By Orlo H. Clark Quan Y., M.D. Duh Nancy D., M.D. Perrier
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For patients currently on thyroid hormone suppression therapy, the T4 is withdrawn for 4 to 6 weeks with a substitution of triiodothyronine (T3) for 2 to 3 weeks. Then T3 is discontinued and the patient is placed on a lowiodine diet (< 50 µg/d) for 1 to 2 weeks prior to the 131 I uptake and scan study. This regimen will allow 90% of patients to achieve a serum TSH concentration > 30 mU/L to stimulate iodide uptake by residual thyroid tissue. At the University of California-San Francisco, an outpatient dose of 30 to 50 mCi 131I is used to ablate residual thyroid tissue at 6 to 12 weeks after operation if focal uptake is detected in the thyroid bed on a 2 to 3 mCi 131I diagnostic scan.
3. Box JC, Watne AL. Inherited syndromes of colon polyps. Semin Surg Oncol 1995;11:394–8. 4. Loh KC. Familial nonmedullary thyroid carcinoma: a metareview of case series. Thyroid 1997;7:107–13. 5. Nikiforov YE, Rowland JM, Bove K, et al. Distinct pattern of ret oncogene rearrangements in morphologic variants of radiation-induced and sporadic thyroid papillary carcinomas in children. Cancer Res 1997;57:1690–4. 6. Bongarzone I, Butti MG, Coronelli S, et al. Frequent activation of ret protooncogene by fusion with a new activating gene in papillary thyroid carcinomas.
When these data are plotted as cumulative survival curves Differentiated Thyroid Carcinomas A 33 B Figure 2–17. Papillary thyroid carcinoma with symptomatic bone metastases. A, Plain radiograph of the thoracolumbar spine showing partial destruction of T11 and T12 vertebral bodies, resulting in scoliosis. B, Total-body scan performed 72 hours after a high-dose (200 mCi) radioactive iodine (131I) therapy showing intense 131I uptake in vertebral bodies (arrow) and lesser degrees of 131I uptake in the ribs and the skull (shorter arrows), indicating multiple sites of bony metastases.