Friday, December 31, 2004

His Thyroid Cancer didn't take up Radioiodine. Was this a true test, or hidden contamination by unknown iodine intake?

41 year old male had a well differentiated papillary thyroid cancer removed and was in the process of receiving radioiodine treatment, when it was noted on Ultrasound that a mass was seen in the thyroid area. The biopsy, and
washings for cancer marker,thyroglobulin were positive.
The whole body scan with the TSH > 110 was negative although there was an obvious cancer mass present. I put the patients on low iodine diet, but do not routinely get
24 hour urine iodine to look for unknown sources of iodine contamination. The failure to take up iodine is not a good sign, therefore, I needed to be sure this was true.After his surgery, to remove the mass and strip the nodes, I have set up a protocol to insure there was no iodine contamination. He denied any iodine contrast before the first body scan, and claimed to be strictly on the L.I.D.
The patient will be withdrawn from LT4 and then withdrawn from LT3. 2 weeks of L.I.D will follow. A 24 hour urine for iodine and creatnine will be done. Lithium, a drug known to block release of iodine from the thyroid, will be given for 5 days to "hold" the iodine in any remaining thyroid cancer, or normal thyroid tissue. One last try at getting uptake will be with 100-150 Millicuries I/131. A body scan at day 7 post therapy will tell us if he truly has a thyroid cancer that does not allow us the ability to use radioiodine in his future care. The loss of the ability to take up radioiodine is a sign of a more aggressive tumor. Alternative methods to follow patients, will have to include, in addition to ultrasound, thyroglobulin, MR, and CT, a P.E.T. scan. However positive areas on P.E.T. can not be treated at the present time, unless they can be found on CT, and then surgically removed.

Happy New Year,


Thursday, December 30, 2004

Is Low Level Radioiodine Exposure Harmful?

According to studies at Fred Hutchison Cancer Center in Seattle, on 3440 subjects born near Hanford Nuclear Site in the 1940's, there was no increase in thyroid cancer,thyroiditis,or hypothyroidism. 1986 it was revealed that Iodine/131 was released from the site from 1944-1957. The subjects were exposed to a median dose of 97 mGy.
From 1992-1997 they were examined, had ultrasounds, and a needle biopsy if indicated.
Ionizing radiation does cause thyroid cancer, but low level exposure through ingestion of milk containing I/131 was not associated with increase cancer risk in this study.

I have several thyroid patients from the Hadford area, and they were glad to hear that their thyroid problem was not due to secret nuclear testing by the USA at Hanford.

Happy New Year


Ref: Scott Davis et al, JAMA 2004;292:2600-2613

Tuesday, December 28, 2004

World Iodine Excess/ Deficiency / Thyroid Health

Thyroid Health

In the last 10 years there has been a reduction in the number of countries with a public health problem due to Iodine deficiency ( 110 countries in 1993 had a problem ). In 2003 only 54 countries had a continuing health problem. Iodine deficiency is a significant cause of mental developmental problems in children. The plan of universal salt iodization, has been successful, but more needs to be done. Soil iodine deficiency, leads to low levels in food, and results in the thyroid gland failing to make enough thyroid hormone. The result is a series of functional, and developmental problems called Iodine Deficiency Disorders. Cretinism is the most extreme problem. However, the subtle disorders leading to poor school performance, reduced intellectual ability, and impaired work capacity, are the main reason for the universal iodization program. The USA is sufficient in iodine, except in young women during pregnancy.Some need iodine added to their vitamins during pregnancy.

29 countries have excess iodine intake. Excess iodine can be a problem for patients with thyroid diseases such as Hashimoto's thyroiditis. Iodine induced thyroid disorders, can cause hypothyroidism, hyperthyroidism, nodules, and goiter. People with goiters from iodine insuficient areas of the world, can develop toxic hyperthyroid goiter years after entering the US, caused by the increase in iodine intake in our country.


Toxic Hot Nodule and Cancer?

Thyroid Case of the Week.

40 Y/O female, was noted to have suppressed TSH ( <0.01 ), during an infertility evaluation.
Asymptomatic. Has had a suppressed TSH for 2 years.
Father: Hyperthyroid on Antithyroid drugs
Mother: Hypothyroid on thyroid hormone.
Infertility for 2 1/2 years
Ultrasound: 1 cm mass is noted in her left lobe. Right normal normal.
Thyroid scan: Hot left lobe with suppressed right lobe.
A diagnosis of Autonomous hot nodule with subclinical hyperthyroidism was made.
Normal uptakes at 6/24 hours.
FT4,FT3, TPO, TSI all normal.
Because of her age, and her desire to get pregnant soon, she was offered surgery, instead of radioiodine.
Surgery :left lobectomy.
Pathology Papillary Thyroid cancer, with 1 node positive.
Post surgery Thyroglobulin 10.3 This is consistent with output from a single remnant right lobe.
Second surgery: Right lobectomy: Normal thyroid, but 1/3 nodes positive.

I have never seen a hot nodule produced by a papillary thyroid cancer.
Follicular cancers if they are > 4 cm may make one toxic with suppressed TSH.
I do not understand this case. I can only speculate that the cancer was near, but not
the exact area that produced increased iodine uptake.The patient has a normal TSH post lobe removal TSH 1.4. The cancer is being treated by thyroid hormone suppression, and follow up with ultrasound, and Thyroglobulin. If there is persistent TG in 3-6 months, Radioiodine will be used. She still wants to get pregnant ASAP.


Deborah Norville's Thyroid ?

It has been several weeks since I posted my observation related to a possible mass in the thyroid area on Deborah Norville.I noted this while watching her MSNBC news show. She has not emailed back. I hope I was wrong, or that she went to her doctor to check out my observation. Some people will not acknowledge my email, but go for a check up anyway. I wish her luck.


Monday, December 27, 2004

New Year 2005 Thyroid Blog

Well, I finally found a weblog home at My two previous attempted sites were not very user freindly.
Welcome to The Thyroid Blog.
The first entry will follow on 12/28/2004.

Thursday, December 02, 2004

Does Deborah Norville have a Thyroid Goiter?

Deborah Norville Has a Thyroid Goiter! While watching MSNBC's news show with Deborah Norville, I was struck by the mass in the area of her thyroid in the midline. Does she know she has a thyroid problem? It was clearly moving up and down while she talked and swallowed. If you look at the neck of someone on TV, you may be able to see an enlarged thyroid or nodule. I have picked up goiters while watching TV, but not all the people were glad to hear from me about their problem. Several have come to see me for treatment. I do not know if she knows she has a goiter, but I will email MSNBC to tell her about my finding. In 1974, I was just starting my thyroid center, and still did not have my office built out, when watching a local news show, I noticed the anchor had a lump in her neck. I was excited to see if she knew about the lump. I called her. She was unaware of the thyroid problem. She wanted to see me right away. I had to use another physician's office for the examination. I did a needle biopsy. It was a pure cyst. She was very happy it was not cancer. Dr.G.