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Radioactive Iodine Ablation In Young Adults With Differentiated Thyroid Carcinoma

Radioactive Iodine Ablation In Young Adults With Differentiated Thyroid Carcinoma
Jelani YT, Kartamihardja AHS
Universitas Padjadjaran, Poster Presentation 4th International Conference on Radiopharmaceutical Therapy New World Hotel, Ho Chi Minh City, Vietnam 28 Nov – 2 Dec 2011
Bahasa Inggris
Universitas Padjadjaran, Poster Presentation 4th International Conference on Radiopharmaceutical Therapy New World Hotel, Ho Chi Minh City, Vietnam 28 Nov – 2 Dec 2011
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Introduction. The prevalence of thyroid carcinoma in young adults is about 10% of thyroid malignancy cases. We reported our experience in using radioactive iodine (NaI-131) ablation for young adults with post-total thyroidectomy differentiated thyroid carcinoma. Material and Methods. A retrospective study was conducted in young adults subjects with differentiated thyroid carcinoma who has undergone post-total thyroidectomy and followed by radioiodine ablation therapy.Data was collected from 25 medical records in our department from 1998 to 2010. Histological and laboratory findings (serum TSHs, thyroglobulin/Tg and Anti-Thyroglobulin Antibody/ATA levels) were noted until at least six months after ablation. Only 15 patients were eligible.Complete response after ablation was defined if Tg serum level < 3 ng/ml, with TSHs serum level > 30 ìIU/ml and no detected ATA level; outside this level was defined as residual disease. Results. Of 15 subjects (12 females and 3 males, aged 13-21 years.), 9 subjects werepapillary thyroid carcinoma / PTC (60%) and 6 subjects werefollicular thyroid carcinoma / FTC(40%). Metastases were found in in 5subjects (33.3%) with locoregional lymphatic metastases, 3 subjects (20%)with pulmonary metastases, one subject(6.6%) with bone metastases and one subject(6.6%) with metastases in soft tissue. The first ablation I-131 dose was given between 80-100 mCi. Next I-131 were given after 6-12 months or more, if needed,by increasing the dose to 150 mCi. Three subjects (1 PTC, 2 FTC) hadcomplete response after first ablation, one subject (1 PTC) after second dose, and one subject (1 PTC) after third dose. Four of five subjectshad thyroglobulin serum level < 10 ng/dl. Eighteen months after radioiodine ablation, 10 subjects (66.6%) were categorized as residual cases with thyroglobulin serum level more than 10 ng/dl. There was no side effect observed in all subjects. Discussion. The mainstream management of differentiated thyroid carcinoma is total thyroidectomy, followed by radioactive iodine (I-131) ablation and suppressive doses of thyroid hormone.Complete response was found in 3 subjects after six months radioactive iodine ablation. Other studies used thyroglobulin serum level < 3 ng/dl as the criteria of good response to therapy. Based on this criteria, good response was found in four patients with thyrogobulin serum level < 3 ng/dl. Papillary thyroid carcinoma in young adult has a favorable prognosis. The favorable prognosis is associated with lymphocytic infiltration, as an anticancer reaction during the imunologic activity.Young adults usually have more advanced tumors, with local and distant metastases, higher recurrence rates. Children under 10 years of age have very high mortality rates. In conclusion. It seems that age, histopathology classification, and distant nodal metastases are important factors for non-responsiveness of well differentiated thyroid carcinoma in young adults to radiothyroablation therapy.

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