Col. Trirat Boonya-ussadorn
Transcript of Col. Trirat Boonya-ussadorn
![Page 1: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/1.jpg)
Col. Trirat Boonya-ussadorn
![Page 2: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/2.jpg)
1. Thyroid study in Nuclear Medicine
(cont.)
Thyroid uptake
Thyroid scan: for thyroid nodule (99mTc-
pertechnetate), CA thyroid (I-131)
2. NM radionuclide therapy
I-131 in Hyperthyroidism
I-131 in thyroid cancer
Treatment of bone pain in bony metastasis
![Page 3: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/3.jpg)
I-131 uptake : 2 hrs and 24 hrs.
Normal at 24 hrs = 15-30% (variable)
Grave’s disease 60-80%
Toxic multinodular 50-60%
![Page 4: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/4.jpg)
Drug effect on thyroid uptake
Thyroid hormone
Antithyroid drug: PTU, MMI
Vitamin
Cordarone
Contrast media
Food effect on thyroid uptake
Sea food
Iodinated salt
![Page 5: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/5.jpg)
Discontinue ATD and foods effect on thyroid uptake 1 wk.
NPO
Oral administration of tracer dose of I-131 10 uCi
I-131 uptake 2 hrs and 24 hrs.
![Page 6: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/6.jpg)
Differentiated low and high uptake of
thyrotoxicosis
Using for calculation of administrated
dose of RAI for treating hyperthyroidism
Confirmation of hyperthyroidism: DDx
hyperthyrodism vs thyroiditis
![Page 7: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/7.jpg)
1. Thyroid study in Nuclear Medicine
(cont.)
Thyroid uptake
Thyroid scan: for thyroid nodule (99mTc-
pertechnetate), CA thyroid (I-131)
2. NM radionuclide therapy
I-131 in Hyperthyroidism
I-131 in thyroid cancer
Treatment of bone pain in bony metastasis
![Page 8: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/8.jpg)
Radiopharmaceuticals 99mTc-pertechnetate
I-131
I-123
Indications Thyroid nodules
Ectopic thyroid
Thyroiditis
Graves’ disease
Multinodular toxic goiter (Plummer’s disease)
Solitary hyperfunctioning adenoma (toxic adenoma)
Thyroid cancer
![Page 9: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/9.jpg)
2 ways for performing thyroid scan
Tc-99m Pertechnetate ( IV injection )
dose 3-5 mCi: 140 keV, half life 6 hrs
I-131 (oral): 364 keV, half life 8 days
![Page 10: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/10.jpg)
Tc-99m pertechnetate
![Page 11: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/11.jpg)
Total body scan (TBS) or Whole body scan (WBS) with I-131
ใชใ้นการตรวจและติดตามผลการรกัษาผูป่้วยที่รกัษาดว้ยไอโอดนีรงัส ี(I-131)
ซ่ึงอาศยัรงัสเีบตามา Irradiate เซลลข์องตอ่มไทรอยดท์ี่ เป็นมะเร็งใหห้มดไป การท าสแกนแบบน้ีจะสามารถบอกไดว้า่ยงัมเีซลลม์ะเร็งของตอ่มไทรอยด์
หลงเหลืออยูห่รือไม ่ถา้มกีารแพร่กระจายไปที่ อ่ืนจะเหน็ไดจ้ากภาพสแกนจะไดท้ า
การรกัษาซ า้จนไมม่เีซลลข์องตอ่มไทรอยดเ์หลืออยู ่
![Page 12: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/12.jpg)
off Levothyroxine (Eltroxin, Euthyrox) 1 mo
low iodine diet 1 wk
NPO
Administration of tracer dose
1-5 mCi
Waiting for 48 – 72 hrs
Scan the whole body
![Page 13: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/13.jpg)
![Page 14: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/14.jpg)
![Page 15: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/15.jpg)
1. Thyroid study in Nuclear Medicine
(cont.)
Thyroid uptake
Thyroid scan: for thyroid nodule (99mTc-
pertechnetate), CA thyroid (I-131)
2. NM radionuclide therapy
I-131 in Hyperthyroidism
I-131 in thyroid cancer
Treatment of bone pain in bony metastasis
![Page 16: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/16.jpg)
![Page 17: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/17.jpg)
Hyperthyroidism
Well-diff CA thyroid
Radiopharmaceutical
for specific tumor
Treating bone pain of
metastatic disease
I-131
I-131
I-131 MIBG
Sr-89
Sm-153 EDTMP
![Page 18: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/18.jpg)
Oral form : solution, capsule
I-131---- Xe-131+ gamma ray (γ) 364 keV +
beta ray (β) 192 keV
Half life = 8.06 days
Rx:
1. Hyperthyroidism : Graves’ disease, Toxic
multinodular goiter, Toxic adenoma
2. Well-differentiated thyroid CA: Papillary,
Follicular
![Page 19: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/19.jpg)
![Page 20: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/20.jpg)
Physiologic I-131 uptake :
1. Thyroid gland
2. Salivary glands
3. Gastric mucosa
Excreted via urine and can cross placenta
![Page 21: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/21.jpg)
1. Thyroid study in Nuclear Medicine
(cont.)
Thyroid uptake
Thyroid scan: for thyroid nodule (99mTc-
pertechnetate), CA thyroid (I-131)
2. NM radionuclide therapy
I-131 in Hyperthyroidism
I-131 in thyroid cancer
Treatment of bone pain in bony metastasis
![Page 22: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/22.jpg)
Thyrotoxicosis = increased TFT
Hyperthyroidism = Thyrotoxicosis from
hyperfunctioning thyroid
Diffuse toxic goiter (Graves’ disease)
Toxic multinodular goiter (Plummer disease)
Toxic adenoma
![Page 23: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/23.jpg)
Diffuse enlargement of thyroid gland
Exophthalmos
Pretibial myxedema
![Page 24: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/24.jpg)
เหน่ือยงา่ย ใจสั่น มือสั่น
กนิจุ หิวบอ่ย
น ้าหนักลด
ขี้รอ้น เหง่ือออกมาก
ทอ้งเสยี
ประจ าเดือนนอ้ย
infertility
AF
CHF
Periodic paralysis
( hypoK+ )
Exophthalmos
Eyelid retraction
Osteoporosis
![Page 25: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/25.jpg)
Indication of I-131***
1. Medication failure
> 2 yrs
High dose of ATD
Recurrence
Poor compliance
Drug allergy: agranulocytosis
2. Surgical failure
![Page 26: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/26.jpg)
Withdraw drug and food effected 1 wk.
NPO
Thyroid uptake 2 and 24 hours
Oral administration of I-131
F/U in the next 3 months
Admit in hospital is not necessary.
![Page 27: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/27.jpg)
FT3 or T3 : Hyperthyroid
FT4 : Hypothyroid, Eltroxin/ Euthyrox
(Levothyroxine, LT4)
TSH
![Page 28: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/28.jpg)
Full effect of RAI will occur within 3
months
Euthyroid
No remission
Hypothyroidism
![Page 29: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/29.jpg)
Nausea and vomiting (radiation sickness)
Transient hyperthyroidism or thyroid storm
Thyroiditis (neck swelling)
Induce malignancy ?
Induce teratogenic effect ?
Induce infertility ?
![Page 30: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/30.jpg)
***PREGNANCY*** LACTATION
![Page 31: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/31.jpg)
1. Thyroid study in Nuclear Medicine
(cont.)
Thyroid uptake
Thyroid scan: for thyroid nodule (99mTc-
pertechnetate), CA thyroid (I-131)
2. NM radionuclide therapy
I-131 in Hyperthyroidism
I-131 in thyroid cancer Treatment of bone pain in bony metastasis
![Page 32: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/32.jpg)
Well differentiated CA thyroid***
Poorly differentiated CA thyroid
Anaplastic CA
Medullary CA
![Page 33: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/33.jpg)
Papillary CA
Follicular CA
Metastatic disease from well diff CA
![Page 34: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/34.jpg)
Post–Op for 4-6 wks
+/- Dx Total body scan
(DxTBS with I-131)
![Page 35: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/35.jpg)
Calculated dose of RAI
Oral administration of RAI
![Page 36: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/36.jpg)
Admit until radiation dose is decreased to
accepted level.
Post I-131 TBS before discharged
![Page 37: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/37.jpg)
Home med : Thyroid hormone (Eltroxin, Euthyrox,
Levothyroxine/LT4)
F/U: stimulated Tg +/- TBS with I-131 in 6 months
![Page 38: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/38.jpg)
Preparation for TBS
Induce hypothyroidism
***TSH stimulation***
by discontinuing thyroid hormone 4-6 weeks.
Avoid high iodine diet and drug 1 wk.
![Page 39: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/39.jpg)
Serum thyroid hormone (FT4)
TSH
Thyroglobulin (Tg)
Antithyroglobulin (TgAb)
![Page 40: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/40.jpg)
TBS shows negative result
Continue thyroid hormone
TBS shows residual tumor or thyroid tissue
Repeat dose of RAI treatment
![Page 41: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/41.jpg)
TBS post I-131 treatment 100-200 mCi
![Page 42: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/42.jpg)
Diagnosis TBS with I-131 1-3 mCi
![Page 43: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/43.jpg)
RAI for treatment of CA thyroid usually is high dose ,100 – 200 mCi
Neck swelling
Sialadinitis
Nausea, vomiting, radiation sickness
Hemorrhage (CNS, spinal)
![Page 44: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/44.jpg)
LATE EFFECT
Hypothyroidism
Lung fibrosis
Induce malignancy ?
Induce teratogenic effect ?
Induce infertility ?
![Page 45: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/45.jpg)
1. Thyroid study in Nuclear Medicine
(cont.)
Thyroid uptake
Thyroid scan: for thyroid nodule (99mTc-
pertechnetate), CA thyroid (I-131)
2. NM radionuclide therapy
I-131 in Hyperthyroidism
I-131 in thyroid cancer
Treatment of bone pain in bony metastasis
![Page 46: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/46.jpg)
Sr-89
Pure beta ray
Can be used as OPD case
Effective treatment in bone pain due to
bone metastasis from CA prostate, breast
cancer
No serious side effect
![Page 47: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/47.jpg)
Sm-153 EDTMP
Emit both gamma and beta ray
Preparation : Bone scan, blood chemistry
especially CBC .
Patient should be admitted at lease 4 hrs
After treatment for 24-72 hrs, the patient
should be performed scan
![Page 48: Col. Trirat Boonya-ussadorn](https://reader031.fdocuments.us/reader031/viewer/2022021919/620fde1a4f07bf6fe50bf0cd/html5/thumbnails/48.jpg)