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Nuclear Medicine in Thyroid Cancer Management: A Practical Approach
Thyroid cancers are now being diagnosed at an earlier stage and treatments together with follow-up strategies are more effective. However this is not consistent throughout the world. The practice does differ considerably from country to country and region to region. Many International Atomic Energy Agency (IAEA) Member States can benefit from the lessons learned and improve overall patient management of thyroid cancers.
This publication is a culmination of efforts by more than twenty international experts in the field to produce a global perspective on the subject. Views expressed are those of individual experts involved and are intended to assist national or regional authorities in decisions regarding the frameworks for effective treatment of thyroid cancer.
Contents
- 1. EPIDEMIOLOGY AND AETIOLOGY
- 2. CLASSIFICATION OF THYROID CANCER
- 3. CLINICAL PRESENTATION
- 4. THYROGLOBULIN
- 4.1. Serum thyroglobulin measurements and its limitations
- 4.2. Normal serum thyroglobulin concentrations
- 4.3. Role of thyroglobulin in thyroid cancer
- 4.4. Comparison during and after withdrawal of thyroid hormone therapy or after rhTSH injection
- 4.5. Comparison of thyroglobulin with whole body radioiodine scan
- 4.6. Conclusions
- REFERENCES TO SECTION 4
- 5. RADIOLOGICAL IMAGING
- 6. FUNCTIONAL EVALUATION OF THYROID
- 7. FINE NEEDLE ASPIRATION BIOPSY OF THE THYROID
- 8. PROGNOSTIC FACTORS AND RISK GROUP ANALYSES IN DIFFERENTIATED THYROID CARCINOMA
- 9. DIFFERENTIATED THYROID CANCER IN CHILDHOOD AND ADOLESCENCE
- 9.1. Introduction
- 9.2. Incidence and epidemiology
- 9.3. Aetiology
- 9.4. Pathophysiology
- 9.5. Modes of presentation
- 9.6. Distant metastasis
- 9.7. Diagnosis
- 9.8. Treatment strategies
- 9.9. Radioiodine treatment85
- 9.9.4. Tumour response to radioiodine therapy and possible adverse effect
- 9.10. External radiotherapy
- 9.11. Follow-up
- 9.12. Mortality
- 9.13. Prognostic factors
- 9.14. Conclusion
- REFERENCES TO SECTION 9
- 10. SURGICAL MANAGEMENT
- 10.1. Introduction
- 10.2. Pre-operative evaluation
- 10.3. Thyroid surgery
- 10.4. Risk groups in differentiated thyroid cancer
- 10.5. Surgical management of differentiated thyroid cancers: total vs near total thyroidectomy
- 10.6. Medullary thyroid cancer
- 10.7. Anaplastic cancer
- 10.8. Postoperative complications
- 10.9. Postoperative treatment
- 10.10. Summary
- REFERENCES TO SECTION 10
- 11. RADIOIODINE THERAPY
- 11.1. Postoperative management of primary thyroid carcinoma
- 11.2. Diagnostic radioiodine studies
- 11.3. Optimisation of radiation dose and dose rate for ablation of remnant thyroid tissue
- 11.4. Criteria for therapeutic administration of radioiodine
- 11.5. Calculated dose ablation
- 11.6. Radioiodine treatment for thyroid cancer
- 11.7. Radioiodine therapy for patients with negative diagnostic scans and elevated thyroglobulin levels
- 11.8. Conclusion
- REFERENCES TO SECTION 11
- 12. PRACTICAL ASPECTS OF RADIOIODINE THERAPY
- 12.1. Introduction
- 12.2. Selection of a therapeutic radionuclide for thyroid cancer treatment
- 12.3. Physical characteristics of Iodine-131
- 12.4. Radiation quantities and units
- 12.5. Risks associated with radioiodine therapy
- 12.6. Measurement of radiation
- 12.7. Minimisation of radiation exposure
- 12.8. Pre-treatment preparation
- 12.9. Treatment
- 12.9.1. Protocols and procedures
- 12.9.2. Form of radioiodine
- 12.9.3. Patient dose preparation and administration
- 12.9.4. Possible acute side-effects
- 12.9.5. Excretory pathways
- 12.9.6. Radiation monitoring and radiation safety precautions
- 12.9.7. Waste management
- 12.9.8. Accident/emergency procedures
- 12.9.9. Discharge
- 12.9.10. Safety of family members following discharge
- 12.9.11. Return to work
- 12.9.12. Discharge to a non-home environment
- 12.10. Long term advice
- 12.1.1. Design of facilities
- REFERENCES TO SECTION 12
- 13. ROLE OF EXTERNAL BEAM RADIOTHERAPY
- 14. ROLE OF CHEMOTHERAPY
- 15. POST SURGICAL IMAGING EVALUATION
- 16. LONG TERM FOLLOW-UP
- 16.1. Recurrence of papillary thyroid cancer
- 16.2. Recurrence of follicular cancers
- 16.3. Postsurgical side effects
- 16.4. Long term complications of radioiodine treatment
- 16.4.1. Chronic sialadenitis
- 16.4.2. Radiation effects on gonads and fertility
- 16.4.3. Pregnancy after high therapeutic dosages of in DTC
- 16.4.4. Malignant neoplasm
- 16.4.5. Transformation to anaplastic carcinoma
- 16.4.6. Bone marrow suppression
- 16.4.7. Effect of radioiodine therapy on renal system
- 16.4.8. Radiation pneumonitis and pulmonary fibrosis
- 16.5. Problems of overdosage of thyroxine
- 16.6. Diagnosis and management of residual, recurrent and metastatic MTC
- REFERENCES TO SECTION 16
- 17. REGIONAL EXPERIENCES
- 18. MOLECULAR GENETICS
- 19. EMERGING STRATEGIES
- ANNEX I MANAGEMENT ALGORITHMS
- ANNEX II SAMPLE PATIENT INFORMATION SHEET
- ANNEX III SAMPLE DOSE ADMINISTRATION RECORD
- CONTRIBUTORS TO DRAFTING AND REVIEW
