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Contrast-Enhanced Mammography (CEM) produces a dual-energy subtracted (DES) image that demonstrates iodine uptake (neovascularity) in breast tissue. We aim to review a range of artifacts on DES images produced using equipment from two different vendors and compare their incidence and subjective severity.We retrospectively reviewed CEM studies performed between September 2013 and March 2017 using GE Senographe Essential (n = 100) and Hologic Selenia Dimensions (n = 100) equipment. Artifacts were categorized and graded in severity by a subspecialist breast radiologist and one of two medical imaging technologists in consensus. The incidence of artifacts between vendors was compared by calculating the relative risk, and the severity gradings were compared using a Wilcoxon rank-sum test.Elephant rind, corrugations and the black line on chest wall artifact were seen exclusively in Hologic images. Artifacts such as cloudy fat, negative rim around lesion and white line on pectoral muscle were seen in significantly more Hologic images (p 0.05) whilst halo, ripple, skin line enhancement, black line on pectoral muscle, bright pectorals, chest wall high-lighting and air gap were seen in significantly more GE images (p 0.05). The severity gradings for cloudy fat had a significantly higher mean rank in Hologic images (p 0.001) whilst halo and ripple artifacts had a significantly higher mean rank in GE images (p 0.001 and p = 0.028 respectively).The type, incidence and subjective severity of CEM-specific artifacts differ between vendors. Further research is needed, but differences in algorithms used to produce the DE image are postulated to be a significant contributor.

Radioiodine therapy is the main post-operation method of treatment of advanced differentiated thyroid cancer, but the loss of ability of iodine uptake causes the poor prognosis. The follow-up of patients with radioiodine-refractory differentiated thyroid cancer (RRDTC) is a serious problem. In review the definition, genesis, diagnostics and treatment of RRDTC were revealed. Taking into account the ineffectiveness of traditional methods of redifferentiation therapy, the perspectives of administration of targeted therapies with tyrosine kinase inhibitors were showed. Key words: radioiodine-refractory differentiated thyroid cancer, radioiodine therapy, targeted therapies with tyrosine kinase inhibitors.

Background Iodine-induced thyroid dysfunctions are, despite their rare occurrence, important clinical syndromes. Their immediate recognition can avoid serious consequences. Important triggers can be iodine-containing contrast agents, amiodarone or iodine-containing disinfectants. Iodine-induced hypothyroidism and hyperthyroidism need to be distinguished, whereby the former is usually self-limiting. Objectives The aim of this article is to present current knowledge on the pathogenesis, therapy, and prophylaxis of iodine-induced thyroid dysfunction. Materials and methods We performed a literature search of current publications and linked them to daily clinical experience. Results and conclusion In iodine-induced hyperthyroidism, antithyroid drugs and perchlorate are primarily used to decrease thyroid hormone synthesis and further iodine uptake into the thyroid. For the prophylaxis of x‑ray contrast agent-induced hyperthyroidism, perchlorate can be administered in high-risk settings in combination with antithyroid drugs, if possible starting one day before the iodine exposure.

Tumor organoids offer new opportunities for translational cancer research, but unlike animal models, their broader use is hindered by the lack of clinically relevant imaging endpoints. Here, we present a positron-emission microscopy method for imaging clinical radiotracers in patient-derived tumor organoids with spatial resolution 100-fold better than clinical positron emission tomography (PET). Using this method, we quantify 18F-fluorodeoxyglucose influx to show that patient-derived tumor organoids recapitulate the glycolytic activity of the tumor of origin, and thus, could be used to predict therapeutic response in vitro. Similarly, we measure sodium-iodine symporter activity using 99mTc- pertechnetate and find that the iodine uptake pathway is functionally conserved in organoids derived from thyroid carcinomas. In conclusion, organoids can be imaged using clinical radiotracers, which opens new possibilities for identifying promising drug candidates and radiotracers, personalizing treatment regimens, and incorporating clinical imaging biomarkers in organoid-based co-clinical trials., Positron emission tomography (PET) radiotracers measure the metabolic activity in cancer cells in patients. Here, the authors develop a microscopy method to image organoids using clinical radiotracers, which allows a direct comparison to PET imaging in patients.

ObjectiveTo develop and validate a dual-energy computed tomography (DECT) derived radiomics model to predict peritoneal metastasis (PM) in patients with gastric cancer (GC).MethodsThis retrospective study recruited 239 GC (non-PM = 174, PM = 65) patients with histopathological confirmation for peritoneal status from January 2015 to December 2019. All patients were randomly divided into a training cohort (n = 160) and a testing cohort (n = 79). Standardized iodine-uptake (IU) images and 120-kV-equivalent mixed images (simulating conventional CT images) from portal-venous and delayed phases were used for analysis. Two regions of interest (ROIs) including the peritoneal area and the primary tumor were independently delineated. Subsequently, 1691 and 1226 radiomics features were extracted from the peritoneal area and the primary tumor from IU and mixed images on each phase. Boruta and Spearman correlation analysis were used for feature selection. Three radiomics models were established, including the R_IU model for IU images, the R_MIX model for mixed images and the combined radiomics model (the R_comb model). Random forest was used to tune the optimal radiomics model. The performance of the clinical model and human experts to assess PM was also recorded.ResultsFourteen and three radiomics features with low redundancy and high importance were extracted from the IU and mixed images, respectively. The R_IU model showed significantly better performance to predict PM than the R_MIX model in the training cohort (AUC, 0.981 vs. 0.917, p = 0.034). No improvement was observed in the R_comb model (AUC = 0.967). The R_IU model was the optimal radiomics model which showed no overfitting in the testing cohort (AUC = 0.967, p = 0.528). The R_IU model demonstrated significantly higher predictive value on peritoneal status than the clinical model and human experts in the testing cohort (AUC, 0.785, p = 0.005; AUC, 0.732, p ConclusionDECT derived radiomics could serve as a non-invasive and easy-to-use biomarker to preoperatively predict PM for GC, providing opportunity for those patients to tailor appropriate treatment.

To evaluate the ability of iodine uptake parameters from hepatic multiphasic CT to predict liver fibrosis, and compare absolute contrast enhancement (ΔHU) with dual-energy iodine density (ID) methods. One hundred seventeen patients with pathologically proven liver fibrosis who underwent dual-energy CT during portal-venous phase (PVP) and 3-min delayed phase (DP) between January 2017 and Octotber 2019 were retrospectively included. Two radiologists measured the hepatic and blood-pool iodine uptake using ΔHU and ID methods; extracellular volume fraction (ECV) and the iodine washout rate (IWR) calculated with both methods were compared between different fibrosis stages (F0–1 vs. F2–4, F0–2 vs. F3–4, or F0–3 vs. F4). The inter-observer reproducibility (intraclass correlation coefficients [ICCs]) for ECV and IWR was compared between the ΔHU and ID methods. The areas under the receiver operating characteristic curves (AUCs) to predict liver fibrosis severity were calculated for serum and imaging fibrosis markers. To identify independent predictors, multivariable logistic regression analysis was performed, and combined performance was assessed for the ΔHU and ID models. Patients with F ≥ 2 (n = 70), F ≥ 3 (n = 51), and F4 (n = 29) had higher ECV and lower IWR than those with F ≤ 1, F ≤ 2, and F ≤ 3, respectively (all p < 0.001). ICCs were higher in the ID method than in the ΔHU method (ECV: p = 0.045; IWR: p < 0.001). The AUC ranges of ECVΔHU, ECVID, IWRΔHU, and IWRID for predicting liver fibrosis severity were 0.65–0.71, 0.67–0.73, 0.76–0.81, and 0.81–0.85, respectively. IWR and fibrosis-4 index were independent predictors, with combined AUCs of 0.82–0.87 for the ΔHU model and 0.86–0.89 for the ID model. IWR more accurately predicted liver fibrosis than ECV in routine multiphasic CT. The dual-energy ID method yielded higher inter-observer reproducibility and predictive values than the single-energy ΔHU method. • The IWR calculated from hepatic iodine uptake during PVP and 3-min DP predicted liver fibrosis (AUC, 0.76–0.85), while the ECV had a relatively limited predictive value (ACU, 0.65–0.73). • Compared with the conventional ΔHU method, the dual-energy ID method provided superior inter-observer reproducibility for measurement of ECV (p = 0.046) and IWR (p < 0.001). • The IWR and FIB-4 served as independent predictors of liver fibrosis; their combination yielded the high diagnostic performance particularly when using the ID method (combined AUCs of 0.86–0.89).

An occurrence of an artifact due to contamination is reported. A patient wearing the mandatory face mask because of the ongoing COVID-19 pandemic underwent post-radioiodine therapy scintigraphy. The spot view of the neck showed an area of intense iodine uptake with an unusual appearance. Suspecting a possible artifact due to iodine contamination, the patient was given a new mask to wear and the scan was repeated. Results. The subsequent images revealed that the previously detected hotspot was caused by mask contamination. Conclusions. This finding has led to updating the scan procedure for post-therapy scintigraphy by replacing the patients' masks before the scan acquisition.

Background: Perchlorate-induced natrium-iodide symporter (NIS) interference is a well-recognized thyroid disrupting mechanism. It is unclear, however, whether a chronic low-dose exposure to perchlorate delivered by food and drinks may cause thyroid dysfunction in the long term. Thus, the aim of this review was to overview and summarize literature results in order to clarify this issue. Methods: Authors searched PubMed/MEDLINE, Scopus, Web of Science, institutional websites and Google until April 2020 for relevant information about the fundamental mechanism of the thyroid NIS interference induced by orally consumed perchlorate compounds and its clinical consequences. Results: Food and drinking water should be considered relevant sources of perchlorate. Despite some controversies, cross-sectional studies demonstrated that perchlorate exposure affects thyroid hormone synthesis in infants, adolescents and adults, particularly in the case of underlying thyroid diseases and iodine insufficiency. An exaggerated exposure to perchlorate during pregnancy leads to a worse neurocognitive and behavioral development outcome in infants, regardless of maternal thyroid hormone levels. Discussion and conclusion: The effects of a chronic low-dose perchlorate exposure on thyroid homeostasis remain still unclear, leading to concerns especially for highly sensitive patients. Specific studies are needed to clarify this issue, aiming to better define strategies of detection and prevention.

There is concern among residents that their children might suffer from thyroid cancer in the near future after the Fukushima Daiichi nuclear power station (FDNPS) accident. However, the demographic and geographical distribution of thyroid equivalent doses was not thoroughly evaluated, and direct thyroid measurements were conducted only for 1,200 children, whose individual thyroid doses were assessed on the basis of those measurements accounting for the dynamics of radioiodine intake. We conducted hierarchical clustering analyses of 100 or 300 randomly sampled behavioural questionnaire sheets of children from each of seven municipalities in the evacuation area to reconstruct evacuation scenarios associated with high or low exposures to plumes. In total 896 behaviour records in the Fukushima Health Management Survey were analysed to estimate thyroid equivalent doses via inhalation, using a spatiotemporal radionuclides concentration database constructed by atmospheric dispersion simulations. After a decontamination factor for sheltering and a modifying factor for the dose coefficient—to reflect lower iodine uptake rate in Japanese—were applied, estimated thyroid equivalent doses were close to those estimated from direct thyroid measurement. The median and 95th percentile of thyroid equivalent doses of 1-year-old children ranged from 0.6 to 16 mSv and from 7.5 to 30 mSv, respectively. These results are useful for future epidemiological studies of thyroid cancer in Fukushima.

To retrospectively compare early response to yttrium-90 radioembolization (Y90) according to volumetric iodine uptake (VIU) changes, Response Evaluation Criteria In Solid Tumor 1.1 (RECIST 1.1) and modified RECIST (mRECIST) in patients with intermediate-advanced hepatocellular carcinoma (HCC) and to explore their association with survival. Twenty-four patients treated with Y90 and evaluated with dual-energy computed tomography before and 6 weeks after treatment were included. VIU was measured on late arterial phase spectral images; 6-week VIU response was defined as: complete response (CR, absence of enhancing tumor), partial response (PR, ≥ 15% VIU reduction), progressive disease (PD, ≥ 10% VIU increase) and stable disease (criteria of CR/PR/PD not met). RECIST 1.1 and mRECIST were evaluated at 6 weeks and 6 months. Responders included CR and PR. Overall survival (OS) was evaluated by Kaplan–Meier analysis and compared by Cox regression analysis. High intraobserver and interobserver agreements were observed in VIU measurements (k > 0.98). VIU identified a higher number of responders (18 patients, 75%), compared to RECIST 1.1 (12.5% at 6 weeks and 23.8% at 6 months) and mRECIST (29.2% at 6 weeks and 61.9% at 6 months). There was no significant correlation between OS and RECIST 1.1 (P = 0.45 at 6 weeks; P = 0.21 at 6 months) or mRECIST (P = 0.38 at 6 weeks; P = 0.79 at 6 months); median OS was significantly higher in VIU responders (17.2 months) compared to non-responders (7.4 months) (P = 0.0022; HR 8.85; 95% CI 1.29–88.1). VIU is highly reproducible; as opposite to mRECIST and RECIST 1.1, early VIU response correlates with OS after Y90 in intermediate-advanced HCC patients.

The incidence of thyroid cancer has increased the past few decades, the most frequent type has been identified to be the papillary thyroid carcinoma (PTC). Following thyroidectomy, radioiodine ablation treatment on PTC is routinely performed. However, many patients do not benefit from radioiodine therapy. Therefore, novel targeted therapies to suppress tumor growth and improve radioiodine uptake are required. La ribonucleoprotein domain family member (LARP)7 is a member of the LARP family and functions as a potential suppressor of the progression of carcinoma. In the present study, the expression status of LARP7 in PTC tissues and cell lines was investigated, and the cell viability, proliferation and apoptotic rate, radioiodine uptake ability of PTC cells with overexpression of LARP7 in vitro was determined. Expression levels of LARP7 were significantly downregulated in PTC tissues and cell lines. Overexpression of LARP7 inhibited the proliferation and increased the radioiodine uptake ability of PTC cells in vitro and inhibited the tumor growth in vivo. Furthermore, LARP7 overexpression inhibited the sonic hedgehog (SHH) signaling pathway and increased sodium/iodide symporter (NIS) expression. However, treatment with recombinant human SHH partially reduced radioiodine uptake ability and NIS expression induced by LARP7. In conclusion, LARP7 may act as a tumor suppressor in PTC by inhibiting the SHH signaling pathway and may be a promising therapeutic target in patients with PTC.

Postoperative 131I treatment for differentiated thyroid cancer (DTC) can create a radiation hazard for nearby persons. The present prospective study aimed to investigate radiation dose rates in 131I-treated DTC patients to provide references for radiation protection. A total of 141 131I-treated DTC patients were enrolled, and grouped into a singular treatment (ST) group and a repeated treatment (RT) group. The radiation dose rate of 131I-treated patients was measured. The rate of achieving discharge compliance and restricted contact time were analyzed based on Chinese regulations. Multivariate logistic regression analysis was used to analyze the independent factors associated with the clearance of radioiodine. The rate of achieving discharge compliance (131I retention

Low doses of radiation affect the response of cells to higher doses; this phenomenon is called radio-adaptive response, which leads to increased resistance to subsequent higher doses. We have investigated the adaptive response using 0.37 MBq priming dose of I-131 followed by 296–444 MBq challenging dose in peripheral human lymphocyte cells. The study was performed on 42 patients with Graves' disease and 29 healthy adult persons as a control group. The patients were divided into two groups. In the first group, patients were referred for radioactive iodine therapy with a specific dose, and iodine was given to them on the day of referral. In the second group, patients were referred for radioactive iodine uptake and radioactive iodine therapy, and iodine uptake was initially performed, then 24 h later, iodine therapy was done. In both groups, 1 month after treatment, blood samples were taken to cytokinesis-block micronucleus (MN) assay. The number of MN in binuclear lymphocyte cells was counted as an end point test. The mean frequency of MN in first, second, and control groups was 75.86 ± 12.68, 71.45 ± 12.56, and 20.06 ± 7.30, respectively. Our results showed that the frequency of total chromosome aberration in both radiation groups was higher than controls. However, in the first group was higher than another group, but their difference was not statistically significant. According to the results, we cannot approve the hypothesis that 0.37 MBq I-131 administration before iodine therapy could induce a radio-adaptive response in lymphocytes of Graves' patients.

Pulmonary arterial dual-energy (aDE) CT is an established technique for evaluating pulmonary perfusion blood volume (PBV). As DECT protocols are increasingly used for thoraco-abdominal CT, this study assessed image quality and clinical findings in portal–venous phase dual-energy (vDE) CT and compared it to aDE. In 95 patients, vDE-CT was performed using a dual-source scanner (70/Sn150 kV, 560/140 ref.mAs). Pulmonary triggered aDE-CT served as reference (n = 94). PBV was reconstructed using a dedicated algorithm. Mean relative attenuation was measured in the pulmonary trunk, aorta, and segmented lung parenchyma. A distribution ratio (DL) between vessels and parenchyma was calculated to assess the iodine uptake of the lung parenchyma. Subjective overall diagnostic image quality was assessed for PBV images on a five-point Likert scale. Image artifacts were classified into five groups based on scale rating and compared between vDE and aDE. Pathological findings were correlated with the anatomical image datasets. Mean relative attenuation of the lung parenchyma was comparable in both groups (vDE: 23 ± 6 HU and aDE: 22 ± 7 HU), but significantly lower in the vessels of vDE. Therefore, iodine uptake of the lung parenchyma was significantly higher in vDE (DL: 10% vs. 8%, p < 0.01). The subjective overall image quality of the PBV images was comparable (p = 0.5). Rotation and streak artifacts were found in most of the patients (>86%, both p > 0.6). Dual-source artifacts were found in only a few patients in both groups (vDE 5%, aDE 7%, p = 0.5). Recess and subpleural artifacts were increased in vDE (vDE 53/27%, aDE 24/7%, both p < 0.001). Pathological findings were found in 19% of the vDE patients and 59% of the aDE patients. Comparable objective and subjective image quality of lung perfusion can be obtained in vDE and aDE. Iodine uptake of the lung parenchyma is increased in vDE compared to aDE, suggesting an interstitial pooling effect. Knowledge of the different appearances of artifacts will aid in the interpretation of the images. Additional clinical information about the lung parenchyma can be provided by PBV evaluation in vDE.

Most vendors offer scanners capable of dual- or multi-energy computed tomography (CT) imaging. Advantages of multi-energy CT scanning include superior tissue characterization, detection of subtle iodine uptake differences, and opportunities to reduce contrast dose. However, utilization of this technology in the emergency department (ED) remains low. The purpose of this pictorial essay is to illustrate the value of multi-energy CT scanning in emergency body imaging.

// Ruiguo Zhang 1 , Guizhi Zhang 1 , Renfei Wang 1 , Jian Tan 1 , Yajing He 1 and Zhaowei Meng 1 1 Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China Correspondence to: Jian Tan, email: tanpost@163.com Keywords: Graves’ disease, effective half-life, radioiodine therapy, iodine uptake, predictive model Received: June 27, 2017 Accepted: August 07, 2017 Published: September 12, 2017 ABSTRACT Purpose: Calculation of effective thyroidal half-life (Teff) of iodine-131( 131 I) is cumbersome and tedious. The aim of this study was to investigate factors that could be used to predict Teff and to develop a Teff prediction model in Graves’ disease patients. Methods: A total of 256 patients with GD were involved in this study. We investigated the influences of age, gender, disease duration, thyroid weight, antithyroid drugs, antithyroid drugs discontinuation period (ADP), thyroid function indexes, thyroid autoantibodies, thyroid-stimulating hormone receptor antibody (TRAb) level and radioactive iodine uptake (RAIU) values before 131 I therapy on Teff, applying univariate and multivariate analyses. Results: Teff correlated negatively with thyroid peroxidase antibody, TRAb and thyroid weight, as well as positively with 24-hour, 48-hour, and 72-hour RAIU. Additionally, a longer ADP (especially≥ 14d) or without antithyroid drugs before 131 I therapy led to a longer Teff. Stepwise multiple linear regression analysis showed that 24-hour and 72-hour RAIU were statistically significant predictors of Teff ( P

To evaluate quantification of iodine uptake in metastatic and non-metastatic lymph nodes (LNs) by dual-energy CT (DECT) and to assess if the distribution of iodine within LNs at DECT correlates with the pathological structure. Ninety LNs from 37 patients (23 with lung and 14 with gynaecological malignancies) were retrospectively selected. Information of LNs sent for statistical analysis included Hounsfield units (HU) at different energy levels; decomposition material densities fat–iodine, iodine–fat, iodine–water, water–iodine. Statistical analysis included evaluation of interobserver variability, material decomposition densities and spatial HU distribution within LNs. Interobserver agreement was excellent. There was a significant difference in iodine–fat and iodine–water decompositions comparing metastatic and non-metastatic LNs (p < 0.001); fat–iodine and water–iodine did not show significant differences. HU distribution showed a significant gradient from centre to periphery within non-metastatic LNs that was significant up to 20–30% from the centre, whereas metastatic LNs showed a more homogeneous distribution of HU, with no significant gradient. DECT demonstrated a lower iodine uptake in metastatic compared to non-metastatic LNs. Moreover, the internal iodine distribution showed an evident gradient of iodine distribution from centre to periphery in non-metastatic LNs, and a more homogeneous distribution within metastatic LNs, which corresponded to the pathological structure. • This study demonstrated a lower iodine uptake in metastatic than non-metastatic LNs. • Internal distribution of HU was different between metastatic and non-metastatic lymph nodes. • The intranodal iodine distribution disclosed a remarkable correlation with the histological LN structure.

Hormonal changes and metabolic demands during pregnancy result in alteration in the physiological and biochemical parameters of thyroid function. Among the many physiological alterations which may occur during pregnancy are thyroid enlargement, increased thyroid capability for iodine uptake and increase in serum thyroxine and tri-iodothyronine concentration. However these findings are not usually associated with symptoms of hyperthyroidism. To clarify the changes, a study was undertaken in Rajshahi Medical College Hospital when serum specimens were collected from individual woman at different stages of normal pregnancy and women married but non pregnant. Among the study subjects, 22 women were in their 1st trimester, 20 women were in their 2nd trimester, 32 women were in their 3rd trimester of normal pregnancy and 10 women were married but non pregnant. We have measured serum levels of total and free thyroxine (TT4 & FT4) and total and free triiodothyronine (TT3 & FT3 ) by using RIA. During the 1st trimester of pregnancy serum FT4 and FT3 concentrations are significantly higher than in non pregnant women and women in 3rd trimester. The concentration of FT4 and FT3 progressively declined as the pregnancy advanced and are to control level in the 3rd trimester. The mean serum TT4 and TT3 are significantly elevated throughout pregnancy in comparison to control.KYAMC Journal Vol. 4, No.-2, Jan 2014, Page 415-418

Radioiodine treatment of differentiated thyroid cancer is the treatment of choice for inoperable metastases with iodine uptake [1]. Typically, a fixed amount of radioactivity in the range 3.7–7.4 G...

Restoration of Iodine Uptake with Larotrectinib In a woman with thyroid cancer expressing an EML4-NTRK3 fusion gene, the cancer had become refractory to radioactive iodine when the capacity of the ...

Most differentiated thyroid cancer (DTC) patients have an excellent prognosis. However, about one-third of DTC patients with recurrent or metastatic disease lose the hallmark of specific iodine uptake initially or gradually and acquire radioactive iodine-refractory DTC (RAIR-DTC) with poor prognosis. Due to the potentially severe complications from unnecessarily repeated RAI therapy and encouraging progress of multiple targeted drugs for advanced RAIR-DTC patients, it has become crucial to identify RAIR-DTC early. In this review, we focus on the progress and controversies regarding the defining of RAIR-DTC, further with subsistent approaches and promising molecular nuclear medicine imaging in identifying RAIR-DTC, which may shed light on the proper management methodsof such patients.

Background and aims Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy. This study was designed to investigate the value of computed tomography (CT) spectral imaging in differentiating HCC from hepatic hemangioma (HH) and focal nodular hyperplasia (FNH). Methods This was a retrospective study of 51 patients who underwent spectral multiple-phase CT at 40-140 keV during the arterial phase (AP) and portal venous phase (PP). Slopes of the spectral curves, iodine density, water density derived from iodine- and water-based material decomposition images, iodine uptake ratio (IUR), normalized iodine concentration, and the ratio of iodine concentration in liver lesions between AP and PP were measured or calculated. Results As energy level decreased, the CT values of HCC (n=31), HH (n=17), and FNH (n=7) increased in both AP and PP. There were significant differences in IUR in the AP, IUR in the PP, normalized iodine concentration in the AP, slope in the AP, and slope in the PP among HCC, HH, and FNH. The CT values in AP, IUR in the AP and PP, normalized iodine concentration in the AP, slope in the AP and PP had high sensitivity and specificity in differentiating HH and HCC from FNH. Quantitative CT spectral data had higher sensitivity and specificity than conventional qualitative CT image analysis during the combined phases. Conclusions Mean CT values at low energy (40-90 keV) and quantitative analysis of CT spectral data (IUR in the AP) could be helpful in the differentiation of HCC, HH, and FNH.

Introduction: A good number of hyperthyroid patients may show delayed recovery of Thyroid Stimulating Hormone (TSH) level in clinically evident euthyroid condition after radioiodine therapy. This group of patients need to be addressed in therapeutic decision making. The purpose of the study was to evaluate the duration and pattern of lag in TSH recovery after I - 131 therapy and the relationship between clinical parameters with stable thyroid function status.Materials and Methods: Total 192 hyperthyroid patients treated with I-131 were included in this study. These patients were followed up clinically and biochemically at three month, six month and one year after radioiodine therapy. Patients having suppressed TSH with normal Free Triiodothyronine (FT3) / Free Thyroxin (FT4) level and clinically euthyroid condition were followed-up for one year without giving antithyroid drug.Results: At three months follow-up 42/192 (22%) had suppressed TSH with normal FT3/FT4 level. Duration of lagging behind state of TSH was three months for 42 patients (22 %), six months for 13 patients (7%) and One year in three patients (2 %). Twelve patients were lost from follow-up. Among 30 patients with lag behind TSH level, 16 (53%) became hypothyroid, 8 (27%) became euthyroid and 6 (20%) became hyperthyroid at one year follow-up. Lagging behind patient with high serum FT4 level at diagnosis and high Radio Active Iodine Uptake (RAIU) showed increased rate of relapse of hyperthyroidism.Conclusion: Lagging state of TSH may be unexpectedly prolonged in some hyperthyroid patients treated with I-131. These patients should be followed up with both TSH and thyroid hormone levels. Most of them do not require further therapy with short period of time.Bangladesh J. Nuclear Med. 17(2): 103-107, July 2014

Background: Iodine deficiency disorder (IDD) is the single most important preventable cause of brain damage. Iodine deficiency disorders (IDDs) refer to all of the consequences of iodine deficiency in a population, which can be prevented by taking adequate amount of Iodine. The objectives was to ascertain the prevalence goitre among 6-12 year children by clinical examination in Mahasamund district; 2) to document the iodine uptake status reflected by random urinary excretion levels in a sub-sample of 6-12 year children covered for clinical examination, and 3) to evaluate the coverage of iodized salt at community level (i.e. at household and retail shop) on-the-spot test by using rapid salt testing kit. Methods: A cross sectional community based survey was done in Mahasamund district during April 2015 to September 2015. The study population was children in the age group of 6-12 years. 30 cluster sampling methodology was applied using PPS sampling technique, based on latest survey guidelines of NIDDCP of Govt. of India. The parameters studied were prevalence of goitre, urinary iodine excretion, and iodine content in salt at community level (i.e. household and shop). Results: A total of 2700 children aged from 6-12 years were assessed clinically for goitre. The total goitre prevalence was 4.29% (95% CI: 3.3-5.27). The median urinary iodine excretion (MUIE) was 106.67μg/L (range 11-216.7μg /L) among surveyed children. 37.4% of the urinary iodine excretion values were

The aim of this review was to investigate the effects of possible harmful waves from either cell phone use or being within the range of the cell phone from 450 to 3800 MHz on the thyroid cells and hormones. Eight electronic datasets were systematically searched using MeSH terms, including “cell phone,” “mobile phone,” “GSM,” “radio frequency,” “smartphone,” “triiodothyronine,” “thyroxin,” “thyroid-stimulating hormone,” “T3,” “T4,” “TSH,” and “morphological” and all possible combinations, to identify relevant studies published up to Dec 2018. We also manually searched the reference lists of potentially selected studies to identify further relevant publications. About 161 relevant studies were initially found. After screening titles and abstracts, 139 studies were excluded, and finally 22 studies (comprising 7182 cases) were included in the qualitative synthesis. Of the 22 included studies, 11 studies reported changes in T3 and T4 levels (six reported a decrease in T3 levels and one reported increase in it); moreover, five found decreased T4 levels and two studies an increased level. In other 10 studies, TSH alteration was reported. Of these, two studies reported a decrease in TSH level and one reported an increase in the hormone levels, while in the remaining studies non-significant changes were reported. Finally, seven studies examined histological changes in the thyroid gland follicles and showed that the volume of these cells was reduced. Based on the evidence discussed above, the reduction in diameter of thyroid follicles is potentially linked with cell phone radiation. Exposure may negatively influence the iodine uptake in the thyroid gland or increases temperature effect on the thyroid gland. However, further research are needed in order to show that the level of TSH and thyroid hormone suppression by microwave.

Differentiated thyroid cancer may lose its differential characteristics and transform to a less-differentiated form that does not concentrate radioiodine. These tumors represent an aggressive tumor type and may necessitate alternative therapies. Various attempts have been made to augment iodine uptake and to redifferentiate tumors in order to regain benefit from radioiodine therapy. Thiazolidinediones, such as rosiglitazone, act by binding to peroxisome proliferator-activated receptors (PPARs) and have also shown promise in the redifferentiation treatment of dedifferentiated thyroid carcinomas as antiproliferative and apoptosis-inducing agents. In this section, the effect of rosiglitazone is discussed in a case with dedifferentiated thyroid cancer.

During the follow-up of a patient with differentiated thyroid carcinoma, Tg elevation without iodine uptake on WB scan was noted. She received an empiric dose of radioiodine to evaluate the possible Tg production site; however, no evidence of uptake was found. PET/CT scan showed pulmonary nodules, some of which were FDG avid. Finally, sorafenib treatment was initiated which is currently at the 22nd month of the follow-up.

A 49-year-old woman presented with a multinodular goiter, causing local symptoms and hyperthyroisdism. Besides a hypofunctioning benign nodule (TIRADS 3, benign in FNAC), the conventional diagnostic revealed another small hyperfunctioning nodule with suspicious ultrasound features (TIRADS 4C). To rule out a trapping-only nodule and topographical misalignments, a I PET/ultrasound fusion was performed and confirmed elevated iodine uptake within the suspicious nodule. Further disseminated autonomous areas are suspected to be additionally responsible for the low TSH-level. Because of the local cervical symptoms and the hyperthyroidism, the patient underwent surgery. The small hyperfunctioning nodule turned out to be a classic papillary microcarcinoma.

Fundamental treatment for papillary thyroid carcinoma (PTC) involves total or subtotal thyroidectomy. Iodine-131 (131I) is routinely utilized to target remnant thyroid cancer and metastasis after thyroidectomy. The effectiveness of other therapeutic modalities remains unsatisfactory; thus, these patients have a poor prognosis. The manner in which the ability of 131I uptake can be improved is vital for their prognosis. Bortezomib has been used as a re-differentiation agent for the treatment of patients with multiple myeloma; however, little is reported about the role of bortezomib in thyroid cancer. To evaluate the therapeutic potential of bortezomib in a human PTC cell line, expression of paired-box 8 (Pax8) protein was determined using Western blot in PTC, normal thyroid, and anaplastic/undifferentiated thyroid carcinoma (ATC) cells. The expression of Pax8 protein in PTC cells pretreated with bortezomib was determined using the same method. Iodine uptake was determined using 131I radioactivity assay. The level of Pax8 protein in normal thyroid cells was significantly higher than in PTC (P < 0.05) and ATC cells (P < 0.05); its expression in PTC cells was also significantly higher than in ATC cells (P < 0.05). The PTC cells in the bortezomib-treated group showed a higher expression of Pax8 protein than the control group (P < 0.05). These findings indicate that bortezomib can increase the expression of Pax8, but does not significantly increase the iodine uptake of PTC cells.

Amiodarone, a benzofuranic iodine-rich antiarrhythmic drug, causes thyroid dysfunction in 15-20% of cases. Amiodarone can cause both hypothyroidism (AIH, amiodarone-induced hypothyroidism) and thyrotoxicosis (AIT, amiodarone-induced thyrotoxicosis). AIH is treated by L-thyroxin replacement and does not need amiodarone discontinuation. There are two main forms of AIT: type 1, a form of true iodine-induced hyperthyroidism; and type 2, a drug-induced destructive thyroiditis. However, mixed/indefinite forms exist, contributed to by both pathogenic mechanisms. Type 1 AIT usually occurs in diseased thyroid glands, whereas type 2 AIT develops in substantially normal thyroid glands. Thioamides represent the first-line treatment for type 1 AIT, but iodine-replete glands are poorly responsive; sodium/potassium perchlorate, by inhibiting thyroidal iodine uptake, may increase the response to thioamides. Type 2 AIT is best treated by oral glucocorticoids. Response depends on thyroid volume and severity of thyrotoxicosis. Mixed/indefinite forms may require a combination of thioamides, potassium perchlorate, and steroids. Radioiodine treatment is usually not feasible because amiodarone-related iodine load decreases thyroidal radioiodine uptake. Thyroidectomy represents an important and helpful option in cases resistant to medical therapy. Surgery performed by a skilled surgeon may represent an emergent treatment in patients who have severe cardiac dysfunction.

To investigate the effect of iodine uptake on tissue/organ absorbed doses from CT exposure and its implications in CT dosimetry. The contrast-induced CT number increase of several radiosensitive tissues was retrospectively determined in 120 CT examinations involving both non-enhanced and contrast-enhanced CT imaging. CT images of a phantom containing aqueous solutions of varying iodine concentration were obtained. Plots of the CT number increase against iodine concentration were produced. The clinically occurring iodine tissue uptake was quantified by attributing recorded CT number increase to a certain concentration of aqueous iodine solution. Clinically occurring iodine uptake was represented in mathematical anthropomorphic phantoms. Standard 120 kV CT exposures were simulated using Monte Carlo methods and resulting organ doses were derived for non-enhanced and iodine contrast-enhanced CT imaging. The mean iodine uptake range during contrast-enhanced CT imaging was found to be 0.02-0.46% w/w for the investigated tissues, while the maximum value recorded was 0.82% w/w. For the same CT exposure, iodinated tissues were found to receive higher radiation dose than non-iodinated tissues, with dose increase exceeding 100% for tissues with high iodine uptake. Administration of iodinated contrast medium considerably increases radiation dose to tissues from CT exposure. • Radiation absorption ability of organs/tissues is considerably affected by iodine uptake • Iodinated organ/tissues may absorb up to 100 % higher radiation dose • Compared to non-enhanced, contrast-enhanced CT may deliver higher dose to patient tissues • CT dosimetry of contrast-enhanced CT imaging should encounter tissue iodine uptake

Starting with the 2007–2008 cycle, the National Health and Nutrition Examination Survey (NHANES) also oversampled Hispanics other than Mexicans (OHISP) making it possible to treat OHISP as a separate demographic group along with Mexican Americans (MAs), non-Hispanic whites (NHWs), and non-Hispanic blacks (NHBs). Yet, more often than not, OHISP have been merged with MA to form an all-Hispanic demographic group (HISP) thus limiting comparisons between NHW, NHB, and HISP. Consequently, for the first time, this study was undertaken to evaluate differences in the observed levels of selected environmental contaminants between MA and OHISP from five groups of environmental contaminants, namely, polycyclic aromatic hydrocarbons (PAHs), iodine uptake inhibitors (IUIs), environmental phenols (EPHs), priority pesticides (PPs), and perfluoroalkyl acids (PFAAs). Data for 2007–2010 from NHANES were used to conduct this study. OHISP children born in USA had higher levels of selected PAH metabolites than USA-born MA, and Mexican-born MA adolescents had higher levels of selected PAH metabolites than USA-born MA adolescents. USA-born adolescent MA had higher levels of selected parabens than USA-born adolescent OHISP, and OHISP adults born in another Spanish-speaking country had higher levels of selected parabens than USA-born OHISP adults. USA-born MA adults and seniors had higher levels of selected dichlorophenols than Mexico-born MA adults and seniors, respectively. Females had higher levels of selected PAH metabolites, EPHs, and PPs than males among children, adolescents, adults, and seniors, but the reverse was true for the levels of selected IUIs and PFAAs among adolescents and seniors. Smokers had higher levels of almost all PAH metabolites than non-smokers for adolescents, adults, and seniors. The same was true for urinary thiocynate for adolescents, adults, and seniors. OHISP is a multiracial multiethnic demographic group substantially different from MA with possibly different smoking behavior and with possibly differential levels of exposure to certain environmental contaminants and as such should be treated as a demographic group by itself.

Colposcopy is the systematic evaluation of the lower genital tract using magnification from a colposcope with a good light source. The image which is seen through colposcopy is based on morphological characteristics of epithelium, composition of underlying stroma and surface configuration.The colposcopic findings are described with respect to color of the lesion, its surface, margins, vascular pattern and iodine uptake. The basis for changes seen during colposcopy in a premalignant lesion have been discussed in detail in the chapter.

Introduction: Radioiodine (RAI) therapy for treatment of differentiated thyroid cancer (DTC) requires high serum thyroid-stimulating hormone (TSH) levels to induce a sufficient iodine uptake within thyroid cells. Recombinant Human TSH (rhTSH) induces an exogenous TSH level increase without LT4 withdrawal. It is a valid alternative to LT4-withdrawal (LT4-W) to achieve the TSH levels required for RAI therapy. According to the recent American Thyroid Association (ATA) guidelines, candidates for RAI therapy should be selected based on their DTC risk of recurrence. Areas covered: In this review, we report the studies assessing the effects of rhTSH on RAI ablation compared to thyroid hormone withdrawal in patients with thyroid cancer at different ATA risk of recurrence. We focus our attention on high risk patients and metastatic disease in which RAI treatment is routinely recommended although there are few controversial data about the best possible way of preparing for it. Expert commentary: rhTSH-aided therapy is associated to a better quality of life and to a lower body radiation exposure. Several studies have reported an equivalent efficacy of RAI ablation after TSH stimulation with rhTSH or LT4-W in patients with DTC at low and intermediate risk of recurrence. Although more studies are required, the results are promising even in patients with high risk DTC and metastatic disease. ©

Objective To evaluate the efficacy and feasibility of retinoic acid derivatives and lithium salts for radioiodine-refractory prevention in patients with differentiated thyroid cancer during multistage radioiodine therapy. Materials and methods The retrospective analysis was performed using the diagnostic and treatment results of 40 patients with differentiated thyroid cancer that underwent 131 I therapy, which on the basis of posttherapy whole-body scan had direct indications for subsequent course of radioiodine therapy. The patients were divided into two groups: the control group (20 patients), which conducted a second course of radioiodine therapy on the standard template and without special training$ the main group (20 patients), who were administered Sedalia (900 mg per day for 8 days, p.o.) and isotretinoin (1.2 mg/kg body weight for 60 days, p.o.) to prevention of the 131 I resistance. To evaluate the effectiveness of a repeated course of radioiodine therapy following parameters were used: the thyroglobulin (Tg) and antibodies to thyroglobulin (Tg-Ab) level in the serum, the posttherapy whole body scan in combination with SPECT-CT. Results We have found, that radioactive iodine treatment was effective in 75% of the main group and 90% of patients in the control group. The remission was observed in 10% and 40% in the main and control group, respectively. The partial regression was considered as Tg and TG-Ab reduction, and was observed more in the study group. The resistance to 131 I therapy was found in 20% and 10% in the main and control group, respectively, which was based on the fact of permanent Tg/Tg-Ab serum level and absence of the pathological foci iodine uptake on the whole-body scans. The disease progress was found in one patient in the main group. Conclusion The use of retinoic acid derivatives and lithium salts, in an effort to prevent the resistance to 131 I-theraphy pretend to be unjustified, because it does not lead to significant improvement in long-term results and reduce the number of 131 I-resistance.

Many cases of unexpected radioiodine uptake have been reported, including physiological uptake in healthy tissue and in both benign and malignant nonthyroidal lesions. However, iodine uptake in the uterus has not been well assessed. In this article, we systemically analyzed iodine uptake in the uterus and identified the site in which uptake occurred.Seventy-six female patients who underwent SPECT/CT from neck to pelvis were included in this study; 5 patients with uterine uptake received pelvic MRI. Iodine uptake in the uterus was diagnosed with SPECT/CT and compared with the findings of the MRI. Serum TSH level, administered dose of iodine-131 and number of radioiodine therapies were compared between the 2 groups with and without iodine uptake in the uterus.Twenty (26.3%) of 76 patients showed iodine uptake in the uterine cervix on SPECT/CT. It was difficult to distinguish the uptake in the uterus from that in the urinary bladder or rectum using only planar images. The patients with the uterine uptake were younger than those without (median age, 46.5 vs. 62, P = 0.011). There were no significant differences in serum TSH level, administered dose of iodine-131, or number of radioiodine therapies between the 2 groups. In all instances of the 5 patients who underwent pelvic MRI, iodine uptake in the uteri was located in nabothian cysts.Iodine uptake in the uterus is frequently found if pelvic SPECT/CT is performed. Nabothian cysts are a predominant cause of iodine uptake in the uterine cervix.

Iodine deficiency disorder (IDD) has been recognized as a major public health problem worldwide and has serious detrimental effects on the growth and development of the children. Therefore, monitoring the iodine status of the school-aged children is of great importance. We randomly recruited 159 boarding school students (aged from 6 to 14) from 10 primary schools in Lincang County, Yunnan Province. The dietary iodine level of the students was measured by the new mixed meal method and chemical analysis. Fifty-seven daily water samples and 32 salt samples were collected from the same surveyed area to determine the iodine content using the sulfate cerium catalytic spectrophotometric method and the hyposulphite quantitative titration method, respectively. The iodine level of each water sample was ranged from 0.611 to 1.473 μg/L. The median and the mean value of the iodine content in water were 0.972 and 0.979 ± 0.189 μg/L. The average iodine intake of each age group was higher that the recommended nutrient intakes (RNI) but lower than the tolerable upper intake level (UL). The median and the mean value of the iodine content in salt were 25.53 and 25.62 ± 1.70 mg/kg. Taken together, the present study investigated the iodine intake status of Wa school-aged children through examination of their dietary iodine intake, the environment, and the salt iodine status. Results showed that the status of the iodine uptake of the Wa children were higher than the RNI, but lower than the UL.

Background: Today, human iodine deficiency is, after iron, the most common nutritional deficiency in developed European and underdeveloped third world countries. A current biological indicator of iodine status is urinary iodine, which reflects very recent iodine exposure; a long-term indicator of iodine status remains to be identified. Methods: We analyzed hair iodine in a prospective, observational, cross-sectional, and exploratory study involving 870 apparently healthy Croatians (270 men and 600 women). Hair iodine was analyzed with inductively coupled plasma mass spectrometry. Results: The hair iodine median was 0.499 μg/g, and was 0.482 and 0.508 μg/g for men and women respectively, suggesting no sex-related difference. We studied hair iodine uptake by analyzing the logistic sigmoid saturation curve of the median derivatives to assess iodine deficiency, adequacy, and excess. We estimated overt iodine deficiency to occur when hair iodine concentration was below 0.1–0.15 μg/g. Then there was a saturatio...

Recently, the main therapy of medullary thyroid cancer (MTC) is surgical, but by which way there is a poor prognosis with a mean survival of only 5 years. In some cases, some researchers found that it is the medullary thyroid cancer stem cells (MTCSCs) that cause metastasis and recurrence. This study aimed to eradicate MTCSCs through administration of all-trans-retinoic acid (ATRA). Here we demonstrate that MTCSCs possess stem- like properties in serum-free medium. The ABCG2, OCT4 and sodium iodide symporter (NIS) were changed by ATRA. Additionally, we found that ATRA can increase the expression of NIS in vivo. All the data suggested that ATRA could increase the iodine uptake of MTCSCs through NIS.

Iodine uptake in the lungs and intrathoracic lesions on postcontrast dual-energy computed tomography is used for evaluation of pulmonary embolism-related perfusion defects and pulmonary infarctions. It has been applied in characterization and treatment response assessment of lung and mediastinal abnormalities. We report a new imaging artifact or faulty image postprocessing in a commercially available rapid kV switching technique of dual-energy computed tomography, which can confound its clinical utility for evaluation of iodine uptake.

Aim: Supplementary functional information can contribute to assess response in targeted therapies. The aim of this study was to evaluate semi-automatic RECIST plus iodine uptake (IU) determination in melanoma metastases under BRAF inhibitor (vemurafenib) therapy using dual-energy computed tomography (DECT). Methods: Nine patients with stage IV melanoma treated with a BRAF inhibitor were included. Contrast-enhanced DECT was performed before and twice after treatment onset. Changes in tumor size were assessed according to RECIST. Quantification of IU (absolute value for total IU (mg) and volume-normalized IU (mg/ml)) was based on semi-automatic tumor volume segmentation. The decrease compared with baseline was calculated. Results: The mean change of RECIST diameter sum per patient was −47% at the first follow-up (FU), −56% at the second FU (P

Background: Prior studies which evaluated associations between prenatal exposure to perchlorate, nitrate and thiocyanate are inconsistent. One methodological problem is the high correlation among t...

The review highlights the effects of acute and chronic stress on thyroid metabolism. Special attention is paid to the influence of stress and the direct effects of glucocorticoids on the thyroid status, the activities of thyrocyte iodine uptake, oxidation and organification as well as peripheral metabolism of thyroid hormones (deposition and transport of thyroid hormones, deiodinase activities in different tissues). The role of stress in the development of thyroid pathology is analysed and charestiristic features of thyroid function alterations during impaired functioning of the pitiutary-adrenal system are established. The mechanisms of the stress-induced impairments in thyroid functions are of interest for further research, taking into consideration serious consequences of thyroid deficiency for the body, even in subclinical thyroid insufficiency.

Equal amounts of autonomous thyroid tissue were found with the same frequency before and after 40 years of age in eumetabolic patients in endemic goitre areas. A tentative diagnosis of thyroid autonomy can be made already in euthroid patients with an 80% accuracy by combined estimation of an equivalent of free thyroxine and iodine uptake. The equivalent is taken from determination of thyroid pertechnetate uptake by quantitative scan evaluation. Proof of autonomy is established by the suppression test which in a prolonged fractionated form also permits estimation of the amount of functioning autonomous tissue. There is a linear correlation of technetium thyroid uptake after suppression and the volume of autonomous thyroid tissue. As free thyroxine increases after iodine intake of sufficient amount and duration in proportion with the volume of autonomous tissue, prognosis appears possible: patients with autonomous thyroid tissue above a "critical" volume can be expected to develop hyperthyroidism in case of sufficient iodine uptake. Iodine salt prophylaxis however does not induce hyperthyroidism in patients below 50 years of age provided that the daily additional iodine intake does not exceed 100 micrograms.

Typical signs of so-called hyperthyroiditis are hyperthyroidism, low iodine uptake by the thyroid, absence of local, general or humoral signs of inflammation, and absence of significant antibody titres against thyroid tissue. These features are illustrated by the case report of a 51-year-old man. Since the course of hyperthyroidism is short and has a good prognosis, the importance of the diagnosis lies in avoiding unnecessary therapeutic measures. This cause of hyperthyroidism can be recognized only by including tests of intrathyroid iodine metabolism among diagnostic procedures.

Molecular imaging is the visualization, characterization, and measurement of biologic processes at the molecular and cellular levels in human beings and other living systems. In thyroid cancer, this includes imaging iodine transport, which is active in about 80% of well-differentiated thyroid malignancies. Iodine-124 imaging with positron emission tomography (I-124-PET) is ideal for this purpose because PET provides tomographic images with spatial and contrast resolution. Because iodine-131 is the mainstay for therapy in thyroid cancer, and because success or failure of therapy depends on the degree of iodine uptake by the tumor cells, I-124-PET imaging will increasingly act as a surrogate for this treatment. This approach may serve as a model for individualized therapeutic interventions for many other malignant and nonmalignant diseases.