• 대한두경부종양학회지
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• 제18권2호
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• pp.173-178
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• 2002

Background and Objective: Factors that are associated with the recurrence after radioactive iodine ablation therapy have not been identified yet. The aim of this study is to elucidate the factors that are related to the recurrence after thyroid surgery of the thyroid papillary cancer followed by radioactive iodine ablation therapy. Patients and Methods: Fifty four cases who had underwent thyroid cancer surgery and postoperative radioactive iodine ablation therapy were included in this study. Mean followup duration was 7 years. There were 41 women and 13 men. Data analysis was done retrospectively with medical record review. Chi-square test and Fisher's exact test was used for the statistical analysis. Results: Age over 40, capsular invasion, and loca invasion were the factors that were associated with the high rate of recurrence. But sex, size of the tumor, multiplicity and extent of the surgery were not related to the recurrence. Conclusion: Without the curative resection of the tumor, radioactive iodine ablation therapy cannot lower the recurrence rate. So aggressive resection of the thyroid papillary cancer is important.The more data accumulated and the longer the followup, the easier we can reveal the recurrence-related factors of postoperative radioactive ablation therapy.

• 대한두경부종양학회지
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• 제14권1호
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• pp.61-69
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• 1998

Objectives: The response rate of the radioactive iodine(RI) therapy with low dose was variable. Only a few studies reported the response and complication rate with high dose. The goal of this study was to access the ablation and complication rate after high dose of RI therapy (more than 100mCi) and to evaluate the factors affect the results. Material and Methods: During a period of 12 years, 225 patients received high dose of RI from 100 to 200mCi depending on the RI uptake in the whole body after total thyroidectomy. 100mCi of RI was given to 123 patients for ablation who showed the uptake only in the thyroid bed. 150mCi was given to another 84 patients for ablation who had uptake confined to the neck. The other 21 patients took more than 200mCi of RI because the whole body scan showed distant metastasis. Among these patients, the ablation and the complication rate was investigated. Results: Elevated level of the serum thyroglobulin(Tg) decreased less than 5ng/ml after RI therapy in all patients except two in the first group. The second group showed reduction of the serum Tg in 93%. Eighteen of the 21 patients in the third group are still alive after RI therapy. There were no fatal complications after high dose RI therapy and most of the complications were minimal and transient. The complication rate was not related with the dose of RI, age, sex, DNA flowcytometry, serum thyroglobulin level and the extent of node dissection. Conclusion: We concluded that RI therapy with high dose was very effective for thyroid ablation after operation and it also showed excellent results with minimal complications for treatment of metastatic lesions.

• Nuclear Medicine and Molecular Imaging
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• 제43권4호
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• pp.259-279
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• 2009

Radioiodine ablation therapy has been considered to be a standard treatment for patient with differentiated thyroid cancer after total thyroidectomy. Patients may need to be hospitalized to reduce radiation exposure of other people and relatives from radioactive patients receiving radioiodine therapy. Medical staffs, nursing staffs and technologists sometimes hesitate to contact patients in radioiodine therapy ward. The purpose of this paper is to introduce radiation dosimetry, estimate radiation dose from patients and emphasize the safety of radiation exposure from patients treated with high dose radioiodine in therapy ward. The major component of radiation dose from patient is external exposure. However external radiation dose from these patients treated with typical therapeutic dose of 4 to 8 GBq have a very low risk of cancer induction compared with other various risks occurring in daily life. The typical annual radiation dose without shielding received by patient is estimated to be 5 to 10 mSv, which is comparable with 100 to 200 times effective dose received by chest PA examination. Therefore, when we should keep in mind the general principle of radiation protection, the risks of radiation exposure from patients are low and the medical personnel are considered to be safe from radiation exposure.

• Journal of Medicine and Life Science
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• 제19권3호
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• pp.95-102
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• 2022

This retrospective study aimed to investigate whether there was a difference in the success rate of removal of residual thyroid tissue in patients with the same cutoff serum thyroglobulin (Tg) value-measured 2 weeks after thyroid hormone withdrawal (THW)-for different radioactive iodine (RAI) activities. We identified 132 patients with papillary thyroid cancer who were treated with total thyroidectomy and RAI therapy to evaluate the efficacy of three radioactivities of I-131: 1,110, 3,700, and 5,550 MBq. Serum Tg testing was performed 1 week before RAI treatment and 2 weeks after THW (pre-Tg); the cutoff pre-Tg level was below 10 ng/mL. Stimulated Tg levels were measured on the day of I-131 administration (off-Tg). After 6 months of treatment, we compared the groups for complete ablation, defined as no uptake on a diagnostic I-131 scan, stimulated Tg level of <1.0 ng/mL, and Tg antibody level of <100 ng/mL. Ninety-five patients (72.0%) achieved complete ablation, with 57.1% (8/14), 78.2% (68/87), and 61.3% (19/31) in the 1,110 MBq, 3,700 MBq, and 5,550 MBq groups, respectively. There was no significant difference in the complete ablation rates between the three groups. In the multivariate analysis, the off-Tg level was a significant predictor of complete ablation. RAI therapy with low radioactivity (1,110 MBq) seemed sufficient for ablation in patients with papillary thyroid cancer with a pre-Tg level below 10 ng/mL. The off-Tg level is a promising and useful predictor of complete ablation after initial RAI therapy.

• 대한두경부종양학회지
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• 제14권2호
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• pp.214-219
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• 1998

Objectives: To assess the effectiveness of the low-dose(30mCi) I-131 ablation therapy for remnant thyroid tissue following total thyroidectomy for differentiated thyroid cancer. Methods: Between March 1995 and December 1997, forty-eight patients were given ablative doses(30mCi) of I-131 after total thyroidectomy for differentiated thyroid cancer in the presence of I-131 uptake in remnant thyroid tissue. Effective ablation of remnant thyroid tissue was determined by following I-131 whole body scan. if remnant thyroid tissue remained, we repeated the same management at 6 months interval. Results: Thirty-eight(79.1%) patients had papillary, 8(16.7%) follicular, 1(2.1%) medullary and 1(2.1%) Hurthle cell type cancer. Forty-eight patients underwent total thyroidectomy, among those central neck dissection was performed in 35 cases, and modified radical neck dissection in 14 cases. Postoperative complication developed in 8 cases, which included 4 cases of transient hypoparathyroidism, 1 case of permanent hypoparathyroidism, 2 cases of transient recurrent laryngeal nerve palsy, and 1 case of wound hematoma. There were significant remnant thyroid tissue in 46 cases(95.8%) of patients after total thyroidectomy, which could be ablated by low dose(30mCi) I-131. There were no statistical difference between operative procedures and number of treatment of I-131. Conclusions: These results suggested that repeated low-dose(30mCi) I-131 therapy would be needed, therefore, high -dose I-131 therapy could be considered as ablation therapy for the remnant thyroid tissue after total thyroidectomy for differentiated thyroid cancer.

• 대한후두음성언어의학회지
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• 제24권1호
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• pp.33-40
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• 2013

Background and Objectives:This study is to objectively compare and analyze the acoustic changes in the patients with total thyroidectomy before and after RI therapy. Subjects and Methods:For this study, a total of 50 patients with total thyroidectomy were participated as subjects. Voice samples were obtained at the time of post-operation (Post-OP), before high-dose radioactive iodine therapy (Pre-RIT), and after high-dose radioactive iodine therapy (Post-RIT). Acoustic analysis, the maximum phonation time and K-VHI (Korea-Voice handicap index) were used for subjective evaluation. Results:According to the comparison analysis of the three periods, mFo (Hz) was significantly reduced in all of the vowels /a/ and /i/ as the hormone was discontinued. This can be related to the reduction in vocal range. As thyroid hormone was discontinued, Shim (%) and APQ (%) values, which are the parameters related to the degree of aggressiveness, showed a significant increase in the middle vowel /a/. As thyroid hormone was discontinued, emotional index was significantly decreased in VHI (voice handicap index). Conclusion:These results can be assumed that thyroid hormone suspension is related to the increased changes in the vocal intensity, the increase in noise and the reduction in vocal range. Emotionally, these data can be assumed that the responsive factors of one's own voice disorders were significantly decreased in the patients with vocal handicap.

• Nuclear Medicine and Molecular Imaging
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• 제42권5호
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• pp.375-382
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• 2008

갑상선암 환자의 방사성 요오드 치료를 위한 전 단계로 시행되는 저요오드식이는 표준화된 전처지 방법으로 사용되고 있고 그 시행방법에 관련된 권고들이 최근 생겨나고 있다. 한국은 상대적으로 요오드 섭취가 많은 지역이므로 권장된 요오드 배설 기준을 만족시키지 못할 수도 있다. 이 연구에서는 갑상선의 요오드 섭취를 억제시키는 약물의 제한, 조영제가 사용된 경우에서 최소 3개월 이후로 치료 일정을 정하기, 전담 영양사에 의한 2주간의 엄격한 저요오드식이 교육을 시행하였을 때, 식이 요오드섭취가 많은 한국 갑상선암 환자들에서 소변 요오드량이 적정 수준으로 감소하는 지에 대해 전향적으로 분석하고자 하였다. 방법: 2006년 11월부터 외부 병원에서 갑상선암 진단 후 갑상선 전절제술을 시행 받고, 잔여 갑상선 제거 목적으로 고용량 방사성요오들 치료를 위해 본 연구자들의 병원에 의뢰된 환자들 중 recombinant human thyrotropin 또는 levotriiodothyronine을 사용하는 경우를 제외한 환자들을 대상으로 하였다. 요오드 함유 약물이나 갑상선의 요오드 섭취를 제한할 수 있는 약물을 점검했고, 조영제가 사용된 경우 치료 일정을 최소 3개월 이후로 결정하였으며 전담 영양사에 의한 2주간의 엄격한 저요오드식이 교육을 시행하였다. 저요오드식이 전후로 24시간 소변 내 요오드량을 측정하여 비교하였다. 또한 소변 내 크레아티닌 수치를 이용해서 24시간 소변 채집이 보다 적절한 것으로 판단되는 하부군을 대상으로 24시간 소변 내 요오드량을 비교하였다. 결과: 총 51명이 최종 분석에 포함되었다. 모든 환자에서는 24시간 소변 요오드량이 저요오드식이 전후로 $787\;{\mu}g/d$에서 $85\;{\mu}g/d$로 감소가 되었고 74.4%에서 $100\;{\mu}g/d$ 이하의 결과를 보였다. 소변 채집이 보다 적절한 하부군 14례에서는 저요오드식이 전후로 $505\;{\mu}g/d$에서 $99\;{\mu}g/d$로 감소되었고 78.6%에서 $100\;{\mu}g/d$ 이하의 결과를 보였다. 결론: 갑상선암 환자들에서 잔여갑상선제거를 위한 방사성요오드 치료 전에 2주간의 엄격한 저요오드식이를 시행하여 전향적으로 분석했을 때 24 시간 소변 내 요오드량이 평균 $99\;{\mu}g/d$로 감소하였고, 78.6%에서 $100\;{\mu}g/d$이하의 값을 보였다. 따라서 식이 요오드섭취량이 많은 한국에서는 최소 2주 이상의 엄격한 저요오드식이가 고려되어야 하며, 환자의 순응도를 높이기 위한 체계적인 교육이 뒷받침되어야 한다.

• Journal of Yeungnam Medical Science
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• 제32권2호
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• pp.138-142
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• 2015

L-thyroxine (LT4) withdrawal prior to radioactive iodine (RAI) ablation therapy is a commonly used method for successful treatment of patients with papillary thyroid cancer (PTC). However, a prolonged period of hypothyroidism induced by LT4 withdrawal is sometimes associated with impaired quality of life and cardiopulmonary dysfunction in PTC patients. Furthermore, LT4 withdrawal may have a trophic effect on residual cancer by means of increased thyrotropin. We report on 2 cases of metastatic PTC patients with malignant pleural effusion (MPE) whose disease showed rapid worsening after LT4 withdrawal and RAI therapy. The first case is a 65-year-old woman who had PTC with multiple distant metastases and MPE. During LT4 withdrawal for RAI therapy, MPE showed rapid worsening, and the patient required repetitive therapeutic thoracentesis. The second case is a 49-year-old woman with PTC who underwent 3 additional operations for cancer recurrence in the neck lymph nodes and 6 times of RAI treatments. While preparing for the $7^{th}$ RAI treatment by withdrawing LT4, she developed MPE which became progressively aggravated after RAI therapy. Both patients experienced increased pleural effusion during the LT4 withdrawal period and a rise in the thyroglobulin level was observed after RAI therapy. MPE was not controlled with therapeutic thoracentesis and pleurodesis. Eventually, both patients died of rapid disease progression after RAI therapy. In summary, LT4 withdrawal may have an adverse effect on metastatic PTC patients, particularly those with MPE.

• 핵의학기술
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• 제12권3호
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• pp.147-156
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• 2008

목적 : 방사성옥소 치료팀에서 이루어지고 있는 모든 행위가 나름대로의 원칙과 규정이 있으므로 단일화 된 모델은 적절한 최적화가 아닐 것으로 생각되나 통일성 있는 기준제시에 접근하고자 함이다. 실험재료 및 방법 : 2007년 11월 5일부터 11월 17일까지 29개 병원을 대상으로 핵의학 담당자에게 설문조사하였다. 설문조사의 내용은 환자에 대한 진료부문, 환자관리, 검사 부문, 폐기물관리, 안전관리 등 5개의 카테고리로 정하였으며 질문에 대한 응답내용을 선택하는 방식으로 조사하였다. 결과 : 2007년 10월 기준으로 전체 30개 병원에서 58개의 병실을 운영하고 있었으며 치료계획에 따른 검사 및 일정관리는 약간의 차이가 있었다. 환자에 대한 교육부문은 의사 및 간호사가 주로 담당하였으며 교육에 대한 환자의 만족도는 높은 것으로 평가되었다. 폐기물 관련 자료와 정기적으로 실시되고 있는 정기 감사로 인하여 각 병원별 폐기물 관리 수행은 원만히 이루어지고 있는 것으로 나타났다. 환자 및 작업종사자들에 대한 안전관리는 원자력법에 근거하여 잘 수행되고 있었으며 치료병실에 대한 오염관리에 대해서 대부분 병원에서 철저하게 수행하고 있는 것으로 나타났다. 결론 : 항목별 자료 수집내용을 충분히 검토하여 현실성 있는 설문조사를 통해 구체적인 표준안이 제시되었어야 하나 그러지 못한 부족함이 많다. 그럼에도 불구하고 본 조사에 대해 임상의 활용도 가치를 응답자 중 70.9%로 비교적 높이 평가해 주심에 감사를 표한다. 향후 본 자료를 토대로 각 항목별 세부사항에 대한 조사와 연구가 필요할 것으로 본다.

• 핵의학기술
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• 제12권1호
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• pp.3-12
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• 2008

목적: 방사성옥소 치료시 환자의 배설물(침, 소변)을 통해 표면 오염된 환의 및 침구류를 방사선 측정기로 측정하여 방사성 폐기물의 적정보관기간을 산출하고자 하였다. 대상 및 방법: 2005년도 8월부터 2006년 2월까지 방사성옥소 치료를 받은 환자 70명(남자: 12명, 여자: 58명)이 사용한 환의 및 침구류를 대조군(60 case)과 비대조군(10 case)으로 나누어 측정하였다. 결과: 세탁하지 않고 자체보관한 대조군과 세탁 후 자체 보관한 비대조군의 적정보관기간은 대조군 $44{\pm}16$일, 비대조군 $32{\pm}13$일으로 대조군과 비대조군의 보관기간에 있어서 유의미한 차이가 있는 것으로 나타났다(p<0.001). 환의 및 침구류에 대한 세탁전후의 표면오염도 제염효과는 평균 $83.66{\pm}15.15%$로 나타났으며, 오염 확산여부를 측정하기 위해 실시 된 결과에서 최초 표면오염 되지 않았던 환의에 미치는 영향은 미비하였다(p<0.05). 그러나 세탁과정 중에 발생된 세탁폐액에 대한 오염도는 최초 표면오염의 정도에 따라 허용표면 오염도 수준을 벗어난 것도 있었다. 결론: 표면 오염된 환의 및 침구류 전체를 방사선 측정기로 측정한 후 표면오염도의 정도에 따라 분류하고 적정 보관 기간이후 관리구역 밖으로 불출하는 것이 유용할 것이다.