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The Risk of overlooking thyroid cancer in radioiodine treatment of hyperthyreosis and goiter

The Risk of overlooking thyroid cancer in radioiodine treatment of hyperthyreosis and goiter. Anders Vej-Hansen (1), Lars Thorbjørn Jensen (2), Kaj Siersbæk-Nielsen (3) og Birte Nygaard (1)

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The Risk of overlooking thyroid cancer in radioiodine treatment of hyperthyreosis and goiter

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  1. The Risk of overlooking thyroid cancer in radioiodine treatment of hyperthyreosis and goiter Anders Vej-Hansen (1), Lars Thorbjørn Jensen (2), Kaj Siersbæk-Nielsen (3) og Birte Nygaard (1) 1) Dep. of Endocrinology, Herlev Hospital, 2) Dep. of Clinical Fysiology, Glostrup Hospital, 3) Dep. of Endocrinology, Frederiksberg Hospital, Denmark

  2. Introduction • About 3,000 patients are treated with radioiodine in Denmark for thyroid diseases each year • Alternative treatment is surgery but radioiodine is more gentle • Evaluation strategy includes bloodsamples and a scintiscan

  3. Study N - follow up Treatment No. cancers %/SMR/SIR Ron et al 1998 Death c.thyr. Tox 35.593 – 21 years 23.540 10.876 1.177 All Radioiodine Surgery Medicine 29 25 (12/<4 years) 4 0 0,08 % 2,8 (SMR) 0,11 % 3,9 (SMR) 0,04 % 1,1 (SMR) 0 % 0 (SMR) Dobyns et al 1974 Develop c.thyr. Tox 34.684 – ? years 21.714 11.732 1.238 All Radioiodine Surgery Medicine 86 (10 dead) 28 (9/1. year) 54 (18 mikr.c.) 4 0,25 % 0,19 % 0,50 % 0,30 % Augusti et al 2000 Develop c.thyr. Tox 6.647 – 7 years Radioiodine 10 0,15% No difference from background population Previous studies

  4. Purpose • To evaluate if the evaluation strategy is good enough to exclude thyroid cancer

  5. Materials and methods • We collected information about all patients treated with radioiodine in 3 centre hospitals in Copenhagen • Information was compared with information on reported thyroid cancers in the national cancer register

  6. N (%) Follow up Years, months No. doses Total doses (MBq) All 4,474 9.0 1.38 534 Toxic nodular 2,653 (59) 8.2 1.35 534 Toxic diffuse 732 (16) 9.10 1.34 448 Nontoxic nodular 718 (16) 9.2 1.53 646 Results I

  7. No. cancers Expected no. (backgr.pop.) SIR (backgr.pop.) P All 8 0.88 9.1 < 0,05 Toxic nodular 6 0.47 12.8 < 0,05 Toxic diffuse 1 0.16 12.5 ns Nontoxic nodular 1 0.14 7.1 ns Results II

  8. Description of the cancers No. Goiter Age Time to Time to Age Sex -type RI cancer death death Patology 1 M Tox dif 61,2 -6,11- -0,5- 68,6 Anaplastic 2 F Tox nod 82,8 -0,2- -0,2- 83,0 Unknown 3 F Tox nod 80,7 -4,5- -3,5- 88,5 Folliculary 4 M Tox nod 73,9 -0,8- -0,2- 74,7 Anaplastic 5 F Tox nod 77,7 -7,0- -4,10- 89,5 (alive) Papillifery 6 F Tox nod 75,9 -2,8- -2,0- 80,5 Anaplastic 7 M Atox nod 59,8 -4,5- -0,1- 64,2 Folliculary 8 F Tox nod 53,9 -4,2- -1,8- 59,7 (alive) Papillifery

  9. Discussion • We have found more cancers than expected from the background population • The cancer incidence is at the same level as earlier described in studies of patients with hyperthyreosis treated with medicine, surgery or radioiodine

  10. Study N - follow up Treatment No. cancers %/SMR/SIR Ron et al 1998 Death c.thyr. Tox 35.593 – 21years 23.540 10.876 1.177 All Radioiodine Surgery Medicine 29 25 (12/<4 year) 4 0 0,08 % 2,8 (SMR) 0,11 % 3,9 (SMR) 0,04 % 1,1 (SMR) 0 % 0 (SMR) Dobyns et al 1974 Develo. c.thyr. Tox 34.684 – ? years 21.714 11.732 1.238 All Radioiodine Surgery Medicine 86 (10 death) 28 (9/1. year) 54 (18 mikr.c.) 4 0,25 % 0,19 % 0,50 % 0,30 % Augusti et al 2000 Develo. c.thyr. Tox 6.647 – 7 years Radioiodine 10 0,15% No difference from backgroun population Vej-Hansen et al 2006 Develo. c.thyr. Tox+Atox 4.474 – 9 years Radioiodine 8 (2/1. year, 3/<4 years) 0,18 % 9,1 (SIR) Previous studies

  11. Conclusion • In this study it seems that we don´t overlook cancer if we use scintiscan, and when it shows a cold nodule, we do a biopsy • This is also the evaluation of patients with nontoxic goiter

  12. Thank You!!! Anders Vej-Hansen, Lars Thorbjørn Jensen, Kaj Siersbæk-Nielsen og Birte Nygaard

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