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The Risk of overlooking thyroid cancer in radioiodine treatment
of hyperthyreosis and goiter
Anders Vej-Hansen (1), Lars Thorbjørn Jensen (2),
Kaj Siersbæk-Nielsen (3) og Birte Nygaard (1)
1) Dep. of Endocrinology, Herlev Hospital, 2) Dep. of Clinical Fysiology, Glostrup Hospital, 3) Dep. of Endocrinology, Frederiksberg Hospital, Denmark
Introduction
• About 3,000 patients are treated with radioiodine in Denmark for thyroid diseases each year
• Alternative treatment is surgery but radioiodine is more gentle
• Evaluation strategy includes bloodsamples and a scintiscan
Previous studies
Study N - follow up Treatment No. cancers %/SMR/SIR
Ron et al1998Death c.thyr.Tox
35.593 – 21 years23.54010.8761.177
AllRadioiodineSurgeryMedicine
2925 (12/<4 years)40
0,08 % 2,8 (SMR)0,11 % 3,9 (SMR)0,04 % 1,1 (SMR)0 % 0 (SMR)
Dobyns et al 1974Develop c.thyr.Tox
34.684 – ? years21.71411.7321.238
AllRadioiodineSurgeryMedicine
86 (10 dead)28 (9/1. year)54 (18 mikr.c.)4
0,25 %0,19 %0,50 %0,30 %
Augusti et al2000Develop c.thyr.Tox
6.647 – 7 years Radioiodine 10 0,15%No difference from background population
Purpose
• To evaluate if the evaluation strategy is good enough to exclude thyroid cancer
Materials and methods
• We collected information about all patients treated with radioiodine in 3 centre hospitals in Copenhagen
• Information was compared with information on reported thyroid cancers in the national cancer register
Results I
N (%) Follow upYears, months
No. doses Total doses (MBq)
All 4,474 9.0 1.38 534
Toxic nodular 2,653 (59) 8.2 1.35 534
Toxic diffuse 732 (16) 9.10 1.34 448
Nontoxic nodular 718 (16) 9.2 1.53 646
Results II
No. cancers
Expected no. (backgr.pop.)
SIR(backgr.pop.)
P
All 8 0.88 9.1 < 0,05
Toxic nodular 6 0.47 12.8 < 0,05
Toxic diffuse 1 0.16 12.5 ns
Nontoxic nodular 1 0.14 7.1 ns
Description of the cancers
No. Goiter Age Time to Time to AgeSex -type RI cancer death death Patology
1 M Tox dif 61,2 -6,11- -0,5- 68,6 Anaplastic2 F Tox nod 82,8 -0,2- -0,2- 83,0 Unknown3 F Tox nod 80,7 -4,5- -3,5- 88,5 Folliculary 4 M Tox nod 73,9 -0,8- -0,2- 74,7 Anaplastic5 F Tox nod 77,7 -7,0- -4,10- 89,5 (alive) Papillifery6 F Tox nod 75,9 -2,8- -2,0- 80,5 Anaplastic7 M Atox nod 59,8 -4,5- -0,1- 64,2 Folliculary8 F Tox nod 53,9 -4,2- -1,8- 59,7 (alive) Papillifery
Discussion
• We have found more cancers than expected from the background population
• The cancer incidence is at the same level as earlier described in studies of patients with hyperthyreosis treated with medicine, surgery or radioiodine
Previous studies
Study N - follow up Treatment No. cancers %/SMR/SIR
Ron et al1998Death c.thyr.Tox
35.593 – 21years23.54010.8761.177
AllRadioiodineSurgeryMedicine
2925 (12/<4 year)40
0,08 % 2,8 (SMR)0,11 % 3,9 (SMR)0,04 % 1,1 (SMR)0 % 0 (SMR)
Dobyns et al 1974Develo. c.thyr.Tox
34.684 – ? years21.71411.7321.238
AllRadioiodineSurgeryMedicine
86 (10 death)28 (9/1. year)54 (18 mikr.c.)4
0,25 %0,19 %0,50 %0,30 %
Augusti et al2000Develo. c.thyr.Tox
6.647 – 7 years Radioiodine 10 0,15%No difference from backgroun population
Vej-Hansenet al 2006Develo. c.thyr.Tox+Atox
4.474 – 9 years Radioiodine 8 (2/1. year, 3/<4 years)
0,18 % 9,1 (SIR)
Conclusion
• In this study it seems that we don´t overlook cancer if we use scintiscan, and when it shows a cold nodule, we do a biopsy
• This is also the evaluation of patients with nontoxic goiter
Thank You!!!
Anders Vej-Hansen, Lars Thorbjørn Jensen, Kaj Siersbæk-Nielsen og Birte Nygaard
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