Article Figures & Data
Figures
- FIGURE 1.
Case 1 CT scan. Axial CT demonstrates lobulated and heterogeneous 3.4 × 2.9 × 3.3 cm mass in right thyroid and extending into right superior paratracheal space. Abnormal right cervical and bilateral paratracheal lymph nodes and nonspecific 2-mm nodule in left lower lobe of lung were also seen. Findings were suggestive of thyroid cancer with cervical nodal metastases.
- FIGURE 2.
Case 1 posttherapy scan. (A) Whole-body scan obtained after administration of 2,775 MBq (75 mCi) of 131I. (B) SPECT imaging of neck. These images are consistent with residual thyroid tissue, as focal tracer uptake was noted within thyroid resection bed.
- FIGURE 3.
Case 2 post-RAI therapy scan with intravenous administration of 131I. (A) Whole-body scan obtained after administration of 1,850 MBq (50 mCi) of 131I. (B and C) SPECT/CT imaging of neck obtained in axial and coronal planes, respectively, showing focal tracer uptake in thyroid bed, consistent with residual thyroid tissue. No distant metastases were observed.
- FIGURE 4.
Workflow for management of patients with end-stage renal disease (ESRD) who are on dialysis and referred for RAI.
- FIGURE 5.
Case 3 posttherapy scan. (A) Whole-body post-131I scan. (B–D) Axial SPECT/CT of the lower neck and mid neck, and coronal SPECT/CT of the neck and chest. These images show no evidence of distant metastatic disease. However, they did find 3 discrete regions of tracer activity within neck, consistent with iodine-avid tissue, likely residual thyroid tissue after thyroidectomy.
Tables
Study Summary Similarities to case 1 Differences from case 1 Rini et al. ( 12 ) Capsular 131I tracers exposed patients to higher-than-intended amounts of radiation, compared with liquid 131I tracers Not applicable Inclusion criterion: Graves disease; radiation uptake compared Al Aamri et al. ( 9 ) Several capsule-related mishaps were cited (i.e., acrylic-glass tube adherence, swallowing difficulty, radiation exposure) Pill dysphagia Radioactive mishandling and misuse described Honour et al. ( 15 ) Case series of 144 RAI patients documented minimal fluid intake for speedy recovery Not applicable High-dose solid 131I therapy Shields and Johnson ( 11 ) Novel presentation was made of capsular 131I administration via endoscopic stomach implantation Successful pill dysphagia workaround Endoscopy required; capsule 131I administered Study Summary Similarities to case 3 Differences from case 3 Vermandel et al. ( 25 ) Six ESRD patients were administered reduced RAI formulas to treat thyroid cancer; bone marrow toxicity was analyzed to define optimal dosimetry ESRD; successful removal of 131I remnants Dosimetry used to minimize toxicity Magné et al. ( 21 ) Hemodialysis was safe and effective during oral 131I RAI treatment of differentiated thyroid carcinoma ESRD; metastases; successful excretion Papillary thyroid carcinoma; metastases in 9 of 16 cervical nodes Shields et al. ( 11 ) Safe hemodialysis techniques and protocol were shared for minimizing radiation risks and maintaining RAI treatment ESRD; successful excretion; patient interaction minimized Not applicable Bhat et al. ( 17 ) Radioactive ablation in ESRD patient after complete thyroidectomy remained successful 4 y later ESRD; history of hypertension, diagnostic prescan with 123I Goiter; presented with shortness of breath after left thyroidectomy ESRD = end-stage renal disease.
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