter parent resin for iodide adsorption. Adsorption performance of the oxidizing resin was close to maximal over a wide range of pHs (2–7), and the best results were obtained at pH = 3 (8.5% higher than the resin capacity in neutral pH). Iodide removal selectivity in the presence of three commonly encountered anions SO 4 2 - , NO 3 - and Cl - was improved. The iodide selectivity of oxidizing resin in the presence of Cl - ion was excellent. Breakthrough curves of both resins with and without encountered anions were fitted with common breakthrough curve models. The results were consistent with the results of the batch mood experiments. Pseudo-second-order kinetic was described kinetic behavior of both resins well. An iodide adsorption mechanism was proposed using the results of batch experiments and the resin characterizations (XPS and Raman spectra). The potential of oxidizing resin for iodide oxidation into iodine increased the capacity and selectivity of resin toward iodide ions. [ABSTRACT FROM AUTHOR]

Safe confinement of fission iodine isotopes for long-term radioactive waste disposal remains a formidable challenge, as conventional sorbents provide inherently weak iodine-host interactions. We report here a novel halogen bond (X-bond) directed strategy to sequester volatile iodine in hydrogen-bonded (H-bonded) frameworks with unprecedented stability. Charge-assisted H-bonded frameworks bearing open halide sites are developed, showing distinctive iodine encapsulation behaviors without compromising the crystallinity. Direct crystallographic evidence indicates the formation of X-bonds, i.e., ∣–∣⋯Cl− and ∣–∣⋯Br−, within the confined pore channels. Unusual polyhalogen anions, i.e., [I2Cl2]2− and [I2Br2]2−, sustained in H-bonded frameworks are identified for the first time. The X-bond reinforced host-guest interaction affords robust iodine trapping without leaking out even at elevated temperatures up to 180 °C. By integrating the halogen-bond chemistry with H-bonded frameworks, this study offers fresh concepts for developing effective host reservoirs to secure fission iodine isotopes from spent fuel reprocessing off-gases. [ABSTRACT FROM AUTHOR]

Excessive intake of iodine will do harm to human health. In recent years, high iodine groundwater has become a global concern after high arsenic and high fluorine groundwater. A deep understanding of the environmental factors affecting iodine accumulation in groundwater and the mechanism of migration and transformation is the scientific prerequisite for effective prevention and control of iodine pollution in groundwater. The paper comprehensively investigated the relevant literature on iodine pollution of groundwater and summarized the present spatial distribution and hydrochemical characteristics of iodine-enriched groundwater. Environmental factors and hydrogeological conditions affecting iodine enrichment in aquifers are systematically summarized. An in-depth analysis of the hydrologic geochemistry, physical chemistry, biogeochemistry and human impacts of iodine transport and transformation in the surface environment was conducted, the results and conclusions in the field of high iodine groundwater research are summarized comprehensively and systematically. Stable isotope can be used as a powerful tool to track the sources of hydrochemical components, biogeochemistry processes, recharge sources and flow paths of groundwater in hydrogeological systems, to provide effective research methods and means for the study of high iodine groundwater system, and deepen the understanding of the formation mechanism of high iodine groundwater, the application of isotopic technique in high iodine groundwater is also systematically summarized, which enriches the method and theory of high iodine groundwater research. This paper provides more scientific basis for the prevention and control of groundwater iodine pollution and the management of groundwater resources in water-scarce areas. [ABSTRACT FROM AUTHOR]

Childhood radioactive iodine exposure from the Chornobyl accident increased papillary thyroid carcinoma (PTC) risk. While cervical lymph node metastases (cLNM) are well-recognized in pediatric PTC, the PTC metastatic process and potential radiation association are poorly understood. Here, we analyze cLNM occurrence among 428 PTC with genomic landscape analyses and known drivers (131I-exposed = 349, unexposed = 79; mean age = 27.9 years). We show that cLNM are more frequent in PTC with fusion (55%) versus mutation (30%) drivers, although the proportion varies by specific driver gene (RET-fusion = 71%, BRAF-mutation = 38%, RAS-mutation = 5%). cLNM frequency is not associated with other characteristics, including radiation dose. cLNM molecular profiling (N = 47) demonstrates 100% driver concordance with matched primary PTCs and highly concordant mutational spectra. Transcriptome analysis reveals 17 differentially expressed genes, particularly in the HOXC cluster and BRINP3; the strongest differentially expressed microRNA also is near HOXC10. Our findings underscore the critical role of driver alterations and provide promising candidates for elucidating the biological underpinnings of PTC cLNM. Childhood radioactive iodine exposure from the Chornobyl accident led to an increased papillary thyroid carcinoma (PTC) risk and potentially higher invasiveness depending on tumour genetic profiles. Here, the authors use genomics to characterise and predict cervical lymph node metastases in PTC patients affected by the Chornobyl accident. [ABSTRACT FROM AUTHOR]

Background: Graves' disease is the commonest cause of hyperthyroidism in iodine replete areas. Following universal salt iodization, most Egyptians are considered iodine sufficient. The present study aims to report a survey of real-life practices in the management of graves' disease among Egyptian physicians and compare them to other similar reports. Methods: An online survey was sent to members and affiliates of Alexandria thyroid association. Egyptian physicians were surveyed about initial diagnostics workup, management of an index case of uncomplicated graves' disease not desiring pregnancy. Two modified scenarios were proposed to the index case to survey the impact on treatment preferences. Anonymous responses were collected, analyzed, presented, and compared to other published similar reports. Results: Sixty-eight participated out of 120 invited physicians (56.67%). Initial workup included TSH receptor antibodies 46/68 (67. 6%), thyroid ultrasound 45/68 (66.2%), and thyroid scintigraphy 25/68 (36.8%). Treatment preferences in the index case were antithyroid drugs (ATD's) 52/68 (76.5%), radioiodine 12/68 (17.5%), and surgery 4/68 (6%). Compared to other reports, treatment preferences were almost identical to Italian ones, ATD's (77.1%), radioiodine (16.2%), and surgery (4.5%). If the patient is complicated with graves' orbitopathy, treatment preferences would change into ATD's 37/67 (55%), radioiodine 1/67 (2%), radioiodine with corticosteroids 14/67 (21%), and surgery 15/67 (22%). If the patient is desiring pregnancy, treatment preferences would be ATD's 32/68 (47%), radioiodine 5/68 (7.4%), and surgery 31/68 (45.6%). Conclusion: A high participation rate was observed. Similar to other reports, medical treatment is the preferred modality of treatment in graves' disease and surgery is the least utilized modality. Similar treatment preferences to Italians were observed in the index case. [ABSTRACT FROM AUTHOR]

This study was desinged to evaluate the efficacy and safety of activated allograft combined with the induced membrane technique for reconstruction of infected segment bone defects of lower limbs. A retrospective analysis was conducted on 19 patients from May 2015 to February 2017. After debridements, the bone defects were filled with antibiotic bone cement to form the induced membrane. Autologous mesenchymal stem cells were seeded onto allografts to construct activated allograft, which was implanted into the induced membrane after infection was controlled. The clinical efficacy and complications were observed. 19 patients with 20 infected segment bone defect were evaluated. The average deficit size was 11.08 (4–17) cm in length. After a mean follow-up of 71.84 (61–82) months, bone union was achieved in 16 patients (17 sites), resulting in a final union rate of 84.21% (16/19 patients). The average bone union time was 10.18 (5–28) months. There were 2 patients with recurrence of infection, 3 patients with graft absorption, and 1 patient with malunion due to implant breakage. There were no graft-related complications. This study provides clinical significance for the treatment of patients with insufficient autologous bone. [ABSTRACT FROM AUTHOR]

Purpose: Radioiodine (RAI) is a well-established first-line therapy for autonomously functioning thyroid nodules (AFTN). Radiofrequency ablation (RFA) is a minimally invasive procedure that has been proposed as an alternative treatment option for hyperthyroidism caused by AFTN. Although RFA has been shown to be useful for reducing nodule volume and improving TSH levels in AFTN, no comprehensive comparative clinical studies have been proposed to evaluate the overall response to RFA treatment. The aim of this comparative systematic review and meta-analysis was to evaluate the response of RAI and RFA treatments in AFTN. Methods: A systematic search strategy was applied in PubMed, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov until July 2023 without time or language restrictions. Studies investigating the response to RAI and/or RFA treatment in AFTN patients 6 and/or 12 months after treatment were included. The risk of bias was assessed based on the study design. Random-effect models were used for the meta-analysis. Results: Twenty-three articles (28 reports) met the inclusion criteria and were included in the study. Overall, RAI therapy was found to have a significantly higher treatment response (94%) than RFA (59%), although the volume of AFTNs was reduced to a similar extent. In the direct comparison (n = 3 studies), RFA showed a higher risk of non-response than RAI (RR, 1.24; 95% CI, 0.94–1.63; z = 1.55; p = 0.12). Conclusions: Our results demonstrate the superiority of RAI over RFA in terms of success rates and safety profile and confirm RAI as the first choice for the treatment of AFTNs. [ABSTRACT FROM AUTHOR]

Gaseous iodine compounds especially radioactive iodine compounds such as CH 3 I from nuclear spent fuel, once discharged, being destructive to the environment and harmful to human health are usually captured by solid adsorption. The faujasite (FAU) composed of Si, Al, and O elements is a kind of porous material with a high specific surface area usually used as an adsorbent and catalyst carrier. Excessive micropores in the skeleton of FAU hinder the diffusion of gas molecules to reduce the adsorption efficiency. In the NH 4 F solution, the skeleton of FAU was selectively corroded by F - ions and rearranged to form the construction with different the distribution of pore size. Ag-oxide nanoclusters were deposited inside the mesoporous and microporous pores of corroded FAU by the photoreduction method. To regulate the distribution of pore size, FAU deposited Ag-oxide nanocluster with more mesoporous and microporous pores providing more sufficient space for the diffusion of gaseous CH 3 I presented more excellent adsorption performance. [ABSTRACT FROM AUTHOR]

We carried out an in-depth study on structural characteristics, both primary and conformational structure in solution of a novel sulfated polysaccharide from green seaweed Codium geppiorum collected in central coast of Vietnam. Primary structure of the polysaccharide was determined mainly by NMR spectra, while conformation was elucidated by using small-angle X-ray scattering method. The polysaccharide was evaluated for its cytotoxic effects on three human cancer cell lines. The results indicated that dominant structure of Codium geppiorum polysaccharide is a linear sulfated galactan, and it was composed of → 4)-β-D-Galp3S-(1 → , → 3)-β-D-Galp4S-(1 → and → 3)-β-D-Galp-(1 → residues connected through 1,3-linkages. The polysaccharide has a rodlike conformation in aqueous solution, and it shows chain association with cross-sectional radius of gyration, Rgc, around 0.70 nm as estimated from small-angle X-ray scattering measurements. The polysaccharide exhibited a significant cytotoxic activity against HT29 (colorectal adenocarcinoma), 8505c (undifferentiated thyroid carcinomas) and Hela (cervical cancer) human cancer cell lines with IC50 values of 51.85 ± 2.30, 89.30 ± 2.35 and 72.22 ± 6.73 µg/mL, respectively. [ABSTRACT FROM AUTHOR]

Papillary thyroid carcinoma (PTC) is type of aggressive tumor, with a markedly declined survival rate when distant metastasis occurs. It is of great significance to develop potential biomarkers to evaluate the progression of PTC. LncRNAs are recently widely claimed with biomarker value in malignant tumors. Herein, the role of LncRNA PFAR in PTC was investigated to explore potential prognostic marker for PTC. Compared to NTHY-ORI 3-1 cells, LncRNA PFAR was found markedly upregulated in PTC cell lines. In LncRNA PFAR knockdown TPC-1 cells, markedly declined cell viability, increased apoptotic rate, enhancive number of migrated cells, and elevated migration distance were observed, accompanied by a suppressed activity of the RET/AKT/mTOR signaling. In LncRNA PFAR overexpressed BCPAP cells, signally increased cell viability, declined apoptotic rate, reduced number of migrated cells, decreased migration distance, and increased tumor volume and tumor weight in nude mice xenograft model were observed, accompanied by an activation of the RET/AKT/mTOR signaling. The binding site between LncRNA PFAR and miR-15a, as well as miR-15a and RET, was confirmed by the dual luciferase reporter assay. The FISH study revealed that LncRNA PFAR was mainly located in the cytoplasm. Furthermore, the impact of the siRNA targeting LncRNA PFAR against the growth and migration of PTC cells was abolished by the inhibitor of miR-15a or SC79, an activator of AKT/mTOR signaling. Collectively, LncRNA PFAR facilitated the proliferation and migration of PTC cells by mediating the miR-15a/RET axis. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the impact of fellowship training (FT) for thyroid specialists on the outcomes of patients with thyroid cancer. We reviewed surgeries performed for thyroid cancer before (non-FT group) and after (FT group) fellowship training and compared several variables, including length of stay of patients, tumor diameter, surgical method, lymph node dissection, parathyroid implantation, surgical duration, intraoperative blood loss, and postoperative complications. Compared with the non-FT group, the FT group had a shorter hospital stay, more adequate fine needle aspiration biopsy of the thyroid, less intraoperative blood loss, higher rate of parathyroid implantation, higher lymph node dissection rate, and lower nerve injury and hypoparathyroidism rates. When the surgical duration was < 200 min and/or only central lymph node dissection was performed, the FT group had a lower incidence of postoperative complications than the non-FT group. When, the incidence of postoperative complications, including postoperative nerve injury and hypoparathyroidism. In conclusion, FT for thyroid specialists is beneficial for patients with thyroid cancer and may allow a shorter hospital stay and reduced incidence of postoperative complication. Accordingly, FT may facilitate a more appropriate surgical approach with a preoperative pathological diagnosis. [ABSTRACT FROM AUTHOR]

A silver-based material coated with polyaniline (Ag@PANI) was successfully synthesized to effectively remove I2 and I−. Experimental results showed the sorption capacity of I2 by Ag@PANI reached 132 wt.%, and the I− uptake capacity reached 419.6 mg·g−1. Additionally, Ag@PANI could effectively remove up to 99.9% of low I−-contaminated water, and the distribution coefficient (Kd) toward I− reaches 4.65 × 106 mL·g−1. Adsorption mechanism showed I2 and I− were immobilized on Ag@PANI by conversion to AgI. Moreover, electrostatic interactions might result in higher I− retention ability. Overall, Ag@PANI can be employed as promising adsorbent for the efficient removal of radioactive iodine. [ABSTRACT FROM AUTHOR]

Purpose: To examine whether adherence to a low-iodine diet (LID) enhances the therapeutic efficacy of radioiodine therapy (RAI) in Graves' hyperthyroidism (GH) in iodine-rich areas. Methods: We retrospectively evaluated 185 patients with GH from Aichi (n = 114) and Hokkaido (n = 71) Prefectures. Patients aged ≥ 18 years with GH who underwent RAI between December 2012 and March 2022 were divided into subgroups based on pretreatment with anti-thyroid drug (ATD) or potassium iodide (KI). Patients were followed up with LID from 18 days (group A) or 7 days (group H) before RAI to 3 days after RAI. The dose of radioactive iodine 131 (131I) was adjusted to deliver > 100 Gy to the thyroid. The associations between urinary iodine concentration on UIC2 vs. 24hRU and UIC2 vs. the 1-year RAI success rate (SR) were investigated. Results: Compared with UIC1, UIC2 was significantly decreased in all subgroups (P < 0.01). An inverse correlation between UIC2 and 24hRU was observed in the four groups; however, the difference was insignificant. The SR in groups A and H was 85% and 89%, respectively. Univariate analysis revealed no association between UIC2 and SR in each group. Additionally, stratification of the 185 patients into quartiles using UIC2 yielded no significant differences in SR (p = 0.79). Conclusions: LID sufficiently reduced UIC in patients undergoing RAI. Although a lower UIC2 may increase 24hRU, it did not increase the success of RAI. The benefit of LID in enhancing the efficacy of RAI in GH treatment remains uncertain. [ABSTRACT FROM AUTHOR]

With the rapid development of nuclear industry, how to effectively treat radioactive wastewater is an urgent problem that needs to be solved, especially the treatment of radioactive iodine, which has high volatility and strong diffusion. Here, porous crosslinked cyclodextrin microspheres (P-CDMs) with size around 300 μm have been developed through crosslinking and electrospraying. The P-CDMs show a high capacity to remove I2, I−, and IO3− from aqueous solution and the maximum absorption can reach 668, 205 and 131 mg g−1, respectively. Furthermore, the adsorption is stable in harsh condition (pH = 1.0, 75 °C), which is generally the iodine-bearing nuclear waste condition. P-CDMs also show excellent recycling performance and the adsorption performance remain over 99% after recycle 5 times. Therefore, P-CDMs can be considered as an effective adsorbent for the removal radioactive iodine from nuclear wastewater. [ABSTRACT FROM AUTHOR]

Radioactive iodine isotopes especially 131I are used for diagnosis and treatment of different types of cancer diseases. Due to the leak of radioactive iodine into the patient's urine in turn, the wastewater would be contaminated, so it is worth preparing a novel adsorption green material to remove the radioactive iodine from wastewater efficiently. The removal of 127I and 131I contaminants from aqueous solution is a problem of interest. Therefore, this work presents a new study for removing the stable iodine 127I− and radioactive iodine 131I from aqueous solutions by using the novel nano adsorbent (Nano ZnO/MWCNTs) which is synthesized by the arc discharge method. It is an economic method for treating contaminated water from undesired dissolved iodine isotopes. The optimal conditions for maximum removal are (5 mg/100 ml) as optimum dose with shacking (200 rpm) for contact time of (60 min), at (25 °C) in an acidic medium of (pH = 5). After the adsorption process, the solution is filtrated and the residual iodide (127I−) is measured at a maximum UV wavelength absorbance of 225 nm. The maximum adsorption capacity is (15.25 mg/g); therefore the prepared nano adsorbent (Nano ZnO/MWCNTs) is suitable for treating polluted water from low iodide concentrations. The adsorption mechanism of 127I− on to the surface of (Nano ZnO/MWCNTs) is multilayer physical adsorption according to Freundlich isotherm model and obeys the Pseudo-first order kinetic model. According to Temkin isotherm model the adsorption is exothermic. The removal efficiency of Nano ZnO/MWCNTs for stable iodine (127I−) from aqueous solutions has reached 97.23%, 89.75%, and 64.78% in case of initial concentrations; 0.1843 ppm, 0.5014 ppm and 1.0331 ppm, respectively. For the prepared radio iodine (131I−) solution of radioactivity (20 µCi), the dose of nano adsorbent was (10 mg/100 ml) and the contact time was (60 min) at (pH = 5) with shacking (200 rpm) at (25 °C). The filtration process was done by using a syringe filter of a pore size (450 nm) after 2 days to equilibrate. The removal efficiency reached (34.16%) after the first cycle of treatment and the percentage of residual radio iodine was (65.86%). The removal efficiency reached (94.76%) after five cycles of treatment and the percentage of residual radio iodine was (5.24%). This last percentage was less than (42.15%) which produces due to the natural decay during 10 days. [ABSTRACT FROM AUTHOR]

Considering the importance of sustainable nuclear energy, effective management of radioactive nuclear waste, such as sequestration of radioiodine has inflicted a significant research attention in recent years. Despite the fact that materials have been reported for the adsorption of iodine, development of effective adsorbent with significantly improved segregation properties for widespread practical applications still remain exceedingly difficult due to lack of proper design strategies. Herein, utilizing unique hybridization synthetic strategy, a composite crystalline aerogel material has been fabricated by covalent stepping of an amino-functionalized stable cationic discrete metal-organic polyhedra with dual-pore containing imine-functionalized covalent organic framework. The ultralight hybrid composite exhibits large surface area with hierarchical macro-micro porosity and multifunctional binding sites, which collectively interact with iodine. The developed nano-adsorbent demonstrate ultrahigh vapor and aqueous-phase iodine adsorption capacities of 9.98 g.g−1 and 4.74 g.g−1, respectively, in static conditions with fast adsorption kinetics, high retention efficiency, reusability and recovery. The development of effective adsorbents of radioiodine nuclear waste remains difficult due to the lack of proper material design strategies. Here the authors report an ultralight hierarchically porous crystalline multifunctional hybrid nanocomposite for ultrafast entrapment of iodine and polyiodide species under both static and dynamic condition. [ABSTRACT FROM AUTHOR]

Differentiated Thyroid carcinoma (DTC) with distant skeletal metastases is associated with a very poor prognosis and are unfortunately resistant to radioiodine therapy (RIT). Surgical removal of the metastases in such selected cases is a beneficial adjunct to RIT. We report two cases of DTC with sternal metastases whom we successfully managed with surgical resection of the sternal lesion with reconstruction of the chest wall defect using titanium mesh implant and myocutaneous flap. [ABSTRACT FROM AUTHOR]

Sorbents for anionic species of iodine are required at every stage of 129I management. Development of iodine adsorbing material suitable for usage as engineered safety barriers (ESB) component in deep geological repository (DGR) sites or geological disposal facilities (GDF) is a particularly important concern due to the final of disposal iodine-containing radioactive waste is one of the most challenging problem in nuclear industry nowadays. This literature review discusses data on silver-containing materials, which are characterized with the highest sorption properties towards anionic iodine species and high fixation permanence of radioiodine. Emphasis is on materials with high surface area modified with silver in various chemical forms (Ag+, Ag0, Ag2O, AgCl etc.), methods of these materials obtaining are analyzed. Studying of data reported in scientific literature shows that porous materials with silver applied on the surface as insoluble compounds, such as silver (I) oxide, silver chloride or bromide, are the most advantageous for usage as ESB component in DGR sites for anionic radioiodine species uptake. [ABSTRACT FROM AUTHOR]

Tumours can arise from thyroid follicular cells if they acquire driver mutations that constitutively activate the MAPK signalling pathway. In addition, a limited set of additional mutations in key genes drive tumour progression towards more aggressive and less differentiated disease. Unprecedented insights into thyroid tumour biology have come from the breadth of thyroid tumour sequencing data from patients and the wide range of mutation-specific mechanisms identified in experimental models, in combination with the genomic simplicity of thyroid cancers. This knowledge is gradually being translated into refined strategies to stratify, manage and treat patients with thyroid cancer. This Review summarizes the biological underpinnings of the genetic alterations involved in thyroid cancer initiation and progression. We also provide a rationale for and discuss specific examples of how to implement genomic information to inform both recommended and investigational approaches to improve thyroid cancer prognosis, redifferentiation strategies and targeted therapies. Genomic data from patients with thyroid cancer, combined with information on mutation-specific mechanisms from experimental models, is transforming the thyroid cancer research field. This Review summarizes the genetic alterations involved in follicular cell-derived thyroid cancer initiation and progression and their biological and clinical implications. Key points: Most thyroid cancers are initiated by a single genomic alteration, typically BRAFV600E or in RAS genes, which constitutively activate the MAPK signalling pathway. Driver mutations BRAFV600E or in RAS genes determine multiple clinicopathological properties of thyroid tumours, including their histology, level of differentiation and routes for metastatic dissemination. Advanced thyroid cancers usually evolve from BRAF-driven or RAS-driven clones and become more aggressive and less differentiated via the acquisition of additional genomic alterations in specific genes. Preclinical models of thyroid cancers are valuable tools to understand the underlying mechanisms and biological consequences of pathogenic mutations, and to test novel therapeutic strategies. Genomic characterization is a useful tool to refine prognosis of patients with thyroid cancers and can predict their responses to strategies to induce redifferentiation for subsequent radioactive iodine treatment. BRAFV600E mutation and RET or NTRK fusions are actionable alterations with matched drugs that are approved for the treatment of certain patients whose thyroid tumours have these genetic defects. [ABSTRACT FROM AUTHOR]

This document discusses the use of radioactive iodine-131 (RAI) therapy for metastatic well-differentiated thyroid cancer (mDTC) and the importance of individualized dosimetry in nuclear oncology. The authors propose a methodology for estimating the radiation-absorbed dose of RAI based on PET imaging and standard uptake value (SUV) measurements. They suggest that this approach can guide the selection of the appropriate amount of radioactivity to administer to patients with multiple metastatic lesions. The document also highlights the potential application of this dosimetry approach to other types of radiopharmaceutical therapy for solid tumors, such as thyroid cancer, neuroendocrine tumors (NETs), and prostate cancer. The authors emphasize the importance of individualized dosimetry in these therapies to maximize treatment efficacy while minimizing normal organ toxicity. They propose the use of biomarkers and statistical approaches to determine the optimal amount of radioactivity to administer to each patient. The document calls for further research and collaboration among experts in the field to implement true dosimetric approaches in clinical practice. [Extracted from the article]

Gamma detection of select fission products or activation products such as 153Sm and 239Np in a fission sample is difficult due to gamma interferences from radiotellurium and radioiodine. To aid in the detection of these difficult-to-detect nuclides, the radiotellurium and radioiodine were removed using Cu metal turnings. This method is highly effective at the removal of the interfering radionuclides removing > 98% of the radiotellurium and radioiodine. A mechanistic study was conducted. Determining the deposition mechanism, using a number of techniques including XANES and electrochemistry providing an understanding of the electrochemical path for the Te deposition. Initial work focused on the use of stable Te, further expanding into activated TeO2, and a fresh fission sample. This method presents a rapid method for the direct detection of select fission products that could have a significant impact on nuclear related fields including nuclear forensics. [ABSTRACT FROM AUTHOR]

The Cu2O/Cu modified shungite (ShC) absorbent (Cu2O/Cu-ShC) was synthesized by hydrothermal method, benefiting from the mineral backbone and Cu2O/Cu particles, Cu2O/Cu-ShC can remove ~ 96% of I− within 60 min, the batch experiments showed that the I− adsorption process follows pseudo-second-order model and Langmuir model with maximum adsorption capacity of 10.99 mg/g. The high binding affinity between Cu+ and I− contributes effective removal of I− and excellent selectivity at high concentrations of competing ions. This work highlights the feasibility of Cu2O/Cu-ShC for the radioactive iodine separation, and provides a promising sorbent material for large-scale purification of radioactive iodine anions in wastewater. [ABSTRACT FROM AUTHOR]

This document discusses the treatment options for hyperthyroidism, a condition characterized by low levels of thyroid-stimulating hormone and normal or high levels of triiodothyronine and thyroxine. Radioactive iodine (RAI) therapy and surgery are the main treatment options, but radiofrequency ablation (RFA) has recently been proposed as an alternative. A systematic review and meta-analysis comparing RFA to RAI found that RAI therapy had a higher success rate and lower risk of failure compared to RFA. The document concludes that RAI therapy remains the treatment of choice for hyperthyroidism, although RFA may have potential with further improvements. [Extracted from the article]

The article discusses the use of thyroid scintigraphy (TS) in patients with thyrotoxicosis before deciding on radioiodine therapy (RIT). The authors argue for the use of TS in all thyrotoxic patients, regardless of the cause, to detect potentially malignant cold nodules. They suggest that future revisions of treatment guidelines should consider the value of TS in patients without palpable nodules. However, the article raises some concerns about the use of TS, including its limited sensitivity for small lesions and the availability of more effective diagnostic methods such as ultrasound. The authors conclude that the use of TS to detect non-palpable nodules may be outdated in the era of integrated thyroid diagnostics. [Extracted from the article]

Purpose: Pathogenic fusion events involving neurotrophic receptor tyrosine kinase (NTRK) have been described in ~ 2% of differentiated thyroid cancer (DTC). The selective tropomyosin receptor kinase (TRK) inhibitors entrectinib and larotrectinib have been approved in a tumor agnostic manner based on phase 1/2 clinical trials. In a real-world setting at five referral centers, we aimed to describe the prevalence of NTRK gene fusions and the efficacy and safety of TRK inhibitor treatment for non-medullary, advanced thyroid cancer (TC). Methods: A total of 184 TC patients with testing for NTRK gene fusions were included. Progression-free survival (PFS) and overall survival (OS) probabilities were estimated using the Kaplan–Meier method in six patients with NTRK fusion-positive TC who underwent TRK inhibitor therapy. Results: 8/184 (4%) patients harbored NTRK gene fusions. Six patients with radioiodine (RAI)-refractory TC harboring NTRK1 (n = 4) and NTRK3 (n = 2) gene fusions were treated with larotrectinib. Five patients (83%) had received ≥ 1 prior systemic therapy and one patient did not receive prior systemic therapy. All patients had morphologically progressive disease before treatment initiation. Objective response rate was 83%, including two complete remissions. Median PFS from start of TRK inhibitor treatment was 23 months (95% confidence interval [CI], 0–57.4) and median OS was not reached (NR) (95% CI, NR). Adverse events were of grade 1–3. Conclusion: The prevalence of NTRK gene fusions in our cohort of RAI-refractory TC is slightly higher than reported for all TC patients. Larotrectinib is an effective treatment option in the majority of NTRK gene fusion-positive advanced TC patients after prior systemic treatment and has a favorable safety profile. [ABSTRACT FROM AUTHOR]

Toxic fission products, such as cesium (137Cs) and iodine (129I) are of great concern because of their long half-lives and high solubility in water. The simultaneous removal of Cs and I using a single adsorbent is an area of increasing interest. In this study, MXene/silver nanowire (AgNW) composite was synthesized through physical mixing and employed for simultaneous removal of iodide (I−) and cesium (Cs+) ions from contaminated water. The MXene/AgNW composite demonstrated excellent adsorption capacities of 84.70 and 26.22 mg/g for I− and Cs+, respectively. The experimental data supported the hypothesis of multilayer adsorption of Cs+ owing to the inter-lamellar structures and the presence of heterogeneous adsorption sites in MXene. The interaction between I− and the AgNW involved chemisorption followed by monolayer adsorption. MXene/AgNW composite material exhibited promising results in the presence of competitive ions under extreme pH conditions. Thus, synthesized composite materials holds promising potential as an adsorbent for the remediation of radioactive liquid waste. [ABSTRACT FROM AUTHOR]

Graves' disease (GD) is the leading cause of hyperthyroidism in pediatric patients. Radioactive iodine therapy (RAIT) is widely used to treat GD. However, it is still unclear exactly what determines the efficacy of RAIT in childhood and adolescence. The objective of our study was to reveal the most significant predictors of the efficacy of RAIT in pediatric GD patients. A single-center prospective observational exploratory study enrolled 144 pediatric patients (124 females and 20 males) between 8 and 18 years of age who underwent dosimetry-guided RAIT for GD for the first time. The estimated parameters included sex, age, thyroid volume, thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone receptor antibodies (TRABs) at baseline and 12 months after RAIT, 10- to 20-min 99mTc thyroid uptake (%), maximum thyroid 131I uptake (%), specific 131I uptake (MBq/g), and therapeutic activity of 131I (MBq), which was limited to 1100 MBq. The Fisher's exact test, Mann–Whitney U-test, Wilcoxon signed-rank test, ROC analysis, and the Youden index were used for statistical analysis. Twelve months after RAIT, 119 patients (83%) successfully achieved remission, 6 patients (4%) had euthyroidism, and hyperthyroidism persisted in 19 patients (13%). Thyroid volume decreased from 17.6 [14.6; 24.1] to 9.3 [7.6; 13.3] mL 12 months after the treatment (p < 0.001). The main predictor that showed a statistically significant difference between the groups of patients who achieved and did not achieve remission of GD hyperthyroidism after RAIT was the initial thyroid volume. Using the Youden index, the optimal cut-off point for the initial thyroid volume at 45.4 mL was determined. Conclusion: The dosimetry-guided RAIT in pediatric GD patients was 83% effective at 12 months after the treatment, and the initial thyroid volume of less than 45.4 mL was the most important predictor of RAIT success. Other predictors identified in our work included FT4 levels, TRABs levels, 99mTc-pertechnetate uptake, and specific 131I uptake. What is Known: •Radioiodine therapy is a common, effective, and safe treatment for pediatric patients with Graves' disease. What is New: •The initial thyroid volume in pediatric GD patients is an important predictor of achieving hypothyroidism following radioiodine therapy. If the thyroid volume is less than 45.4 ml, radioiodine therapy limited to 1100 MBq will be effective definitive treatment. [ABSTRACT FROM AUTHOR]

A nuclear emergency is a type of accident that can expose a highly variable number of people to isotopes and radiation [[1]]. It can take time to identify radionuclides deposited in the environment and to measure the dose adsorbed by a given individual (which decides the need for specific treatments), but treatments must be started promptly to avoid target organ contamination and deposition. The radionuclides absorbed by the thyroid could lead to thyroid dysfunction and thyroid cancer. [Extracted from the article]

Autoimmune thyroid disease (AITD) is the most common adverse effect in alemtuzumab (ALZ) treated relapsing–remitting (RR) multiple sclerosis (MS) patients. The objective of this prospective study was to analyze the occurrence, timing of onset, clinical course, and laboratory characteristics of AITD post-ALZ. We evaluated 35 RRMS patients treated with ALZ at a single academic MS center; clinical and laboratory data were collected before ALZ initiation and thereafter quarterly on follow-up with a median of 43.5 months. Seventeen out of 31 patients (54.8%) with no prior history of thyroid dysfunction developed AITD with a mean onset of 19.4 months ± 10.2 (SD) after the first ALZ cycle; Graves' disease (GD) (n = 9); hypothyroidism with positive stimulating thyrotropin receptor antibodies (TRAb) (n = 1); Hashimoto thyroiditis (HT) (n = 6); HT with hypothyroidism (n = 1). Interestingly, seven of nine (77.7%) GD patients showed a fluctuating course. Three out of four patients with preexisting thyroid disease remained stable, whereas one with prior HT and hypothyroidism developed fluctuating GD. All patients with GD commenced antithyroid drugs (ATDs); five continued on "block and replace" treatment; one required radioactive iodine, and one total thyroidectomy. Our analysis showed earlier onset of ALZ-induced AITD in comparison to most other ALZ cohorts; overall, these patients required complex therapeutic approaches of the AITD. We observed a higher rate of fluctuating GD, with earlier onset and lower remission rate than previously reported, which in the majority of patients required prolonged "block and replace" therapy in the minimum dose of each therapeutic agent or more definitive interventions. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the factors influencing the short-term response to the initial radioiodine therapy (RT) course in patients with intermediate- and high-risk papillary thyroid carcinoma (PTC). A total of 182 patients with intermediate- and high-risk PTC who underwent RT in our hospital from March 2018 to October 2020 were retrospectively enrolled. The patients were divided into incomplete response (IR) and nonincomplete response (Non-IR) groups according to the response observed in clinical follow-up within 6–12 months after RT. Univariate and multivariate logistic regression analyses were used to investigate the effects of 15 observed factors on the response to RT. Receiver operating characteristic (ROC) curve analysis was used to determine the value of factors found to be significant in multivariate analyses for predicting an IR. A total of 182 patients with intermediate- and high-risk PTC were analyzed; the percentage of patients with a Non-IR was 61.54% (112/182), and the percentage of patients with an IR was 38.46% (70/182). The CD4+ T-cell percentage (t = 4.757, P = 0.000), CD4/CD8 (z = − 2.632, P = 0.008), stimulated thyroglobulin (sTg) level (z = − 8.273, P = 0.000) and M stage (χ2 = 17.823, P = 0.000) of the two groups were significantly different. Multivariate analysis showed that only the sTg level (OR: 1.116, 95% CI 1.068–1.165, P < 0.001) and CD4+ T-cell percentage (OR: 0.909, 95% CI 0.854–0.968, P = 0.003) were independent factors associated with the therapeutic response to RT. The cutoff sTg level and CD4+ T-cell percentage for predicting an IR were 7.62 μg/L and 40.95%, respectively. The sTg level and CD4+ T-cell percentage were verified to be independent predictive factors of RT response. Higher sTg levels and lower CD4+ T-cell percentages were related to an IR in patients with intermediate- and high-risk PTC. [ABSTRACT FROM AUTHOR]

Background: Current guidelines of the radioiodine uptake (RAIU) test allow the use of different equipment, isotopes, activity and region-of-interest (ROI). We evaluated presence and extent of these differences in clinical practice and evaluated the effect of some of these variations on RAIU outcomes. Also, gamma camera-specific reference standards were calculated and retrospectively compared with measurements obtained during clinical RAIU tests. Materials and methods: First, questionnaires were sent to Dutch nuclear medicine departments requesting information about equipment usage, isotope, isotope formulation, activity and measurement techniques. Secondly, a neck phantom containing a range of activities in capsule or water-dissolved formulation was scanned. Counts were measured using automatic ROI, square box ROI or all counts in the image. Thirdly, clinical RAIU data were collected during 2015–2018 using three different gamma cameras. Reference standards for each scanner were calculated using regression analysis between reference activity and measured counts. Uptake measurements using this gamma camera-specific reference standard were compared with original measurements. Results: The survey demonstrated significant differences in isotope, isotope formulation, activity, use of neck phantoms, frequency and duration of reference measurements, distance to collimator, use of background measurements and ROI delineation. The phantom study demonstrated higher counts for the water-dissolved formulation than capsules using both automatic and square box ROI. Also, higher counts were found using a square box ROI than an automatic ROI. The retrospective study showed feasibility of RAIU calculations using camera-specific reference standards and good correlation with the original RAIU measurements. Conclusions: This study demonstrated considerable technical variation in RAIU measurement in clinical practice. The phantom study demonstrated that these differences could result in differences in count measurements, potentially resulting in different dose calculations for radioactive iodine therapy. Retrospective data suggest that camera-specific reference standards may be used instead of individual reference measurements using separate activity sources, which may thus eliminate some sources of variation. [ABSTRACT FROM AUTHOR]

Purpose: Dosimetry is rarely performed for the treatment of differentiated thyroid cancer patients with Na[131I]I (radioiodine), and information regarding absorbed doses delivered is limited. Collection of dosimetry data in a multi-centre setting requires standardised quantitative imaging and dosimetry. A multi-national, multi-centre clinical study was performed to assess absorbed doses delivered to normal organs for differentiated thyroid cancer patients treated with Na[131I]I. Methods: Patients were enrolled in four centres and administered fixed activities of 1.1 or 3.7 GBq of Na[131I]I using rhTSH stimulation or under thyroid hormone withdrawal according to local protocols. Patients were imaged using SPECT(/CT) at variable imaging time-points following standardised acquisition and reconstruction protocols. Whole-body retention data were collected. Dosimetry for normal organs was performed at two dosimetry centres and results collated. Results: One hundred and five patients were recruited. Median absorbed doses per unit administered activity of 0.44, 0.14, 0.05 and 0.16 mGy/MBq were determined for the salivary glands of patients treated at centre 1, 2, 3 and 4, respectively. Median whole-body absorbed doses for 1.1 and 3.7 GBq were 0.05 Gy and 0.16 Gy, respectively. Median whole-body absorbed doses per unit administered activity of 0.04, 0.05, 0.04 and 0.04 mGy/MBq were calculated for centre 1, 2, 3 and 4, respectively. Conclusions: A wide range of normal organ doses were observed for differentiated thyroid cancer patients treated with Na[131I]I, highlighting the necessity for individualised dosimetry. The results show that data may be collated from multiple centres if minimum standards for the acquisition and dosimetry protocols can be achieved. [ABSTRACT FROM AUTHOR]

This document provides the new EANM guideline on radioiodine therapy of benign thyroid disease. Its aim is to guide nuclear medicine physicians, endocrinologists, and practitioners in the selection of patients for radioiodine therapy. Its recommendations on patients' preparation, empiric and dosimetric therapeutic approaches, applied radioiodine activity, radiation protection requirements, and patients follow-up after administration of radioiodine therapy are extensively discussed. [ABSTRACT FROM AUTHOR]

131-I radioactive iodine (RAI) scan is an important modality in the management of differentiated thyroid cancer to detect recurrent or residual disease. Thus it is important to have knowledge about the possibility of false positive findings in these scans to avoid wrongful diagnosis and unnecessary treatment. We here by present a patient who underwent total thyroidectomy with lymph node dissection and followed by radioactive iodine therapy for papillary thyroid cancer. He had 131-I iodine avid nodular lesion in the left parotid gland which was later proven to be oncocytoma on histopathology. False positive findings on radioactive iodine scans are a possibility which should be known to surgeons as well as nuclear medicine physicians for accurate diagnosis and appropriate management. [ABSTRACT FROM AUTHOR]

Objectives: Graves' disease (GD) is the most common cause of hyperthyroidism. Antithyroid drug (ATD) is often the first-line treatment but > 50% patients suffer a relapse when ATD is discontinued. Surgery or radioiodine remains the current options of definitive treatment in these patients. This pilot study examined the short-term efficacy of single-session thyroid radiofrequency ablation (RFA) as a novel definitive treatment for persistent/relapsed GD. Methods: Consecutive patients with persistent/relapsed GD requiring ATD were considered. Those with a clear surgical indication, either thyroid lobe volume ≥ 20 mL; those who were pregnant or lactating; and those who had any severe medical conditions that would pose extra treatment risks were excluded. Eligible patients received ultrasound-guided RFA of the entire bulk of thyroid gland. Thyroid function tests were monitored bi-monthly. The primary outcome was disease remission rate, defined as a state of biochemical euthyroidism or hypothyroidism without ATD. Secondary outcomes were complication rates. Results: Of the 68 patients considered, 15 (22.1%) patients were eligible. Most were females (93.3%). The median age was 37 (IQR 31–48) years old. The disease remission rates were 79.0% at 6 months and 73.3% at 12 months. Among the 4 patients who relapsed after RFA, three required less ATD dose than before RFA. RFA was well-tolerated in the ambulatory setting. There were no vocal cord palsy, skin burn, hematoma, or thyroid storm after RFA. Conclusions: In well-selected patients, single-session RFA of the thyroid gland may be a potential treatment for patients with persistent/relapsed GD. It is a safe and well-tolerated ambulatory procedure. Key Points: • Radiofrequency ablation of the thyroid gland is an efficacious treatment for persistent/relapsed Graves' disease in well-selected patients. • Radiofrequency ablation of the thyroid gland for the treatment of persistent/relapsed Graves' disease is a safe and well-tolerated ambulatory procedure. • Radiofrequency ablation of the thyroid gland may be a potential alternative treatment for well-selected patients with persistent/relapsed GD who do not wish to undergo either thyroidectomy or radioactive iodine or continue antithyroid drugs. [ABSTRACT FROM AUTHOR]

Purpose: To introduce a biomarker-based dosimetry method for the rational selection of a treatment activity for patients undergoing radioactive iodine 131I therapy (RAI) for metastatic differentiated thyroid cancer (mDTC) based on single-timepoint imaging of individual lesion uptake by 124I PET. Methods: Patients referred for RAI therapy of mDTC were enrolled in institutionally approved protocols. A total of 208 mDTC lesions (in 21 patients) with SUVmax > 1 underwent quantitative PET scans at 24, 48, 72, and 120 h post-administration of 222 MBq of theranostic NaI-124I to determine the individual lesion radiation-absorbed dose. Using a general estimating equation, a prediction curve for biomarker development was generated in the form of a best-fit regression line and 95% prediction interval, correlating individual predicted lesion radiation dose metrics, with candidate biomarkers ("predictors") such as SUVmax and activity in microcurie per gram, from a single imaging timepoint. Results: In the 169 lesions (in 15 patients) that received 131I therapy, individual lesion cGy varied over 3 logs with a median of 22,000 cGy, confirming wide heterogeneity of lesion radiation dose. Initial findings from the prediction curve on all 208 lesions confirmed that a 48-h SUVmax was the best predictor of lesion radiation dose and permitted calculation of the 131I activity required to achieve a lesional threshold radiation dose (2000 cGy) within defined confidence intervals. Conclusions: Based on MIRD lesion-absorbed dose estimates and regression statistics, we report on the feasibility of a new single-timepoint 124I-PET-based dosimetry biomarker for RAI in patients with mDTC. The approach provides clinicians with a tool to select personalized (precision) therapeutic administration of radioactivity (MBq) to achieve a desired target lesion-absorbed dose (cGy) for selected index lesions based on a single 48-h measurement 124I-PET image, provided the selected activity does not exceed the maximum tolerated activity (MTA) of < 2 Gy to blood, as is standard of care at Memorial Sloan Kettering Cancer Center. Trial registration: NCT04462471, Registered July 8, 2020. NCT03647358, Registered Aug 27, 2018. [ABSTRACT FROM AUTHOR]

Background: Lenvatinib is widely used to treat unresectable and advanced thyroid carcinomas. We aimed to determine whether 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) performed 1 week after lenvatinib treatment initiation could predict treatment outcomes. Results: This was a prospective, nonrandomised, multicentre study. Patients with pathologically confirmed differentiated thyroid carcinoma (DTC) and lesions refractory to radioiodine treatment were eligible for inclusion. Patients were treated with 24 mg lenvatinib as the initial dose and underwent PET/CT examination 1 week after treatment initiation. Contrast-enhanced CT was scheduled at least 4 weeks later as the gold standard for evaluation. The primary endpoint was to evaluate the discrimination power of maximum standardised uptake value (SUVmax) obtained by PET/CT compared to that obtained by contrast-enhanced CT. Evaluation was performed using the area under the receiver operating characteristic (ROC-AUC) curve. Twenty-one patients were included in this analysis. Receiver operating characteristic (ROC) curve analysis yielded an AUC of 0.714 for SUVmax after 1 week of lenvatinib treatment. The best cut-off value for the treatment response for SUVmax was 15.211. The sensitivity and specificity of this cut-off value were 0.583 and 0.857, respectively. The median progression-free survival was 26.3 months in patients with an under-cut-off value and 19.7 months in patients with an over-cut-off value (P = 0.078). Conclusions: The therapeutic effects of lenvatinib were detected earlier than those of CT because of decreased FDG uptake on PET/CT. PET/CT examination 1 week after the initiation of lenvatinib treatment may predict treatment outcomes in patients with DTC. Trial registration: This trial was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (number UMIN000022592) on 6 June, 2016. [ABSTRACT FROM AUTHOR]

Purpose: An accurate postoperative assessment is pivotal to inform postoperative 131I treatment in patients with differentiated thyroid cancer (DTC). We developed a predictive model for post-treatment whole-body scintigraphy (PT-WBS) results (as a proxy for persistent disease) by adopting a decision tree model. Methods: Age, sex, histology, T stage, N stage, risk classes, remnant estimation, TSH, and Tg were identified as potential predictors and were put into regression algorithm (conditional inference tree, ctree) to develop a risk stratification model for predicting the presence of metastases in PT-WBS. Results: The lymph node (N) stage identified a partition of the population into two subgroups (N-positive vs N-negative). Among N-positive patients, a Tg value > 23.3 ng/mL conferred a 83% probability to have metastatic disease compared to those with lower Tg values. Additionally, N-negative patients were further substratified in three subgroups with different risk rates according to their Tg values. The model remained stable and reproducible in the iterative process of cross validation. Conclusions: We developed a simple and robust decision tree model able to provide reliable informations on the probability of persistent/metastatic DTC after surgery. These information may guide post-surgery 131I administration and select patients requiring curative rather than adjuvant 131I therapy schedules. [ABSTRACT FROM AUTHOR]

These levels include an activity-based prescription with patient-averaged dosimetry, an activity-based prescription with patient-specific dosimetry and, a dosimetry-based prescription and post-therapy dosimetry verification. In those documents, time of medical physicists for an outpatient therapy of thyrotoxicosis with [ SP 131 sp I]I-NaI, an in-patient therapy of differentiated thyroid carcinoma with [ SP 131 sp I]I-NaI and for a complex therapy, such as therapies with [ SP 131 sp I]I-mIBG, SP 177 sp Lu or SP 90 sp Y, are reported. It was concluded that in the UK, most medical physics groups are well equipped to provide a simple form of dosimetry service, but in most cases refrain to perform dosimetry routinely by "lack of clinical evidence and practice" and that more complex dosimetry will require additional staffing. Whole-body dosimetry using a portable radiation detector in the treatment of neuroblastoma wi... In treatments of neuroblastoma with [ SP 131 sp I]I-mIBG, patients often spend several days in the treatment room for radiation-protection purposes [[29]]. [Extracted from the article]

This study aimed to assess recurrence-free survival (RFS) rates and recurrence-related factors of patients who received adjuvant therapy (AT) with radioactive iodine (RAI) for differentiated thyroid cancer (DTC) following thyroidectomy. We evaluated 284 patients who underwent AT between January 2011 and July 2020 at our hospital. Recurrence was defined as visible recurrent lesions on image analysis or need for repeat surgery with pathologically confirmed recurrent lesions. RFS rate and prognostic factors were statistically evaluated. The median observation period was 30.2 months (range, 5.7–294 months). Overall, 192 patients were female and 92 were male, and the median age was 54 years (range, 9–85 years). Initial assessment revealed 39 recurrence cases. The 3-year RFS rate was 85.8% (95% confidence interval: 81.1–90.9%). Univariate analysis revealed that histology (except for papillary carcinoma), Tg level > 4 ng/dL before AT, and AT result significantly exacerbated the RFS rate. In multivariate analysis, histology and AT result were also important contributors to the worsening RFS rate. Results of AT can be determined relatively early and are important in predicting future recurrence in patients with DTC. Increasing the success rate of AT may lead to an improved prognosis. [ABSTRACT FROM AUTHOR]

Purpose: Lugol's solution could control thyroid function and suppress 131I uptake in hyperthyroidism. This study aimed to investigate the appropriate time to withdraw Lugol's solution before 131I therapy (RIT) in Graves' disease (GD) patients, and how this should influence 131I uptake and RIT outcome. Methods: Two groups (125 cases and 1805 cases) of GD patients received RIT, who were pre-treated with and without Lugol's solution (RI-CI group and RI group). The RI-CI group was further divided into the following sub-groups depending on the duration span between Lugol's solution withdrawal and RIT: sub-group A, 4–7 d (n = 49); sub-group B, 8–14 d (n = 41); and sub-group C, 15–30 d (n = 35). The highest radioactive iodine uptake rate (RAIUmax), effective half-life (Teff), TRAb, and free triiodothyronine (FT3) and free thyroxine (FT4) levels were compared, and therapeutic outcome was evaluated. Results: There were no significant differences in RAIUmax, TRAb, and Teff among the four sub-groups (P > 0.05). Both FT3 and FT4 levels in sub-groups A and B were lower than those in group RI and sub-group C (P < 0.05). The outcome of non-hyperthyroidism (euthyroidism + hypothyroidism) in groups RI-CI and RI was significantly different at post-RIT month 1 and 3 (P < 0.05). However, intergroup differences at 6 and 12 months were not significant (P > 0.05). Conclusions: Withdrawal of Lugol's solution 4–7 or 8–14 d before RIT does not influence 131I uptake and RIT efficacy in GD. Moreover, in order to avoid a rapid increase in thyroid hormone levels at the same time, Lugol's solution should be withdrawn 4–7 d before RIT. [ABSTRACT FROM AUTHOR]

This article discusses the successful use of the selective RET inhibitor selpercatinib in a patient with rearranged during transfection (RET) fusion-positive metastatic papillary thyroid cancer. The patient initially had radioiodine-refractory cancer, but after receiving selpercatinib for nine months, they showed restoration of radioiodine avidity and had a positive response to radioiodine treatment. The article highlights the potential benefits of mutation-specific kinase inhibitors in improving the prognosis of patients with specific driver mutations in thyroid cancer. The authors declare no competing interests, and the LIBRETTO-001 trial, in which the patient was included, had ethics approval. [Extracted from the article]

This document discusses the management of patients with differentiated thyroid cancer (DTC) through the combined evaluation of clinical and biochemical data. The standard treatment for DTC involves surgery followed by radioactive iodine therapy. Recurrence of the disease is common, and radioactive iodine therapy plays a significant role in reducing tumor burden and improving prognosis. The American Thyroid Association guidelines are used to determine the risk of recurrence and guide treatment decisions. Thyroglobulin (Tg) levels, a marker of thyroid tissue, can be used in combination with positron emission tomography and computed tomography to evaluate disease status. A recent study developed a model to predict post-therapy whole-body scan findings based on pre-therapy Tg levels and other clinical variables. The study found that nodal stage and Tg levels were predictive of persistent disease. This approach can improve initial staging and treatment protocols, allowing for a personalized therapeutic approach. [Extracted from the article]

Radioactive iodine is a hazardous fission product and a major concern for public health. Special attention is paid to iodine out of 80 fission products because of its short half-life of 8.02 days, high activity, and potential health hazards like its irreversible accumulation in thyroid gland and ability to cause thyroid cancer locally. Radioactive iodine can get released in the form of aerosols (cesium iodide), elemental iodine, and organic iodide after a nuclear accident and can cause off-site and on-site contamination. Filtered containment venting system (FCVS) is a safety system whose main objective is mitigation of severe accidents via controlled venting and removal of different forms of iodine to ensure safety of people and environment. After nuclear accidents like Fukushima, extensive research has been done on the removal of iodine by using dry scrubbers. This review paper presents research status of iodine removal by dry adsorbents especially after 10 years of Fukushima to assess the progress, research gap, and challenges that require more attention. A good adsorbent should be cost-effective; it should have high selective adsorption towards iodine, high thermal and chemical stability, and good loading capacity; and its adsorption should remain unaffected by aging and the presence of inhibitors like CO, NO2, CH3Cl, H2O, and Cl2 and radiation. Research on different dry adsorbents was discussed, and their capability as a potential filter for FCVS was reviewed on the basis of all the above-mentioned features. Metal fiber filters have been widely used for removal of aerosols especially micro- and nanoscale aerosols. For designing a metal fiber filter, optimal size or combination of sizes of fibers, number of layers, and loading capacity of filter should be decided according to feasibility and requirement. Balance between flow resistance and removal efficiency is also very important. Sand bed filters were successful in retention of aerosols, but they showed low trapping of iodine and no trapping of methyl iodide at all. For iodine and methyl iodide removal, many adsorbents like activated carbon, zeolites, metal organic frameworks (MOFs), porous organic frameworks (POPs), silica, aerogels, titanosilicates, etc. have been used. Impregnated activated carbon showed good results but low auto-ignition temperature and decline in adsorption due to aging and inhibitors like NOx made them less suitable. Silver zeolites have been very successful in methyl iodide and iodine removal, but they are expensive and affected by presence of CO. Titanosilicates, macroreticular resins, and chalcogels were also studied and they showed good adsorption capacities, but their thermal stability was low. Other adsorbents like silica, MOFs, aerogels, and POPs also showed promising results for iodine adsorption and good thermal stability, but very limited or no research is available on their performance in severe accident conditions. This review will be very helpful for researchers to understand the merits and demerits of different types of dry adsorbents, the important operating parameters that need optimization for designing an efficient scrubber, margin of research, and foreseeable challenges in removal of different forms of iodine. [ABSTRACT FROM AUTHOR]

A method is presented for isolating iodine isotopes from aqueous coolant of the nuclear power plants' first circuit. At first, all forms of iodine radionuclides are converted into molecular form by the sequential addition of a carrier–potassium iodide, as well as hydroxylamine chloride, nitric acid and potassium nitrite. Then molecular iodine is transferred into the gas phase and volatile iodine radionuclides are immobilized on a membrane impregnated with metallic silver. The main advantage of the method is high selectivity of iodine release in relation to radionuclides interfering with the measurement of its activity. [ABSTRACT FROM AUTHOR]