Thyroid Diseases: Hänscheid H

Lassmann M, Hänscheid H, Chiesa C, Hindorf C, Flux G, Luster M, Anonymous00045. · Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany. · Eur J Nucl Med Mol Imaging. · Pubmed #18491092 No free full text.

Abstract: INTRODUCTION: The purpose of the EANM Dosimetry Committee Series on "Standard Operational Procedures for Pre-therapeutic Dosimetry" (SOP) is to provide advice to scientists and clinicians on how to perform pre-therapeutic and/or therapeutic patient-specific absorbed dose assessments. MATERIAL AND METHODS: This particular SOP gives advice on how to tailor the therapeutic activity to be administered for systemic treatment of differentiated thyroid cancer (DTC) such that the absorbed dose to the blood does not exceed 2 Gy (a widely accepted limit for bone marrow toxicity). The methodology of blood-based dosimetry has been developed in the 1960s and refined in a series of international multi-centre trials in the framework of the introduction of new diagnostic and therapeutic tools, e.g. recombinant human thyroid-stimulating hormone in the management of DTC. CONCLUSION: The intention is to guide the user through a series of measurements and calculations which the authors consider to be the best and most reproducible way at present.

Lassmann M, Luster M, Hänscheid H, Reiners C. · Klinik und Poliklinik für Nuklearmedizin der Universität Würzburg, Würzburg, Germany. · J Nucl Med. · Pubmed #15073258 links to  free full text

Abstract: Recent publications described many discrepant findings about thyroid "stunning" after the administration of (131)I diagnostic activities to patients with differentiated thyroid carcinoma. Stunning may play a major role in reducing the therapeutic efficacy of high (131)I activities given for ablation therapy. METHODS: Participation in a multicenter study to investigate differences in iodine biokinetics in the hypothyroid state and after the application of recombinant human thyroid-stimulating hormone enabled us to study quantitative changes in thyroid iodine biokinetics after the administration of 74 MBq of (131)I twice within 6 wk and an ablation activity of 3-4 GBq 7-12 d after the second diagnostic administration of (131)I in 6 patients. RESULTS: The uptake and half-life of the first 74 MBq of (131)I were significantly reduced to a mean of 44% and a mean of 51%, respectively, after the second diagnostic administration and further reduced to a mean of 40% and a mean of 30%, respectively, during ablation therapy. The residence times were reduced to 25% in the second dosimetric assessment and to 10% during therapy compared with the value in the first assessment. For one patient, an estimated absorbed dose as high as 38 Gy was found in the first diagnostic study. The mean dose for all patients after the first assessment was 15 Gy; after each further assessment, the dose was reduced according to the decrease in residence time. CONCLUSION: This study shows a severe impact of 74 MBq of (131)I on the biokinetics of thyroid remnants during subsequent radioiodine therapy.

Luster M, Sherman SI, Skarulis MC, Reynolds JR, Lassmann M, Hänscheid H, Reiners C. · Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany. · Eur J Nucl Med Mol Imaging. · Pubmed #12856155 No free full text.

Abstract: Iodine kinetics were studied in patients with differentiated thyroid cancer while euthyroid under exogenous thyroid stimulating hormone (TSH) and while hypothyroid to detect differences in radioiodine uptake, distribution and elimination. Nine patients with total or near-total thyroidectomy on thyroid hormone suppressive therapy received two or three daily doses of 0.9 mg recombinant human TSH (rhTSH) followed by administration of a diagnostic activity of 2 mCi (74 MBq) iodine-131. After the biokinetics assessments had been performed, patients stopped taking thyroid hormones to become hypothyroid. A second 2 mCi (74 MBq) diagnostic activity of 131I was administered, followed by a second set of biokinetics assessments. One week later the patients underwent remnant ablation with a therapeutic activity of 131I. A comparison of the 131I kinetics in the patients while euthyroid and while hypothyroid showed major differences in the doses to the remnant as well as in residence times and radiation exposure to the blood. In the first diagnostic assessment the remnant dose was higher in eight of the nine patients and clearance of the activity from the blood was faster in all of them. The data from this study suggest that radioiodine administration is potent and safe when administered to euthyroid patients following rhTSH administration. Enhanced residence time in the remnant and decreased radiation exposure to the blood were noted when patients were euthyroid compared to when they were rendered hypothyroid. However, all patients received diagnostic activities in the same order: first while euthyroid, followed by hypothyroidism. It is quite possible that "stunning" from the radioiodine administered in the initial uptake study inhibited the subsequent uptake of radioiodine by the remnant lesions in the second uptake study.

Kreissl M, Tiemann M, Hänscheid H, Rendl J, Reiners C. · Klinik und Poliklinik für Nuklearmedizin, Julius-Maximilians-Universität Würzburg. · Dtsch Med Wochenschr. · Pubmed #11256036 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: Administration of levothyroxine and/or iodide can effectively reduce the volume of endemic goitre. However, TSH suppression during levothyroxine treatment may increase the number of recurrences through the persistence of intrathyroidal iodine deficiency. With special attention paid to the level of levothyroxine, a comparison was made of two dosages of combined levothyroxine and iodide. PATIENTS AND METHODS: 44 patients with diffuse euthyroid goitre were randomized to two treatment groups. Group A received 100 micrograms levothyroxine + 100 micrograms iodide, group B 75 micrograms levothyroxine + 150 micrograms iodide, all of them for three months. This was followed by three months without the medication. Intrathyroidal iodine concentration was measured at the onset of the study, then three months and six months later. At these same times thyroid volume was measured by ultrasound, as well as urinary iodine and various parameters of thyroid function. RESULTS: Thyroid gland volume was reduced in both groups (group A: -17.3%; group B: -14.8%; p < 0.001). There was no significant difference of intrathyroidal iodine concentration and thyroid volume between both groups. After the treatment period, TSH suppression was more marked in group A, while TSH rise was greater in group B. CONCLUSIONS: Both drug combinations resulted in comparable reduction of thyroid volume, while the intrathyroid concentration of iodine remained unchanged. The smaller rise of TSH after the treatment suggests that the dosage of 75 micrograms levothyroxine + 150 micrograms iodine is to be preferred.

Lassmann M, Hänscheid H. · University of Würzburg, Würzburg, Germany. · J Nucl Med. · Pubmed #17204691 links to  free full text

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Reiners C, Lassmann M, Hänscheid H. · University of Würzburg Würzburg, Germany. · J Nucl Med. · Pubmed #17015887 links to  free full text

This publication has no abstract.

Hänscheid H, Lassmann M, Luster M, Thomas SR, Pacini F, Ceccarelli C, Ladenson PW, Wahl RL, Schlumberger M, Ricard M, Driedger A, Kloos RT, Sherman SI, Haugen BR, Carriere V, Corone C, Reiners C. · Klinik und Poliklinik für Nuklearmedizin, Universität Würzburg, D-97080 Würzburg, Germany. · J Nucl Med. · Pubmed #16595499 links to  free full text

Abstract: Technical aspects and results of the dosimetric assessments of postoperative radioiodine ablation in the framework of an international, prospective, controlled, randomized, comparative study of the effectiveness of ablation therapy with 3.7 GBq (131)I in differentiated thyroid cancer after stimulation with recombinant human TSH (rhTSH) or by thyroid hormone withdrawal (THW) are presented. METHODS: Sixty-three patients were randomized after thyroidectomy to either the THW or the rhTSH group. Scintigraphic neck images were acquired starting 48 h after radioiodine administration to assess biokinetics in the thyroid remnant. The activity in blood samples was quantified and data from whole-body probe measurements and scintigraphic whole-body scans were combined to deduce retention curves in blood and whole body, respectively. The absorbed dose to the blood was calculated using a modified approach based on the formalism of the MIRD Committee of the Society of Nuclear Medicine. RESULTS: The effective half-time in the remnant thyroid tissue was significantly longer after rhTSH than THW (67.6 +/- 48.8 vs. 48.0 +/- 52.6 h, respectively; P = 0.01), whereas the observed differences of the mean 48-h (131)I uptakes (0.5% +/- 0.7% vs. 0.9% +/- 1.0% after THW; P = 0.1) and residence times (0.9 +/- 1.3 vs. 1.4 +/- 1.5 h after THW; P = 0.1) between the rhTSH and THW groups were not statistically significant. The specific absorbed dose to the blood was significantly (P <0.0001) lower after administration of rhTSH (mean, 0.109 +/- 0.028 mGy/MBq; maximum, 0.18 mGy/MBq) than after THW (mean, 0.167 +/- 0.061 mGy/MBq; maximum, 0.35 mGy/MBq), indicating that higher activities of radioiodine might be safely administered after exogenous stimulation with rhTSH. CONCLUSION: Indication of an influence of the residence time of radioiodine in the blood on the fractional uptake into thyroid remnant was found. A novel regimen is proposed in which therapeutic activities to be administered are determined from the individual specific blood dose.

Lassmann M, Luster M, Hänscheid H, Reiners C. · No affiliation provided · J Nucl Med. · Pubmed #15872368 links to  free full text

This publication has no abstract.

Schneider P, Biko J, Hänscheid H, Hilliger S, Koutsampelas C, Kranzfelder M, Ladner S, Reiners C. · Clinic for Nuclear Medicine, University of Würzburg, Josef-Schneider Strasse 2, 97080, Würzburg, Germany. · Eur J Nucl Med Mol Imaging. · Pubmed #15759147 No free full text.

Abstract: PURPOSE: In a prospective randomised study, we investigated the influence of the route of administration of radioiodide on dosimetry and therapy outcome. METHODS: Fifty-four patients suffering from Graves' disease (GD) and 60 patients with unifocal autonomy (UA) participated in the study and were randomly treated with either orally or intravenously administered radioiodide. Pretherapeutic dosimetry was based on single uptake measurements with a calibrated uptake probe system. The radioiodine kinetics during hospitalisation was assessed by daily bedside uptake measurements. Therapeutic dose was determined by half-life and thyroid uptake at the time of discharge using the same uptake probe as for the radioiodine test. RESULTS: No improvement in accuracy of dosimetry was achieved when radioiodide was administered intravenously. Mean therapeutic doses were identical following intravenous or oral administration. Variation in the achieved dose was slightly higher in the patients receiving oral administration, this being attributable to larger deviations in discrete activities of the capsules administered as compared with the values determined by dosimetry. No differences according to treatment modality were found with regard to therapeutic outcome. Eighty-seven patients attended 6-month follow-up after therapy. In the UA group, successful treatment, defined as a normal or elevated TSH level, was observed in 94% of patients after oral administration and in 80% after intravenous administration; corresponding figures in the GD group were 68% and 65%. CONCLUSION: The causes of individual differences between targeted and therapeutically achieved doses remain undetermined. Variations in the bioavailability of radioiodide or other parameters affecting thyroid status may be involved, and further investigations are needed to clarify this.

Schneider P, Körber C, Körber-Hafner N, Hänscheid H, Reiners C. · Klinik und Poliklinik für Nuklearmedizin der Universität Würzburg. · Nuklearmedizin. · Pubmed #12520660 No free full text.

Abstract: AIM: The impact of our dosimetry concept on radioiodine therapy success in Graves' disease (GD) was analysed. Three questions arised: Did individual estimation of pretherapeutic halflife improve therapeutic success? Did individual dosimetry result in accurate dose calculation? Did antithyroid medication have a measurable influence on therapeutic success under the prevailing conditions? METHODS: 126 consecutive patients were treated with 200 Gy I-131 in our therapy ward for GD and followed-up six to nine months after therapy. Success quote was assessed using a standardized protocol and treatment was classified as successful when the patient was eu- or hypothyroid, or unsuccessful when he or she presented with a suppressed TSH-level or in hyperthyroid condition after antithyroid medication withdrawal. Antithyroid medication, activity I-131, dose, concentration of fT3 and fT4, specific delivered dose and halflife were put into a multiple regression model to assess their influence on therapeutic success. In order to assess possible factors disturbing the therapeutic outcome, relevant parameters were analyzed using Logit transformation. RESULTS: Out of 126 patients 84 were classified as successfully treated and 42 (33.3%) as failures. A significant influence on the outcome only was found for thyroid mass. However, therapeutic success appeared to be more distinctly determined by the specific delivered dose using an estimated halflife of 5.5 days (Odds: 10.0, p < 0.001). Accurate intratherapeutic dosimetry did not play a significant role to enhance therapeutic success. Neither did antithyroid medication during radioiodine therapy exert any significant impact. CONCLUSIONS: Measurement of individual intratherapeutic halflife as opposed to an estimate using a standard halflife did not provide improved results concerning the target dose. Retrospectively, the therapeutic outcome on the basis of a measured halflife as compared to a standard halflife did not significantly improve. In addition, no influence of antithyroid medication on therapy success was found.

Körber C, Schneider P, Körber-Hafner N, Hänscheid H, Reiners C. · Clinic for Nuclear Medicine, University of Würzburg, Germany. · Eur J Nucl Med. · Pubmed #11585295 No free full text.

Abstract: There is controversy over the factors that may influence the outcome of radioiodine therapy for benign thyroid diseases. Antithyroid medication has been claimed to negatively influence the effectiveness of radioiodine therapy in Graves' disease. In a longitudinal study, we assessed the influence of sex, age, antithyroid drugs, target radiation dose, target mass, applied activity, delivered dose, interval between last meal and application, and TSH, FT3 and FT4 levels on the outcome of radioiodine therapy. One hundred and forty-four patients (111 female, 33 male) suffering from Graves' disease (GD) and 563 patients (434 female, 129 male) with toxic nodular goitre (TNG) were entered in the study and followed up until 8 months after therapy. Treatment was defined as successful when the TSH level was found to be normal or elevated. Ninety-eight GD patients and 418 TNG patients were successfully treated. Forward stepwise multiple regression analysis models retained only the target mass in GD and the applied activity in TNG as significantly associated with the outcome of therapy. The predictive value of all variables involved was extremely low in both disease groups. Whereas concomitant antithyroid medication had no influence in GD, it adversely influenced radioiodine therapy of TNG. This effect may be attributed to a radioiodine "steal phenomenon" induced by TSH-stimulated normal thyroid tissue, which causes overestimation of the uptake in toxic nodules.

Körber C, Schneider P, Hänscheid H, Köck PR, Reiners C. · Klinik und Poliklinik für Nuklearmedizin, Universität Würzburg. · Nuklearmedizin. · Pubmed #10726251 No free full text.

Abstract: AIM: According to the new recommendations of the Federal German Radiation Protection Committee (SSK) for patient discharge, that were published in April 1997, patients can be discharged after radioiodine therapy with a radiation exposure of less than 1 mSv per year in 2 m distance. The aim of this study was to evaluate whether the measurement of the achieved dose was different 48 hours after application of I-131 and after an interval of one week. The study was planned in order to ensure quality management in the follow-up of the patients. METHOD: In a prospective study 115 patients were followed, that were treated for a benign thyroid disease. The patients were discharged 48 hours after the intake of I-131 after falling short of the exposure limit. All patients were measured at discharge and about 8 days later with the same uptake facility. RESULTS: Because of similar results focal and disseminated forms of benign thyroid diseases could be analysed together. The calculated doses 8 days after the discharge were higher than the values at the time of discharge. The doses were underestimated about 4% with an standard error of 15%. CONCLUSION: The error in early dosimetric measurements is small in comparison to the overall uncertainty in therapy and uptake dosimetry. A valid dosimetry and sufficient quality management can be guaranteed even for an early discharge.

Lassmann M, Hänscheid H, Reiners C, Thomas SR. · No affiliation provided · J Nucl Med. · Pubmed #15872369 links to  free full text

This publication has no abstract.