Thursday, April 11, 2024

Whole Body Scan For Thyroid Cancer

What Is A Metastatic Survey Scan


A Whole-Body I-131 Metastatic Survey scan is used to detect areas of residual functioning thyroid tissue and thyroid cancer. It is a nuclear medicine exam which combines a small amount of radioisotope with a pharmaceutical that is targeted to go to a specific organ. This radiopharmaceutical can be injected, inhaled or swallowed and is absorbed by specific cells within your body. Nuclear medicine exams differ from other radiological exams in that they provide both functional and structural information. The exams are very sensitive and can detect disease at its earliest stage. The exams are safe, relatively painless and the radiation exposure is similar to that of other diagnostic X-Ray exams.

Biomarker Imaging Of Thyroid Cancer

Surveillance with 131I WBS is the most specific imaging modality only when the thyroid cancer is iodine-avid, the patient has been depleted of iodine stores, and TSH is elevated. I-131 SPECT enhances the planar WBS images by producing computer-reformatted, three-dimensional, cross-sectional slices, but unfortunately increases radiation exposure.

PET depicts the accumulation of radioactive-tagged glucose by rapidly growing or dividing tissues or organs, including neoplastic tissue , lymphoma, inflammation, and infection. It is not as specific for thyroid cancer as 131I WBS. Indeed, benign thyroid adenomas, nodular hyperplasia, focal thyroiditis, Hashimotos thyroiditis, Graves disease, and thyroglossal duct cyst have been reported to accumulate excessive FDG.100 Focal accumulation of FDG thought to be thyroid in origin on PET has been reported to represent nonthyroid malignancies in 1.2% to 4.3% of such studies.101-104

As a general rule, thyroid cancer that is well differentiated concentrates 131I but utilizes relatively less glucose than poorly differentiated thyroid cancer that does not accumulate 131I. PET may reveal relatively poorly differentiated thyroid cancer in WBS-negative patients, and thus is useful clinically when thyroglobulin is elevated but other evidence of cancer is lacking.

ManfredBlum , in, 2010

What Is The Prognosis Of Thyroid Cancer

Overall, your prognosis with differentiated thyroid cancer is excellent, especially if you are younger than 55 years of age and have a small cancer. If your papillary thyroid cancer has not spread beyond the thyroid gland, patients like you rarely if ever die from thyroid cancer. If you are older than 55 years of age, or have a larger or more aggressive tumor, your prognosis remains very good, but the risk of cancer recurrence is higher. The prognosis may not be quite as good if your cancer is more advanced and cannot be completely removed with surgery or destroyed with radioactive iodine treatment. Nonetheless, even if this is your situation, you will likely be able to live a long time and feel well, despite the fact that you are living with cancer. It is important to talk to your doctor about your individual profile of cancer and expected prognosis. It will be necessary to have lifelong monitoring, even after successful treatment.

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What Causes Thyroid Cancer

Thyroid cancer is more common in people who have a history of exposure to high doses of radiation, have a family history of thyroid cancer, and are older than 40 years of age. However, for most people, we dont know why thyroid cancer develops.

High dose radiation exposure, especially during childhood, increases the risk of developing thyroid cancer. Radiation therapy used to treat cancers such as Hodgkins disease or breast cancer has been associated with an increased risk for developing thyroid cancer if the treatment included exposure to the head, neck or chest. Routine X-ray exposure such as dental X-rays, chest X-rays and mammograms are not associated with a high risk of thyroid cancer. As always, you should minimize radiation exposure by only having tests which are medically necessary.

Exposure to radioactivity released during nuclear disasters has also been associated with an increased risk of developing thyroid cancer, particularly in exposed children, and thyroid cancers can be seen in exposed individuals as many as 40 years after exposure.

The Presence Of Uptake In Thyroid Bed On Diagnostic Whole

PET Scan in Thyroid Cancer

We performed a blood test before diagnostic WBS after radioiodine ablation on intermediate-risk patients, and the scan results were compared between patients with negative Tg Ab, dividing the results of TSH-stimulating Tg levels into two groups based on levels below 2 ng/mL and above 2 ng/mL . On diagnostic WBS, 16 out of 250 patients had Tg levels higher than 2 ng/mL, and these patients also had a significantly higher uptake in thyroid bed compared to the below 2 ng/mL group . However, the recurrence of thyroid cancer was not statistically significant . The clinical pathology of relapsed patients is described in Table 5.

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Change In Patient Management

In 11 patients the Dx scan changed clinical management, of which 4 patients required additional surgery . The indication for additional surgery was confirmed with MRI of the neck region. A fifth patient with uptake of 42.9%, first underwent re-surgery. Thereafter, the uptake was still 23.9% resulting in the administration of a decreased activity of I-131. In these 5 patients, pathological examination after resurgery revealed benign thyroid tissue in 3 patients and in 2 patients DTC in a thyroid remnant with additional lymph node metastases was found. For 6 patients with an uptake between 5.6 and 24.0% the I-131 activity was reduced by 50% due to high uptake on the Dx scan. A further 6 patients had an uptake of > 10% but required no additional surgery or lower activity of I-131 at the discretion of the treating physician.

Table 2 Patient and treatment characteristics associated with a change in clinical management.

Furthermore, there was no association between uptake measurement and results of re-stratification with a diagnostic I-131 whole body scan 6 months after I-131 therapy .

How Is The Procedure Performed

Doctors perform nuclear medicine exams on outpatients and hospitalized patients.

Thyroid Scan

You will lie on an exam table. If necessary, a nurse or technologist will insert an intravenous catheter into a vein in your hand or arm.

For most exams, you will receive an injection of the radiotracer. Or, you may swallow it or inhale it as a gas.

When radiotracer is taken by mouth, in either liquid or capsule form, it is typically swallowed up to 24 hours before the scan. The radiotracer given by intravenous injection is usually given up to 30 minutes prior to the test.

When it is time for the imaging to begin, you will lie down on a moveable examination table with your head tipped backward and neck extended. The gamma camera will then take a series of images, capturing images of the thyroid gland from three different angles. You will need to remain still for brief periods of time while the camera is taking pictures.

After the exam, you may need to wait until the technologist determines if more images are needed. Sometimes, the technologist takes more images to clarify or better visualize certain areas or structures. The need for more images does not necessarily mean there was a problem with the exam or that something is abnormal. It should not cause you concern.

If you have an intravenous line for the procedure, your technologist will usually remove it. The technologist will leave it in place if you are to have another procedure that same day that requires an IV line.

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Recovery From A Thyroid Scan

After your thyroid scan, you must contact your physician for instructions on how to resume taking your thyroid medication.

The radioactive iodine in your body is passed when you urinate. You may be advised to drink extra fluids and empty your bladder often to flush out the radionuclide. You may need to be careful to protect others from potential exposure to the material. To do this, your doctor may advise you to flush twice after using the toilet for up to 48 hours after the test.

You can typically resume your normal diet and activities immediately after any thyroid scan.

Diagnostic And Treatment Protocol

Iodine-131 Therapy for Thyroid Cancer | Manipal Hospitals India

In patients with a palpable thyroid nodule, ultrasonography guided fine needle aspiration cytology was performed, either at the UMCG or at the referring non-tertiary hospital. At the same session, ultrasound characteristics of the thyroid nodule were described and screening for metastatic lymph nodes in the neck region took place. All patients included in this study underwent a thyroidectomy with lymph node dissection if indicated, either at the UMCG or at one of the 19 referring hospitals. The seventh edition of the AJCC cancer staging system was used . Patients were classified as low risk or high risk , according to the Dutch risk stratification at that time . In addition, patients were retrospectively classified according to a simplified ATA risk stratification as low risk , intermediate risk or high risk . The hospitals where the surgery was performed were classified as tertiary- vs. non-tertiary hospitals . In addition, information about the surgical procedure was obtained to assess whether the thyroidectomy was performed in one or two sessions .

Free T4 and TSH were measured at the time of the Dx scan, using immunochemiluminometric E-module assay with normal values of respectively 11.0 – 19.5 pmol/L and 0.54.0 mU/l. For the measurement of thyroglobulin , the Tg immunoradiometric assay by Thermo Fisher Scientific was used, with a limit of detection of 0.1 ng/mL and a functional sensitivity of 0.3 ng/mL.

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Thyroid Scan And Uptake

Thyroid scan and uptake uses small amounts of radioactive materials called radiotracers, a special camera and a computer to provide information about your thyroid’s size, shape, position and function that is often unattainable using other imaging procedures.

Tell your doctor if there’s a possibility you are pregnant or if you are breastfeeding. Inform your doctor of any recent illnesses, medical conditions, allergies, medications you’re taking and whether you’ve had any procedures within the last two months that used iodine-based contrast material. Your doctor will instruct you on how to prepare and may advise you not to eat for several hours prior to your exam. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.

Clinicopathologic Characteristics According To Diagnostic Whole

The clinicopathologic characteristics according to the results of diagnostic WBS in intermediate-risk patients were observed . Among 255 intermediate-risk patients, 233 had no uptake in the thyroid bed, and 22 had uptake on the thyroid bed. On diagnostic WBS, the group showing uptake in the thyroid bed had significantly smaller tumors than the group with no uptake , higher lymph node metastasis , Tg levels below 2 ng/mL in the absence of Tg Ab . There was no statistically significant between thyroid intake and age, sex, TNM stage, or Tg Ab.

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How Do You Feel After Rai

Most people dont feel different after treatment. But a few people may have nausea. Within a few days after treatment, the radioactive iodine will leave your body in your urine and saliva. How long it takes will depend on your age and on the dose you received.

What happens when iodine-131 enters the body?

Radioactive iodine , an isotope of iodine that emits radiation, is used for medical purposes. When a small dose of I-131 is swallowed, it is absorbed into the bloodstream in the gastrointestinal tract and concentrated from the blood by the thyroid gland, where it begins destroying the glands cells.

Management Of Suspected Recurrent Or Metastatic Disease


WBS after therapeutic doses of 131-I is more sensitive than the diagnostic WBS to search for recurrent or metastatic DCT

High-resolution, cervical ultrasound performed by an expert

CT for neck and chest

MRI for bones and brain

Indicated and sensitive when post 131-I WBS is negative and serum Tg is high

Presents specificity problems: FDG is taken up by inflamed tissues

Sensitivity increases with high TSH

Higher uptake avidity of 18FDG by neoplastic tissue worsens the prognosis

It can be indicated in:

Undifferentiated or invasive Hürthle cell cancers

Patients with unexpectedly elevated Tg

Ari J. Wassner, in, 2019

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What Is A Radioactive Iodine Uptake Test

The radioactive iodine uptake test involves using a small amount of radioactive iodine and a gamma camera to detect cancer cells in the thyroid gland.

For the procedure, the patient swallows a capsule of I-123, which is absorbed by the thyroid gland. Using a gamma camera, the front of the patients neck is imaged several hours later to determine where and how the radioactive iodine has accumulated. Thyroid cancer cells absorb more iodine than surrounding tissue.

To detect thyroid cells located elsewhere in the body, the gamma camera will scan the entire body .

Radioiodine scans are also used in the care and management of patients with differentiated thyroid cancer, which includes papillary, follicular and Hurthle cell thyroid cancers.

Preparing For A Thyroid Scan

Tell your physician about any prescription or over-the-counter medications youre taking. Discuss how they should be used before and during the test.

You may have to discontinue thyroid medication from four to six weeks before your scan. Some heart medications and any medicine containing iodine also may require adjustments.

For any thyroid scan, you may be asked to avoid certain foods that contain iodine for about a week before your procedure. Typically, you shouldnt eat:

You shouldnt have any other imaging tests that use radioactive iodine for six weeks before your thyroid scan. A few days before your procedure, your doctor may request a blood test to confirm that your thyroid function is still abnormal. Thyroid scans are used as secondary diagnostic tools to other tests, such as blood work. A scan isnt typically used when thyroid functions are normal. An exception to this is when there are nodules or goiters present.

You may have to fast for several hours before your exam. Food can affect the accuracy of the RAIU measurement.

Youll have to remove any jewelry or other metal accessories before the test. These may interfere with the accuracy of the scan.

A doctor who specializes in nuclear imaging will evaluate the images and results of your thyroid scan. Your results will be sent in a report to your doctor.

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Magnetic Resonance Imaging Scan

MRI scans use magnets instead of radiation to create detailed cross-sectional images of your body. MRI can be used to look for cancer in the thyroid, or cancer that has spread to nearby or distant parts of the body. But ultrasound is usually the first choice for looking at the thyroid. MRI can provide very detailed images of soft tissues such as the thyroid gland. MRI scans are also very helpful in looking at the brain and spinal cord.

What Will I Experience During And After The Procedure

Thyroid Cancer Treatment 1st Full Body Scan

Most thyroid scan and thyroid uptake procedures are painless. However, during the thyroid scan, you may feel uncomfortable when lying completely still with your head extended backward while the gamma camera is taking images.

You will feel a slight pin prick when the technologist inserts the needle into your vein for the intravenous line. You may feel a cold sensation moving up your arm during the radiotracer injection. Generally, there are no other side effects.

Radiotracers have little or no taste. Inhaling a radiotracer feels no different than breathing the air around you or holding your breath.

It is important to remain still during the exam. Nuclear imaging causes no pain. However, having to remain still or in one position for long periods may cause discomfort

Unless your doctor tells you otherwise, you may resume your normal activities after your exam. A technologist, nurse, or doctor will provide you with any necessary special instructions before you leave.

The small amount of radiotracer in your body will lose its radioactivity over time through the natural process of radioactive decay. It may also pass out of your body through your urine or stool during the first few hours or days after the test. Drink plenty of water to help flush the material out of your body.

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How Is Radioiodine Used In Thyroid Cancer

Radioiodine, also called radioactive iodine, is the radioisotope of iodine, a naturally occurring non-metallic element. Iodine is an essential part of our dietthe body requires small amounts of iodine to produce thyroid hormones essential to growth and development. When either form of iodine is introduced into the body, it accumulates in the thyroid gland. This allows nuclear medicine physicians to use radioiodine in:

  • Diagnosis: as an aid in choosing a nodule to biopsy.
  • Staging: a whole body iodine scan after treatment is very good at looking to see if the thyroid cancer has spread.
  • Treatment: Iodine-131 has been used to treat differentiated thyroid cancer for over 60 years.
  • Manage ongoing care: by detecting where the cancer has come back in patients with elevated levels of the protein thyroglobulin in the blood.

How Long Does A Whole Body Scan Take

A whole body bone scan takes around 3-4 hours, which includes two separate visits. In the first visit you will be given an injection of a radioactive isotope into a vein in your arm. There are no side effects to this injection. The isotope takes 2-3 hours to circulate in the blood and get absorbed in the bone.

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Risks Of A Thyroid Scan

Theres a small but safe amount of radiation contained in the radionuclide used in any thyroid scan. Your exposure to radiation will be minimal and within the acceptable ranges for diagnostic exams. There are no known long-term complications of having a nuclear medicine procedure.

Allergic reactions to the radionuclide material are extremely rare. The effects are mild when they occur. You may experience mild pain and redness at the injection site for a short time if you receive an injection of the radionuclide.

Even though the radiation exposure is minimal and short term, thyroid scans arent recommended for pregnant or breastfeeding women. Your doctor may recommend that you avoid becoming pregnant or fathering a child for six months after the test if youve had a metastatic scan.

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