Right time to detect urine iodine during papillary thyroid carcinoma diagnosis and treatment:A case report

BACKGROUND This is the first documentation of a spontaneous and nonspecific chemical reaction of an iodinated contrast media with ammonium persulfate used in As3+-Ce4+catalytic spectrophotometry for urine iodine concentration(UIC)detection.CASE SUMMARY We herein report an incidental case who had a dual source computed tomography examination for papillary thyroid carcinoma diagnosis.Serial spot urine specimens were collected during her hospitalization and were measured by As3+-Ce4+catalytic spectrophotometry on a Beckman Coulter AU5800.The reacted solutions were“brownish”,and the results showed extremely high iodine concentrations despite serial dilutions.The patient claimed no dietary habit of iodized salt or iodine-containing medical history,which strongly pointed to iodinated contrast media(ICM)via intravenous injection.Even with 0.01%ICM,its interruption is still profound on the desired urine iodine reaction with ammonium persulfate,leading to inaccurate UIC and possibly inappropriate treatment.CONCLUSION The following laboratory suggestions should be considered:(1)As3+-Ce4+catalytic spectrophotometry is only suitable for UIC measurement after confirmed ICM renal clearance;(2)A mass spectrometry-based method can be applied as an alternative during the ICM clearance period;and(3)The UIC baseline can be confirmed after ICM injection by consecutive detection for at least 2 mo.

Comparison of Thyroglobulin and Thyroid Function in Pregnant Women between Counties with a Median Urinary Iodine Concentration of 100-149 μg/L and 150-249 μg/L

Objective This study explored whether thyroglobulin and thyroid disease prevalence rates were higher in pregnant Chinese women with a median urinary iodine concentration of 100-149μg/L,compared with those with a median urinary iodine concentration of 150-249μg/L maintained through sustainable universal salt iodization.Methods This was a cross-sectional study in which 812 healthy pregnant women were enrolled to collect samples of their household edible salt,urine,and blood during their routine antenatal care in the18 counties in Fujian Province,China.The levels of salt iodine concentration,urinary iodine concentration(UIC),free triiodothyronine(FT3),free thyroid hormone(FT4),thyroid-stimulating hormone(TSH),thyroglobulin(Tg),thyroid peroxidase antibody and thyroglobulin antibody were assessed during the routine antenatal care visits.Results The median UIC(m UIC)in pregnant women was 130.8μg/L(interquartile range=91.5-198.1μg/L)in the counties with an m UIC of 100-149μg/L(Group I),and 172.0μg/L(interquartile range=123.5-244.4μg/L)in the counties with an m UIC of 150-249μg/L(Group II).Goiter prevalence and thyroid nodule detection rates showed no difference between Group I and Group II(P>0.05).Except for FT4 values,the TSH,FT4,FT3,Tg and Tg values>40(μg/L)and the thyroid diseases prevalence rate(TDR)showed no significant differences between Group I and Group II(P>0.05),whether or not iodine supplementation measures were taken.Conclusion Compared with an m UIC of 150-249μg/L,not only there was no difference in thyroid morphology,but also the Tg value,rate of Tg values>40μg/L,and TDR were not higher in pregnant women in the counties with an m UIC of 100-149μg/L achieved through sustainable universal salt iodization in Fujian Province,China.

Relationship between Whole Body Iodine-131 Effective Half-Life and Estimated Glomerular Filtration Rate for Papillary Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy

Background: The aim of this work was to examine the relationship between the estimated glomerular filtration rate (eGFR) as indicator of renal efficiency potentially related to the ability to release radioactive iodine from the patients bodies and the radioactive iodine whole body effective half-life (WBEHL) defined as the time taken for the administered activity to decay to half of its value for papillary thyroid cancer (PTC) patients undergoing radioactive iodine therapy (RAIT) in a tertiary care medical Centre. Methods: This retrospective observational study included seventy nine patients, sixty females and nineteen males. The patients were divided in two subgroups, those who have WBEHL of less than 11 hours (n = 51) and those with more than 11 (n = 28) hrs based on k-means clustering technique. Results: Analysis of variance (ANOVA) was used to find out if there is a statistically significant difference between the two subgroups Conclusion: There was not a statistically significant difference between the short and the longer WBEHL patients’ groups analyzed in this study. .

New approaches for patients with advanced radioiodine-refractory thyroid cancer

The cumulative evidence over the past decades has shown that the incidence of differentiated thyroid carcinoma(DTC)has exponentially increased.Approximately 10%of patients with DTC exhibit recurrent or metastatic disease,and about two-thirds of the latter will be defined as refractory to radioactive iodine(RAIR)treatment.Since this condition implies 10-year survival rates less than 10% after detection,using available treatments,such as systemic and targeted therapies,have become increasingly relevant.The initiation of these treatments aims to reach stabilization,tumor volume reduction,and/or symptom improvement and it should be decided by highly specialized endocrinologists/oncologists on the basis of patient’s features.Considering that despite enlarged progression-free survival was proven,multikinase inhibitors remain non-curative,their benefits last for a limited time and the side effects potentially cause harm and quality of life reduction.In this context,molecular testing of cancer cells provides a promising spectrum of targeted therapies that offer increased compatibility with individual patient needs by improving efficacy,progression free survival,overall survival and adverse events profile.This review article aims to provide a summary of the current therapeutic strategies in advanced RAIR-DTC,including approved target therapies as well as those for off-label use,RAI resensitization agents,and immunotherapy.

Prevalence of Thyroid Nodules and Its Relationship with Iodine Status in Shanghai:a Population-based Study

Objective This study was designed to evaluate the prevalence of thyroid nodules（TNs） and its relationship with urine iodine concentrations（UICs） after the regional rapid economic growth and lifestyle changes. Methods A cross-sectional survey was conducted in the general population aged 15-69 years. A questionnaire regarding general and personal characteristics and relevant information was administered. Ultrasonography of the thyroid was performed, and serum triiodothyronine（T3）, tetraiodothyronine（T4）, serum thyroid stimulating hormone（TSH）, free triiodothyronine（FT3）, free tetraiodothyronine（FT4）, thyroglobulin antibody（Tg Ab）, thyroid peroxidase antibody（TPOAb）, and TSH receptor antibody（TRAb） levels were measured for each individual subject. Results The prevalence rates of TNs in the whole population, females and males were 27.76%, 34.04%, and 21.60%, respectively. The prevalence of multiple nodules increased with age, whereas the prevalence peaks differed between males and females. The median UICs in the whole population and females with non-TNs were higher than those of subjects with TNs（P=0.0035, P=0.0068）. The median UICs in subjects with a single TN were higher than those in subjects with multiple TNs（P=0.0164, P=0.0127）. The result showed a U-shaped curve relationship between UIC and prevalence of TNs. The prevalence of TNs was the lowest when the UIC was 140-400 μg/L. Conclusion The prevalence of TNs was nearly 30% and increased with age. The relationship between UIC and prevalence of TNs is U-shaped, with an increase in risk when the UIC was 〈140 μg/L and 〉400 μg/L. Very low or high UIC levels need attention and correction.

Serial stimulated thyroglobulin measurements are more specific for detecting distant metastatic differentiated thyroid cancer before radioiodine therapy

Objective: Preablative stimulated thyroglobulin (ps-Tg) has the potential to be used in identifying distant metastatic differentiated thyroid carcinoma (DM-DTC), but its single level can be affected by remnant thyroid tissue and thyrotropin (TSH). The objective of this retrospective study was to evaluate the value of serial ps-Tg measurements in identifying DM-DTC specifically. Methods: A total of 317 DTC patients with serial measurements of ps-Tg, TSH and anti-Tg antibody were divided into M1 (n=72) and M0 (n=245) according to the presence of distant metastasis (DM) or not. The initial psTg measurement, with a corresponding TSH exceeding 30 mu IU/mL, was marked as Tg1, and ps-Tg measured right before radioactive iodine (RAI) therapy was defined as Tg2, with a median interval of 8 days. Delta Tg denotes Tg2-Tg1, and Delta TSH denotes TSH2-TSH1. Tg1, Tg2, Delta Tg, and Delta Tg/Delta TSH were tested for efficacy in identifying DM-DTC using receiver operating characteristic (ROC) curve analysis, and further compared with chest computed tomography (CT) and posttreatment whole-body RAI scan (RxWBS). Results: Compared with single ps-Tg measurement (Tg1 or Tg2), both Delta Tg and Delta Tg/Delta TSH were more narrowly distributed around zero in the M0 group, which made their distribution in the M1 group more distinguished in a relatively dispersed way. Delta Tg/Delta TSH manifested a higher accuracy (88.64%) and specificity (90.20%) in identifying DM-DTC than Tg1 or Tg2 measurements, with a much higher specificity than chest CT (90.20% vs. 66.00%) and a much higher sensitivity than RxWBS (83.33% vs. 61.11%). Conclusions: Serial ps-Tg measurements even over as short an interval as 8 days hold incremental value in identifying DM-DTC. Delta Tg/Delta TSH is a specific early biochemical marker for DM-DTC.

Relationship between Iodine Content in Household Iodized Salt and Thyroid Volume Distribution in Children

Objective To assess the effect of different levels of salt iodine content on thyroid volume（ThV） distribution using data from the 1999, 2011, and 2014 Chinese national iodine deficiency disorder（IDD） surveys. Methods Probability proportion to size（PPS） sampling method was used to obtain a representative national sample of 34,547, 38,932, and 47,188 Chinese children aged 8-10 years in 1999, 2011, and 2014 Chinese national IDD surveys, respectively. The iodine content in household iodized salt and urinary iodine concentration were measured and thyroid ultrasound examination was performed. The data were analyzed by SAS software using histograms and box plots. The skewness and kurtosis were calculated for testing the normality of ThV. Results The median iodine content in household iodized salt dropped from 42.30 mg/kg in 1999 to 25.00 mg/kg in 2014. The median urinary iodine concentration of children aged 8-10 years decreased from 306.0 μg/L in 1999 to 197.9 μg/L in 2014. The median and interquartile range（IQR） of ThV in 1999, 2011, and 2014 surveys were 3.44 m L and 1.50 m L, 2.60 m L and 1.37 m L, 2.63 m L and 1.25 m L, respectively. The skewness and kurtosis of ThV distribution in 1999, 2011, and 2014 surveys were 1.34 and 5.84, 0.98 and 3.54, 1.27 and 5.49, respectively. Conclusion With reduced salt iodization levels, the median urinary iodine concentration and median ThV of children decreased significantly, and the symmetry of the ThV distribution improved.

Effects of High Fluoride and Low Iodine on Thyroid Function in Offspring Rats

Thirty-two Wistar rats were divided randomly into four groups of eight with six females and two males in each group. The rats were exposed to high fluoride drinking water （45 mg F-L^-1 from 100 mg NaF L-1）, low dietary iodine （0.0855 mg kg-1）, or both together in order to assess the effects of these three regimens on the thyroid function of the offspring rats. After the animal model was established, the offspring rats were bred and 10-, 20-, 30-, 60-, and 90-d-old rats were used for the experiment. The treatments for the offspring rats were the same as those of their parents. In comparison with control rats, the relative thyroid glands were changed by three regimens, but the mean values of thyroid weight in the experimental groups saw no marked difference. Serum TT3 levels were increased in all stages in the low iodine （LI） group. In the high fluoride （HiF） group, increase in TT3 levels was observed except in 20-d-old rats. Decrease in TT3 at 20- and 90-d and increase in TT3 at 30- and 60-d were found in HiF＋LI group. Serum TT4 levels first saw an increase, and then dropped in the LI and HiF＋LI group. However, an increase in TT4 was found in the HiF group. The levels of TSH in serum rocketed at d 20, and then dropped in the next stages in experimental groups. The results suggested that thyroid disorder could be induced by high flroride in drinking water, low iodine diet, or both of them. Exposure time to fluoride or low iodine diet was one of the important factors that fluoride can induce the development of thyroid dyfunction.

Strong Correlation of Abnormal Serum and Urinary Iodine Levels with Papillary Thyroid Cancer:A Case-control Study

Thyroid cancer is the most common malignancy of the endocrine system,and its incidence is increasing worldwide.In China,its incidence has increased from 1.78/104 in 1988 to 10.58/104 in2013.Thyroid cancers are mainly classified into papillary thyroid cancer(PTC),follicular thyroid cancer(FTC),medullary thyroid cancer(MTC).

Change of Iodine Load and Thyroid Homeostasis Induced by Ammonium Perchlorate in Rats

Ammonium perchlorate （AP）, mainly used as solid propellants, was reported to interfere with homeostasis via competitive inhibition of iodide uptake. However, detailed mechanisms remain to be elucidated. In this study, AP was administered at 0, 130, 260 and 520 mg/kg every day to 24 male SD rats for 13 weeks. The concentrations of iodine in urine, serum thyroid hormones levels, to- tal iodine, relative iodine and total protein, and malondialdehyde （MDA）, superoxide dismutase （SOD） and catalase （CAT） activity in thyroid tissues were measured, respectively. Our results showed that high-dose perchlorate induced a significant increase in urinary iodine and serum thyroid stimu- lating hormone （TSH）, with a decrease of total iodine and relative iodine content. Meanwhile, free thyroxine （FT4） was decreased and CAT activity was remarkably increased. Particularly, the CAT activity was increased in a dose-dependent manner. These results suggested that CAT might be en- hanced to promote the synthesis of iodine, resulting in elevated urinary iodine level. Furthermore, these findings suggested that iodine in the urine and CAT activity in the thyroid might be used as biomarkers for exposure to AP, associated with thyroid hormone indicators such as TSH. FT4.

Zinc influences on brain development, pituitary and thyroid function in iodine-deficient pregnant and neonatal rats

BACKGROUND： Zinc （Zn） has been shown to greatly influence brain development. Zn supplements may reduce injury to cell membranes of the thyroid gland due to iodine deficiency. OBJECTIVE： To establish an iodine deficiency rat model using low-iodine food, which was supplemented with compound Zn and Zn gluconate, to observe the effects of Zn on brain development, as well as pituitary gland and thyroid gland function in iodine-deficient rats. DESIGN, TIME AND SETTING： Randomized grouping study of neural development was performed in the central laboratory of Shandong Institute for Prevention and Treatment of Endemic Disease from 1998 to 1999. MATERIALS： A total of 270 Wistar, female rats, one month after weaning, were used in this study, including 150 pregnant and 120 neonatal rats. Rats were randomly divided into six groups： normal control, model, iodine, compound Zn, iodine and compound Zn, and zinc gluconate. Each group contained 25 pregnant rats and 20 neonatal rats. METHODS： The pregnant rats and 20 neonatal rats, and well as the normal group, were fed standard chow and allowed free access to tap water （containing 5 u g/L iodine and 1 mg/L Zn）. The remaining five groups were fed low-iodine chow. However, the model group received distilled water, the iodine group received potassium-iodide distilled water （containing 300 u g/L iodine）, the compound Zn group received distilled water and intragastrically administrated 10 mL/kg compound Zn solution, once per day, the iodine and compound Zn group received distilled water with 300 u g/L iodine and intragastrically administrated 10 mL/kg compound Zn solution, once per day. All treatments lasted 90 days. MAIN OUTCOME MEASURES： All pregnant rats were sacrificed on the day 21 of pregnancy. Body mass number and rate of fetal absorption, as well as fetal death and malformation, were determined. Thyroid and pituitary gland weights were measured, as well as serum levels of thyroid hormone, gonadotropin, and sex hormones. In the experimental study of neonatal rats, the animals normally gave birth at day 21. At day 45 after birth of the neonatal rats, thyroid and pituitary gland weights were measured, and protein, DNA, and RNA concentrations were measured. RESULTS： Pregnant rats in the iodine group exhibited decreased urine iodine and body mass （F = 7.37, P 〈 0.01 ）, increased thyroid absolute and relative weight （F= 7.01, 50.27, P 〈 0.01）, as well as decreased T4 and FF4 （F = 7.01, 29.32, P 〈 0.01 ） and increased T3 and VI＇3 （F = 41.20, 5.94, P 〈 0.01）. Gonadotropic and sexual hormones were abnormal. The pregnant rats displayed decreased weight gain, and the rates of malformation, dead, and absorbed fetuses were increased. Compared with the control group, the neonatal rats with iodine deficiency exhibited lower brain weights （P 〈 0.01 ）. Brain protein, DNA, and RNA, concentrations were decreased, with a rate of RNA/DNA （F = 5.70, 55.86, 25.65, 5.44, P 〈 0.01）. Body mass was gradually increased （F= 6.74, P 〈 0.01）, and the thyroid glands were enlarged （F= 50.01, 76.13, P 〈 0.01）. Following Zn administration, thyroid gland weight was decreased in pregnant rats （P 〈 0.01 ）. Thyroid hormone, gonadotropic hormones, and sexual hormones were restored to some degree. Fetal weight was increased, and the rates of malformation, dead, and absorbed fetuses were decreased. At the same time, neonatal rats gained body weight, displayed decreased thyroid gland weight, as well as increased protein, DNA, and RNA concentrations in the brain. The ratio of RNA/DNA and protein/DNA increased following Zn administration （P 〈 0.01 ）. CONCLUSION： Zn supplementation may decrease the degree of goiter, ameliorate thyroid hormone disorder, as well as gonadotropic and sexual hormone disorders, and increase protein, DNA, and RNA content. Zn supplementation antagonized reproductive abnormalities in pregnant rats, decreased fetal growth,and disturbed brain development in neonatal rats as a result of iodine deficiency.

Differentiated Thyroid Cancer with Thyroglobulin Elevation and Negative Iodine Scintigraphy (TENIS Syndrome)

Background and Objectives: Following the initial management, some patients with differentiated thyroid cancer (DTC) develop a state of high thyroglobulin (Tg) and Negative Iodine Scintigraphy. The predisposing factors and outcome of this condition are unclear. In this study, our objectives were to analyze the characteristics of patients with high Tg level and negative Iodine scintigraphy and to determine the predictive factors for development of high Tg and negative scintigraphy. Patients and Methods: Retrospective study of 34 patients undergoing treatment for DTC, followed in the Nuclear Medicine department of the University Hospital—Sahloul Sousse between 1990 and 2006 and having a high Tg and negative Iodine scintigraphy. Fourteen patients had Tg between 2 and 10 ng/ml, 16 had Tg between 11 and 100 ng/ml and 4 patients had Tg more than 100 ng/ml. Results: There were 25 women and 9 men. The mean age was 51.65 years. In 94.1% of cases, the tumor was papillary carcinoma. Follicular tumors accounted for only 5.9%. The mean nodule size was3.26 cm. Capsular invasion was seen in 47.1% cases. The locoregional invasion was found in 35.3%. The lymph node extension was found in 84.8% of patients having lymph node surgery. Lymph node involvement was observed in 92.8% of patients with papillary cancer but it was found in 7.2% of patients with follicular cancers. Lymph node invasion was unilateral in 28.6% (N1a) and bilateral, contralateral or mediastinal in 71.4% (N1b). Initial level of Tg was as follows: 7 patients had Tg between 2 and 10 ng/ml, 14 patients had Tg between 11 and 100 ng/ml and 12 had Tg more than 100 ng/ml. The mean number of radioactive Iodine cure was 11.08 for patients with Tg more than 100 ng/ml with a significant difference (P = 0.001). Conclusion: Among epidemiological, pathological and clinical characteristics, lymph node invasion is the most frequent parameter found in patients with a DTC with high Tg level and negative Iodine scintigraphy.

Study on the relationship of iodine nutritional status with thyroid function and autoantibodies in pregnant women in Baotou

Objective:To investigate the relationship of iodine nutritional status with thyroid function in pregnant women in Baotou,and provide a scientific basis for the guide of reasonable iodine supplementation.Methods:By use of As-Ce catalysis spectrophotometry,the urinary iodine concentration was determined in 90 women during different periods of pregnancy admitted to Baogang Hospital of Inner Mongolia from January 2017 to December 2017.The determination of thyroid function and the autoantibody level was carried out by electro-chemiluminescence immunoassay(ECLIA).Results:In the early trimester of pregnancy,pregnant women with iodine deficiency,iodine sufficiency and iodine excess accounted for 36.67%,40.00%and 23.33%respectively;in the middle trimester of pregnancy,they accounted for 66.67%,26.67%and 6.66%respectively;they made up 40.00%,40.00%and 20.00%respectively in the late trimester of pregnancy.The rate of iodine deficiency in women in the middle trimester of pregnancy was significantly higher than that in women in the early and the late trimesters of pregnancy respectively,and the difference was statistically significant(p<0.05).The rate of iodine deficiency in pregnant women was positively correlated to the positivity of thyroid peroxidase antibody.Moreover,it had no relationship with the positivity of thyroglobulin antibody.No matter in the pregnant women with iodine deficiency or with iodine excess,the abnormality rate of thyroid function and autoantibodies was significantly higher than that in the pregnant women with iodine sufficiency.The difference was statistically significant(p<0.05).Conclusions:The iodine deficiency in the women in the middle trimester of pregnancy is more severe than that in the women in the early and the late trimesters of pregnancy.Iodine deficiency during pregnancy is positively correlated with the positivity of thyroid peroxidase antibody.Pregnant women with iodine deficiency and iodine excess show a higher abnormality rate of thyroid function and autoantibodies.It is recommended to advocate health education on iodine nutrition to pregnant women,and conduct the dynamic monitoring of urinary iodine concentration and the screening of thyroid function and autoantibodies during pregnancy.

Studies on the Free Radicals and Thyroid Hormone Metabolism in Cattle with Iodine and Selenium Deficicncy

In order to interpret pathologic mechanism of free radicals and thyroid hormone metabolism in cattle iodine and selenium deficiency, 20 heads of yellow cattle were selected from NiuJia town, Wu Chang City, Heilongjiang Province, China, and were randomly devided into 4 groups with 5 for each. ① supplemented with 0.7 mg·kg -1 iodine(potassium iodine), ② supplemented with 0.2 mg·kg -1 selenium (sodium selenite), ③ supplemented with 0.7 mg·kg -1 iodine(potassium Iodine) plus 0.2 mg·kg -1 selenium (sodium selenite) per day for 30 days, respectively. ④control group. The whole blood glutathione peroxidase (GSH-px) and catalase (CAT) activities, free radicals (FR) concentration, erythrocyte superoxide dismutase (SOD) activity and molonaldehyde (MDA) concentration, the serum triiodothyronine (T 3)、thyroxine (T 4) and thyrotropin (TSH) were determined on the day of supplementation day-0 and day-30, respectively. It was showed that average iodine concentration in drinking water and diet were 3.82 μg·L -1 and 0.285mg·kg -1 , respectively, Diet selenium was 0.0498mg·kg -1 , Serum protein bound iodine(PBI) was 7.02 μg·100 mL, Blood selenium was 0.14 mg·L -1 , the schoolchildren′s goiter was 21.8%. It indicated that iodine and selenium were deficient in the investigated area. Whole blood GSH-px and CAT activities and serum T 3 concentration were significantly higher (P< 0.01 ), FR concentration and serum TSH were significantly lower(P<0.01) in the first three groups than that of the control, T 4 content in the first group was higher(P<0.05), T 4 was also higher (P>0.05) in the second group. and lower in the third group. The SOD and MDA in erythrocyte were not changed during the experimental period, The results also showed that GSH-px and CAT activities were increased, and FR decreased oberviously in the third group more than the other two groups, In addition, Thyroid hormone metabolism was more coincided with the physiologic status in the third group. the iodine and the selenium played an important role in the pathologic process of free radical metabolic disorder. selenium not only had the function of antioxidation by derectly scavenging free radicals, but also affected through GSH-px and CAT activities. iodine deficiency results in the Goiter, selenium deficiency aggravated iodine deficiency, Iodine and the selenium were dependent and restrained each other in the course of free radicals and thyroid hormone metabolism with a synergistic state.

Review on Thyroid Disorders,Epidemiology and Treatment Methods

Thyroid disorders are commonly overwhelming health conditions reported worldwide.The prevalence of thyroid disorders such as hypothyroidism and hyperthyroidism is increasing in developed and developing countries,including India.This is due to change in traditional foods to Besides low/insufficient iodine intake,smoking,ageing,genetic susceptibility,lifestyle,usage of new medicine,endocrine disrupting chemicals and immune status of an individual are the key determinants for thyroid disorders.This review emphasizes the various disorders of the thyroid gland and,its epidemiology and treatment methods.

Diagnostic Value of Dual-Energy CT in Differentiating Malignant and Benign Thyroid Nodules: A Systematic Review and Meta-Analysis

Objectives: To evaluate the diagnostic performance of the quantitative iodine parameters, including Iodine Concentration (IC), Normalized Iodine Concentration (NIC), and λHU, in distinguishing malignant and benign thyroid nodules. Methods: Relevant studies were searched from Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure database and other complementary sources from inception to May 20, 2020. Study selection, data extraction, quality assessment, and data analyses were performed following the Cochrane standards and the PRISMA-DTA guideline. Results: Eight studies were included (595 patients with 737 thyroid nodules). The pooled sensitivity, specificity and summary diagnostic odds ratio of IC were 79% (95% CI: 69% - 86%), 76% (95% CI: 65% - 84%) and 11 (95% CI: 5 - 27) respectively;those of NIC were 78% (95% CI: 70% - 85%), 80% (95% CI: 74% - 85%) and 15 (95% CI: 9 - 24) respectively;those of λHU were 80% (95% CI: 71% - 87%), 77% (95% CI: 70% - 83%) and 14 (95% CI: 8 - 24) respectively. Conclusion: DECT can be a potential evaluation tool for thyroid nodules. The NIC may be the most sensitive iodine parameter and could be comparable between different DECT machines in thyroid nodule assessment.

Analysis of the incidence and influencing factors of hyponatremia before ^(131)I treatment of differentiated thyroid carcinoma

BACKGROUND Hyponatremia is a common clinical electrolyte disorder.However,the association between hyponatremia and acute hypothyroidism is unclear.Acute hypothyroidism is usually seen in patients who undergo preparation for radioactive iodine therapy.AIM To analyze the incidence and influencing factors of hyponatremia in a condition of iatrogenic acute hypothyroidism in patients with differentiated thyroid cancer(DTC)before ^(131)I treatment.METHODS The study group consisted of 903 DTC patients who received ^(131)I treatment.The clinical data before and after surgery,as well as on the day of ^(131)I treatment were analyzed.According to the blood sodium level before ^(131)I treatment,patients were divided into the non-hyponatremia group and hyponatremia group.Correlations between serum sodium levels before ^(131)I treatment and baseline data were analyzed.Univariate analysis and binary logistic regression were performed to identify the influencing factors of hyponatremia.RESULTS A total of 903 patients with DTC,including 283(31.3%)males and 620(68.7%)females,with an average age of 43.8±12.7 years,were included in this study.The serum sodium levels before surgery and ^(131)I treatment were 141.3±2.3 and 140.5±2.1 mmol/L,respectively(P=0.001).However,the serum sodium levels in males and females before ^(131)I treatment were lower than those before surgery.Patients aged more than 60 years and less than 60 years also showed decreased serum sodium levels before ^(131)I treatment.In addition,the estimated glomerular filtration rate(eGFR)in males and females decreased before ^(131)I treatment compared with those before surgery(P=0.001).Moreover,eGFR in patients over 60 years and under 60 years decreased before ^(131)I treatment,when compared with that before surgery.There were no significant differences in serum potassium,calcium,albumin,hemoglobin,and blood glucose in patients before surgery and ^(131)I treatment(P>0.05).Among the 903 patients,23(2.5%)were diagnosed with hyponatremia before ^(131)I treatment,including 21 cases(91.3%)of mild hyponatremia and 2 cases(8.7%)of moderate hyponatremia.Clinical data showed that patients with mild hyponatremia had no specific clinical manifestations,while moderate hyponatremia cases were mainly characterized by fatigue and dizziness,which were similar to neurological symptoms caused by hypothyroidism and were difficult to distinguish.Correlation analysis showed a correlation between serum sodium before ^(131)I treatment and the preoperative level(r=0.395,P=0.001).There was no significant correlation between blood sodium and thyroid-stimulating hormone(TSH)levels and urine iodine before ^(131)I treatment(r=0.045,P=0.174;r=0.013,P=0.697).Univariate analysis showed that there were significant differences in age,sex,history of diuretic use,distant metastasis,preoperative blood sodium,blood urea nitrogen(BUN),eGFR,TSH and urinary iodine between the two groups(all P<0.05).Logistic regression analysis showed that factors such as history of diuretic use,distant metastases,preoperative sodium and BUN were all influencing factors of hyponatremia.The Hosmer and Lemeshow test(c2=2.841,P=0.944)suggested a high fit of the model.Omnibus tests of model coefficients indicated the overall significance of the model in this fitted model(P<0.05).Preoperative serum sodium was a significant factor associated with pre-^(131)I therapy hyponatremia(OR=0.763;95%CI:0.627-0.928;P=0.007).CONCLUSION The incidence of hyponatremia induced by ^(131)I treatment preparation was not high.Preparation for radioactive iodine therapy was not a risk factor for the development of hyponatremia in thyroid cancer patients.

Evaluation of Quality of Life Related to I-131 Therapy in Patients with Well-Differentiated Thyroid Cancer and Emphasis in Salivary Morbidity: A Follow up Study after Treatment

Goal: To evaluate the impact of iodine-131 therapy received during childhood and adolescence and correlate it with the quality of life in these patients. Methods: We studied 19 patients diagnosed with cancer in childhood or adolescence who underwent thyroidectomy and supplemental therapy with I-131. We also recruited a control group of healthy subjects with the same demographic parameters. All patients were subjected to a scintigraphy examination of the salivary glands, and were also asked to complete a questionnaire in order to assess their overall quality of life. In addition, a more specific questionnaire for patients with head and neck cancer was also given to all study participants. Results: The quantitative and qualitative analyses of the salivary glands showed functional deficits with greater involvement of the parotid gland for volume, concentration and excretion. The right submandibular gland showed significant changes for volume in the patient group. The questionnaires made it possible to observe significant differences between the patient and control groups for symptoms such as thick saliva, dry mouth and speech problems. Conclusion: In spite of being very effective and widely used, iodine radionuclide therapy is correlated with a lower quality of life in young people.

Rising Thyroid Cancer Incidence Proximate to a New York City-Area Nuclear Power Plant

Thyroid cancer incidence has risen steadily in the US for several decades. While any cause of this trend has yet to be clearly identified, most analyses have concluded that there are factors other than improved detection accounting for the increase. Since exposure to radioactive iodine is the only acknowledged root cause of thyroid cancer, a review of temporal trends in incidence since the late 1970s near the Indian Point nuclear power plant, just 23 miles from the New York City border, was conducted. Rates in the four counties closest to Indian Point, where virtually the entire population resides within 20 miles of the plant, were compared with national trends in the US. The relative ratio in the local area was 0.778 in the period 1976-1981, or 22.2 percent lower than the national rate. This ratio increased steadily, to 1.579 (57.9 percent greater than the US) by the period 2000-2004, which slightly declined to 1.515 (51.5 percent greater) in the latest period available (2010-2014). Significant increases occurred for both males and females, and in each of the four counties. Annual new cases diagnosed among residents of the four counties increased from 51 to 412 between 1976-1981 and 2010-2014. Because the two large reactors at Indian Point began operations in 1973 and 1976, and exposures to radioiodine isotopes can manifest as cancer from five years to several decades after exposure, iodine emissions from Indian Point emissions should be considered as a potential factor in these trends. More studies near Indian Point and other nuclear installations should be conducted to further explore this potential association.

Thyroid Dysfunction in Children Exposed to Iodinated Contrast Media:A Meta-Analysis and Systematic Review

Iodinated contrast media(ICM)has the potential to cause thyroid dysfunction in some patients.However,it is unclear whether this relationship exists in children.We conducted a systematic review and meta-analysis aim to obtain a general overview of the relationship between ICM exposure and the risk of thyroid dysfunction in children.Methods:Computer search of Web of Science,EMbase,PubMed,Cochrane Library,collection of relevant literature on ICM and thyroid dysfunction in children,the search period was from the establishment of the database to July 2021.Meta-analysis was performed using Stata 14.0 software.Results:A total of 8 literatures with 3497 children.The incidence of hypothyroidism in children with ICM exposure was 0.05(95%CI:0.05,0.12),P<0.0001.Subgroup analysis showed that the incidence of hypothyroidism in ICM exposed children in the European region was 0.21(95%CI:0.13,0.30),P<0.0001,a statistically significant difference.Conclusion:The current evidence shows that children exposed to ICM are at risk for hypothyroidism,with a higher risk in neonates,especially children with congenital heart disease.