The risk of overlooking thyroid cancer in radioiodine treatment of hyperthyreosis and goiter
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The Risk of overlooking thyroid cancer in radioiodine treatment of hyperthyreosis and goiter. Anders Vej-Hansen (1), Lars Thorbjørn Jensen (2), Kaj Siersbæk-Nielsen (3) og Birte Nygaard (1)

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The risk of overlooking thyroid cancer in radioiodine treatment of hyperthyreosis and goiter

The Risk of overlooking thyroid cancer in radioiodine treatment of hyperthyreosis and goiter

Anders Vej-Hansen (1), Lars Thorbjørn Jensen (2),

Kaj Siersbæk-Nielsen (3) og Birte Nygaard (1)

1) Dep. of Endocrinology, Herlev Hospital, 2) Dep. of Clinical Fysiology, Glostrup Hospital, 3) Dep. of Endocrinology, Frederiksberg Hospital, Denmark


Introduction
Introduction treatment

  • About 3,000 patients are treated with radioiodine in Denmark for thyroid diseases each year

  • Alternative treatment is surgery but radioiodine is more gentle

  • Evaluation strategy includes bloodsamples and a scintiscan


Previous studies

Study treatment

N - follow up

Treatment

No. cancers

%/SMR/SIR

Ron et al

1998

Death c.thyr.

Tox

35.593 – 21 years

23.540

10.876

1.177

All

Radioiodine

Surgery

Medicine

29

25 (12/<4 years)

4

0

0,08 % 2,8 (SMR)

0,11 % 3,9 (SMR)

0,04 % 1,1 (SMR)

0 % 0 (SMR)

Dobyns et al 1974

Develop c.thyr.

Tox

34.684 – ? years

21.714

11.732

1.238

All

Radioiodine

Surgery

Medicine

86 (10 dead)

28 (9/1. year)

54 (18 mikr.c.)

4

0,25 %

0,19 %

0,50 %

0,30 %

Augusti et al

2000

Develop c.thyr.

Tox

6.647 – 7 years

Radioiodine

10

0,15%

No difference from background population

Previous studies


Purpose
Purpose treatment

  • To evaluate if the evaluation strategy is good enough to exclude thyroid cancer


Materials and methods
Materials and methods treatment

  • We collected information about all patients treated with radioiodine in 3 centre hospitals in Copenhagen

  • Information was compared with information on reported thyroid cancers in the national cancer register


Results i

N (%) treatment

Follow up

Years, months

No. doses

Total doses (MBq)

All

4,474

9.0

1.38

534

Toxic nodular

2,653 (59)

8.2

1.35

534

Toxic diffuse

732 (16)

9.10

1.34

448

Nontoxic nodular

718 (16)

9.2

1.53

646

Results I


Results ii

No. cancers treatment

Expected no. (backgr.pop.)

SIR

(backgr.pop.)

P

All

8

0.88

9.1

< 0,05

Toxic nodular

6

0.47

12.8

< 0,05

Toxic diffuse

1

0.16

12.5

ns

Nontoxic nodular

1

0.14

7.1

ns

Results II


Description of the cancers
Description of the cancers treatment

No. Goiter Age Time to Time to Age

Sex -type RI cancer death death Patology

1 M Tox dif 61,2 -6,11- -0,5- 68,6 Anaplastic

2 F Tox nod 82,8 -0,2- -0,2- 83,0 Unknown

3 F Tox nod 80,7 -4,5- -3,5- 88,5 Folliculary

4 M Tox nod 73,9 -0,8- -0,2- 74,7 Anaplastic

5 F Tox nod 77,7 -7,0- -4,10- 89,5 (alive) Papillifery

6 F Tox nod 75,9 -2,8- -2,0- 80,5 Anaplastic

7 M Atox nod 59,8 -4,5- -0,1- 64,2 Folliculary

8 F Tox nod 53,9 -4,2- -1,8- 59,7 (alive) Papillifery


Discussion
Discussion treatment

  • We have found more cancers than expected from the background population

  • The cancer incidence is at the same level as earlier described in studies of patients with hyperthyreosis treated with medicine, surgery or radioiodine


Previous studies1

Study treatment

N - follow up

Treatment

No. cancers

%/SMR/SIR

Ron et al

1998

Death c.thyr.

Tox

35.593 – 21years

23.540

10.876

1.177

All

Radioiodine

Surgery

Medicine

29

25 (12/<4 year)

4

0

0,08 % 2,8 (SMR)

0,11 % 3,9 (SMR)

0,04 % 1,1 (SMR)

0 % 0 (SMR)

Dobyns et al 1974

Develo. c.thyr.

Tox

34.684 – ? years

21.714

11.732

1.238

All

Radioiodine

Surgery

Medicine

86 (10 death)

28 (9/1. year)

54 (18 mikr.c.)

4

0,25 %

0,19 %

0,50 %

0,30 %

Augusti et al

2000

Develo. c.thyr.

Tox

6.647 – 7 years

Radioiodine

10

0,15%

No difference from backgroun population

Vej-Hansen

et al 2006

Develo. c.thyr.

Tox+Atox

4.474 – 9 years

Radioiodine

8 (2/1. year, 3/<4 years)

0,18 % 9,1 (SIR)

Previous studies


Conclusion
Conclusion treatment

  • In this study it seems that we don´t overlook cancer if we use scintiscan, and when it shows a cold nodule, we do a biopsy

  • This is also the evaluation of patients with nontoxic goiter


Thank you

Thank You!!! treatment

Anders Vej-Hansen, Lars Thorbjørn Jensen, Kaj Siersbæk-Nielsen og Birte Nygaard