Thyroid Diseases: Silberstein EB

Dillehay GL, Ellerbroek NA, Balon H, Brill DR, Grigsby PW, Macklis RM, Mauch PM, Mian TA, Potters L, Silberstein EB, Williams TR, Wong JC, Gaspar LE, Anonymous00250. · American College of Radiology, Reston, VA, USA. · Int J Radiat Oncol Biol Phys. · Pubmed #16472933 No free full text.

This publication has no abstract.

Meier DA, Brill DR, Becker DV, Clarke SE, Silberstein EB, Royal HD, Balon HR, Anonymous00200. · William Beaumont Hospital, Royal Oak, Michigan, USA. · J Nucl Med. · Pubmed #12050333 links to  free full text

This publication has no abstract.

Silberstein EB. · Department of Nuclear Medicine, University of Cincinnati Medical Center, 234 Goodman St., Room G026, Mont Reid Pavilion, Cincinnati, OH 45219, USA. · J Nucl Med. · Pubmed #18344428 links to  free full text

Abstract: The goal of this study was to reduce the salivary symptoms of pain and xerostomia caused by 131I therapy for papillary and follicular thyroid carcinoma. METHODS: In a single-blind controlled prospective study of 60 patients, we investigated whether pilocarpine, 5 mg orally every 8 h for 1 wk after 131I therapy, would reduce salivary symptoms. All patients received 8 mg of dexamethasone and 100 mg of dolasetron mesylate orally 2 h before therapy and every 12 h for another 5 doses after 131I ingestion. In addition, for a week after therapy all drank 2,400 mL of nondairy liquid per day and had sugar-free gum or candy in their mouths at all times when awake for a week and, for the first 3 nights, every 3 h after retiring. All brushed their mouths out every 3 h while awake and also for the first 3 nights after 131I therapy. Symptoms and signs were followed by frequent telephone calls over the first week and every 8-12 wk thereafter, a physical examination within the first 10 d after therapy, and a clinic visit 6-8 mo after therapy. Statistical comparisons were by chi2 analysis. RESULTS: The 2 patient groups were not statistically different in age, sex, type of thyroid cancer, or 131I activity administered (P > 0.05). There were no statistical differences between the groups in the prevalence of sialadenitis, stomatitis, xerostomia, or dysgeusia over the next 6 mo (P > 0.05). CONCLUSION: Under the conditions of the study, pilocarpine did not reduce the occurrence of radiation sialadenitis or stomatitis. The occurrence, however, was lower than had previously been reported in the literature, possibly because of the concurrent stringent application of physiologic sialogogues (candy, gum, fluids), dexamethasone, and dolasetron mesylate, a serotonin receptor antagonist.

Silberstein EB. · Division of Nuclear Medicine, Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio 45219, USA. · J Nucl Med. · Pubmed #17574976 links to  free full text

Abstract: Detection of residual tissue after thyroidectomy for papillary or follicular thyroid carcinoma may be performed using diagnostic imaging with either (123)I or (131)I. The former is often preferred to avoid "stunning"-defined as a reduction in uptake of the therapeutic dose of (131)I caused by some form of cell damage from the diagnostic dosage of the radionuclide. Stunning could potentially reduce the therapeutic efficacy of (131)I given to ablate a post-thyroidectomy remnant. This study examines the outcomes of ablative (131)I therapy after diagnostic studies with either (123)I or (131)I to determine if the diagnostic dosages of these radionuclides used in our Thyroid Cancer Center reduce the efficacy of (131)I given for remnant ablation. METHODS: Fifty patients with nonmetastatic papillary or follicular carcinoma of the thyroid received total thyroidectomy; this was followed by thyroid hormone withdrawal to achieve a serum thyroid-stimulating hormone level in excess of 30 microIU/mL. They were divided prospectively into 2 groups. Group 1 had diagnostic imaging with 14.8 MBq of (123)I followed by thyroid remnant ablation with 3.7 GBq of (131)I. Group 2 had empiric ablation with the same 3.7-GBq (131)I dosage, but the preceding diagnostic scan was performed with 74 MBq of (131)I. Comparisons of equivalence of the 2 population samples and of the post-ablation outcomes were evaluated by chi(2) analysis. Successful ablation required a negative follow-up thyroid scan 6-8 mo after ablation and also an undetectable serum thyroglobulin level in the absence of antithyroglobulin antibodies. RESULTS: There was no significant difference between the 2 groups demographically, in tumor burden or stage, or in the post-thyroidectomy ablation rate (group 1, 81%; group 2, 74%; P > 0.05). CONCLUSION: If thyroid remnant stunning occurs due to 74 MBq (131)I used as a diagnostic agent before (131)I ablation, it has no significant clinical correlate, as it yields the same ablation rate as that which occurs after 14.8 MBq of (123)I used for imaging.

Coover LR, Silberstein EB, Kuhn PJ, Graves MW. · Nuclear Medicine Section and Hamot Research Center, Erie, Pennsylvania 16550, USA. · J Nucl Med. · Pubmed #11079497 links to  free full text

Abstract: The Code of Federal Regulations, title 10, part 35.75 (10CFR35.75), provides greater latitude and flexibility in the dosing and management of outpatients treated with therapeutic 131I than did preceding regulations. Prescribing physicians should consider applying these new regulations to enhance patient convenience and lower the cost of managing appropriate outpatients. Managed care organizations and third-party payers may require that all eligible patients be treated as outpatients or that justification for hospital admission be specifically documented. To facilitate application of the code and guidelines, maximum 131I doses for patients undergoing thyroid remnant ablation, therapy for metastatic or recurrent thyroid cancer, or therapy for hyperthyroidism have been calculated and summarized in tables. METHODS: A model was developed that calculates the maximum dose of 131I that may be dispensed to an outpatient. This model complies with 10CFR35.75. The maximum dose is calculated as a function of 5 variables: the occupancy factors for 3 periods after dose administration, the fractional uptake of 131I by residual thyroid tissue or metastasis, and the duration of constrained activity. Occupancy factor, a key new concept in the regulatory guidelines, is a physician estimate of the time that a treated patient will be near the individual with whom the patient will spend the most time after treatment. The model also considers 3 constants: the effective half-life of 131I during the preequilibrium period, and the effective half-lives of 131I in both the thyroidal component and the extrathyroidal component during the equilibrium period. Tables for maximum allowable patient 131I doses were derived on the basis of this model. RESULTS: Through dosing charts, maximum 131I therapy doses may easily be calculated. Most outpatients undergoing thyroid remnant ablation, therapy for metastatic or recurrent thyroid cancer, or therapy for hyperthyroidism may be treated with 7400 MBq (200 mCi) 131I or more. CONCLUSION: If the prescribing physician understands the concept of occupancy factor and how to use the dosing charts, our model facilitates application of and adherence to 10CFR35.75.