Friday, December 31, 2004
His Thyroid Cancer didn’t take up Radioiodine. Was this a true test, or hidden contamination by unknown iodine intake?
washings for cancer marker,thyroglobulin were positive.
The whole body scan with the TSH > 110 was negative although there was an obvious cancer mass present. I put the patients on low iodine diet, but do not routinely get
24 hour urine iodine to look for unknown sources of iodine contamination. The failure to take up iodine is not a good sign, therefore, I needed to be sure this was true.After his surgery, to remove the mass and strip the nodes, I have set up a protocol to insure there was no iodine contamination. He denied any iodine contrast before the first body scan, and claimed to be strictly on the L.I.D.
The patient will be withdrawn from LT4 and then withdrawn from LT3. 2 weeks of L.I.D will follow. A 24 hour urine for iodine and creatnine will be done. Lithium, a drug known to block release of iodine from the thyroid, will be given for 5 days to “hold” the iodine in any remaining thyroid cancer, or normal thyroid tissue. One last try at getting uptake will be with 100-150 Millicuries I/131. A body scan at day 7 post therapy will tell us if he truly has a thyroid cancer that does not allow us the ability to use radioiodine in his future care. The loss of the ability to take up radioiodine is a sign of a more aggressive tumor. Alternative methods to follow patients, will have to include, in addition to ultrasound, thyroglobulin, MR, and CT, a P.E.T. scan. However positive areas on P.E.T. can not be treated at the present time, unless they can be found on CT, and then surgically removed.
Happy New Year,
Thursday, December 30, 2004
From 1992-1997 they were examined, had ultrasounds, and a needle biopsy if indicated.
Ionizing radiation does cause thyroid cancer, but low level exposure through ingestion of milk containing I/131 was not associated with increase cancer risk in this study.
I have several thyroid patients from the Hadford area, and they were glad to hear that their thyroid problem was not due to secret nuclear testing by the USA at Hanford.
Happy New Year
Ref: Scott Davis et al, JAMA 2004;292:2600-2613
Tuesday, December 28, 2004
In the last 10 years there has been a reduction in the number of countries with a public health problem due to Iodine deficiency ( 110 countries in 1993 had a problem ). In 2003 only 54 countries had a continuing health problem. Iodine deficiency is a significant cause of mental developmental problems in children. The plan of universal salt iodization, has been successful, but more needs to be done. Soil iodine deficiency, leads to low levels in food, and results in the thyroid gland failing to make enough thyroid hormone. The result is a series of functional, and developmental problems called Iodine Deficiency Disorders. Cretinism is the most extreme problem. However, the subtle disorders leading to poor school performance, reduced intellectual ability, and impaired work capacity, are the main reason for the universal iodization program. The USA is sufficient in iodine, except in young women during pregnancy.Some need iodine added to their vitamins during pregnancy.
29 countries have excess iodine intake. Excess iodine can be a problem for patients with thyroid diseases such as Hashimoto’s thyroiditis. Iodine induced thyroid disorders, can cause hypothyroidism, hyperthyroidism, nodules, and goiter. People with goiters from iodine insuficient areas of the world, can develop toxic hyperthyroid goiter years after entering the US, caused by the increase in iodine intake in our country.
40 Y/O female, was noted to have suppressed TSH ( <0.01 ), during an infertility evaluation.
Asymptomatic. Has had a suppressed TSH for 2 years.
Father: Hyperthyroid on Antithyroid drugs
Mother: Hypothyroid on thyroid hormone.
Infertility for 2 1/2 years
Ultrasound: 1 cm mass is noted in her left lobe. Right normal normal.
Thyroid scan: Hot left lobe with suppressed right lobe.
A diagnosis of Autonomous hot nodule with subclinical hyperthyroidism was made.
Normal uptakes at 6/24 hours.
FT4,FT3, TPO, TSI all normal.
Because of her age, and her desire to get pregnant soon, she was offered surgery, instead of radioiodine.
Surgery :left lobectomy.
Pathology Papillary Thyroid cancer, with 1 node positive.
Post surgery Thyroglobulin 10.3 This is consistent with output from a single remnant right lobe.
Second surgery: Right lobectomy: Normal thyroid, but 1/3 nodes positive.
I have never seen a hot nodule produced by a papillary thyroid cancer.
Follicular cancers if they are > 4 cm may make one toxic with suppressed TSH.
I do not understand this case. I can only speculate that the cancer was near, but not
the exact area that produced increased iodine uptake.The patient has a normal TSH post lobe removal TSH 1.4. The cancer is being treated by thyroid hormone suppression, and follow up with ultrasound, and Thyroglobulin. If there is persistent TG in 3-6 months, Radioiodine will be used. She still wants to get pregnant ASAP.
Monday, December 27, 2004
Thursday, December 02, 2004
Sunday, November 28, 2004
Saturday, November 27, 2004
Wednesday, November 24, 2004
Tuesday, November 23, 2004
Thursday, November 18, 2004
Wednesday, November 17, 2004
Tuesday, November 16, 2004
Thursday, November 11, 2004
Wednesday, November 10, 2004
Thursday, November 04, 2004
Wednesday, November 03, 2004
The government was able to keep this story under wraps until the election was over. Now GW Bush will be able to replace him, and not JFKerry. Dr.G.