scholarly journals Variations in Radioiodine Therapy in Europe – Decision-Making after Total Thyroidectomy

Oncology ◽  
2021 ◽  
Author(s):  
Flavio Forrer ◽  
Galina Fischer ◽  
Ole Maas ◽  
Luca Giovanella ◽  
Martha Hoffmann ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Total Thyroidectomy ◽  
Radioiodine Therapy ◽  
Management Strategies ◽  
Daily Practice ◽  
General Level ◽  
American Thyroid Association ◽  
Ablation Therapy ◽  
Post Surgery ◽  
Level Of Agreement

The role of radioiodine therapy (RIT) (used as ablation therapy or adjuvant therapy) following total thyroidectomy for differentiated thyroid cancer (DTC) changed. Major revisions of the American Thyroid Association (ATA) Guidelines in 2015 resulted in significant differences in treatment recommendations in comparison to the European Association of Nuclear Medicine (EANM) 2008 guidelines. Recently, we presented the effects on daily practice for RIT among Swiss Nuclear Medicine centers. We now performed a study at the European level and hypothesized that there is also considerable variability among European experts. We performed a decision-tree based analysis of management strategies from all members of the EANM thyroid committee to map current practice among experts. We collected data on whether or not RIT is administered, on which criteria these decision are based, and collected details on treatment-activities and patient preparation. Our study shows discrepancies for low-risk DTC, where “follow-up only” is recommended by some experts while RIT with significant doses is used by other experts. E.g. for pT1b tumors without evidence of metastases the level of agreement for the use of RIT is as low as 50%. If RIT is administered, activities of I-131 range from 1.1 GBq to 3.0 GBq. In other constellations (e.g. pT1a) experts diverge from current clinical guidelines as up to 75% administer RIT in certain cases. For intermediate and high-risk patients, RIT is generally recommended. However, dosing and treatment preparation (rhTSH vs. THW) vary distinctly. In comparison to the Swiss study, the general level of agreement is higher among the European experts. The recently proposed approach on the use of RIT, based on integrated post-surgery assessment (Martinique paper) and results of ongoing prospective randomized studies are likely to reduce uncertainty in approaching RIT treatment. In certain constellations, consensus identified among European experts might be helpful in formulating future guidelines.

scholarly journals Predictors of thyroglobulin in the lymph nodes recurrence of papillary thyroid carcinoma undergoing total thyroidectomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhichao Xing ◽  
Yuxuan Qiu ◽  
Zhe Li ◽  
Lingyun Zhang ◽  
Yuan Fei ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Total Thyroidectomy ◽  
Radioactive Iodine ◽  
Independent Predictor ◽  
Central Neck Dissection ◽  
American Thyroid Association ◽  
Papillary Thyroid ◽  
Serum Thyroglobulin

Abstract Background To investigate the association between postoperative lymph nodes (LNs) recurrence and distinct serum thyroglobulin (Tg) levels in patients with papillary thyroid carcinoma (PTC). Methods This study included PTC patients who underwent total thyroidectomy (TT) with at least central neck dissection and then re-operated due to recurrence of LNs between January 2013 and June 2018. These patients were grouped by negative or positive serum Tg levels according to the American Thyroid Association guidelines. Results Of the 60 included patients, 49 underwent radioactive iodine (RAI) treatment. Maximum unstimulated Tg (uTg) ≥ 0.2 ng/mL were associated with larger diameter of recurrent LNs (P = 0.027), and higher rate of metastatic LNs (P < 0.001). Serum-stimulated Tg (off-Tg) ≥ 1 ng/mL (P = 0.047) and unstimulated Tg (on-Tg) ≥ 0.2 ng/Ml (P = 0.013) were associated with larger diameter of recurrent LNs. Number of metastatic LNs ≥ 8 was an independent predictor for postoperative maximum uTg ≥ 0.2 ng/mL (OR = 8.767; 95% CI = 1.392–55.216; P = 0.021). Ratio of metastatic LNs ≥ 25% was an independent predictor for off-Tg ≥ 1 ng/mL (OR = 20.997; 95% CI = 1.649–267.384; P = 0.019). Conclusion Postoperative Tg-positive status was associated with larger size of recurrent LNs. Number of metastatic LNs ≥ 8 and ratio of metastatic LNs ≥ 25% were independent predicators for uTg-positive and off-Tg-positive status, respectively.

scholarly journals Egyptian practical guidance in lipid management 2020

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Hesham Salah El Din Taha ◽  
Hala Mahfouz Badran ◽  
Hossam Kandil ◽  
Nabil Farag ◽  
Abbas Oraby ◽  
...  
Keyword(s):  
Risk Estimation ◽  
Low Density Lipoprotein ◽  
Management Strategies ◽  
Density Lipoprotein ◽  
Daily Practice ◽  
Main Body ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Management ◽  
Physician Awareness ◽  
User Friendly

Abstract Background Numerous epidemiological investigations and randomized clinical studies have determined that dyslipidemia is a major contributor to atherosclerotic cardiovascular disease (ASCVD). Consequently, the management of serum cholesterol and low-density lipoprotein levels has become a central objective in the effort to prevent cardiovascular events. Main body Many guidelines were issued by different organizations and societies to define patient risk and establish important recommendations for management strategies. Newer cholesterol-lowering agents (non-statin drugs) are described, and their use is directed primarily to secondary prevention in patients at very high risk of new ASCVD. Conclusion The present guidance summarizes the current methods for risk estimation and outlines the most recent data on lipid management in a simple user-friendly format, to improve physician awareness and help implement guidelines in the daily practice.

scholarly journals Measuring Knowledge, Attitudes, and Barriers to Medication Adherence in Potential Bariatric Surgery Patients

2021 ◽  
Author(s):  
Emanuela Bianciardi ◽  
Claudio Imperatori ◽  
Marco Innamorati ◽  
Mariantonietta Fabbricatore ◽  
Angelica Maria Monacelli ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Binge Eating ◽  
Treatment Effectiveness ◽  
Self Report ◽  
General Level ◽  
Psychiatric Interview ◽  
Obesity Epidemic ◽  
Post Surgery ◽  
Final Sample ◽  
The Status

Abstract Background Bariatric surgery is an effective treatment for the obesity epidemic, but the poor attendance and adherence rates of post-surgery recommendations threaten treatment effectiveness and health outcomes. Preoperatively, we investigated the unique contributions of clinical (e.g., medical and psychiatric comorbidities), sociodemographic (e.g., sex, age, and educational level), and psychopathological variables (e.g., binge eating severity, the general level of psychopathological distress, and alexithymia traits) on differing dimensions of adherence in a group of patients seeking bariatric surgery. Methods The final sample consisted of 501 patients (346 women). All participants underwent a full psychiatric interview. Self-report questionnaires were used to assess psychopathology, binge eating severity, alexithymia, and three aspects of adherence: knowledge, attitude, and barriers to medical recommendations. Results Attitude to adherence was associated with alexithymia (β = ˗2.228; p < 0.001) and binge eating disorder (β = 0.103; p = 0.047). The knowledge subscale was related to medical comorbidity (β = 0.113; p = 0.012) and alexithymia (β = −2.256; p < 0.001); with age (β = 0.161; p = 0.002) and psychiatric comorbidity (β =0.107; p = 0.021) manifesting in the barrier subscale. Conclusion We demonstrated that alexithymia and psychiatric and eating disorders impaired adherence reducing attitude and knowledge of treatment and increasing the barriers. Both patient and doctor can benefit from measuring adherence prior to surgery, with a qualitative approach shedding light on the status of adherence prior to the postsurgical phase when the damage regarding adherence is, already, done.

scholarly journals How to Intervene in the Health Management of the Oncological Patient and of Their Caregiver? A Narrative Review in the Psycho-Oncology Field

2021 ◽  
Vol 11 (7) ◽  
pp. 99
Author(s):  
Gian Piero Turchi ◽  
Marta Silvia Dalla Riva ◽  
Luisa Orrù ◽  
Eleonora Pinto
Keyword(s):  
Quality Of Life ◽  
Health Management ◽  
Psychological Treatment ◽  
Management Strategies ◽  
Well Being ◽  
Narrative Review ◽  
Treatment Modalities ◽  
Oncological Patient ◽  
Post Surgery

Starting from statistical data derived from the oncological field, some articles have highlighted the importance of communication in the patient–caregiver dyad and have considered the various roles involved in a cancer diagnosis situation. Thus, the question of how to intervene in terms of “quality of life” from the time of diagnosis to the recovery or death of a cancer patient, beyond the sanitary and physical dimensions, has become relevant. Therefore, the present narrative review aims to offer an overview of the state of the art in terms of the psychological treatment modalities of cancer patients, from the diagnosis to the post-surgery period. A total of 67 articles were collected and analyzed, in relation to (1) psychological constructs employed in the oncological field, (2) intervention models and (3) quality of life and well-being measurement and evaluation tools. We described these articles, differentiating between those focusing on the role of (1) the patient, (2) the caregiver, (3) the patient–caregiver dyad and (4) healthcare professional roles. The oncological diagnosis and its repercussions in the lives of the patient and caregiver were explored and critical aspects that emerged from the literature were highlighted. In conclusion, the analysis allowed some considerations about the need to define research protocols and useful management strategies for increasing the overall health of patients with cancer diagnoses and the people who surround them.

Nuclear medical inpatient treatment in Germany

2010 ◽  
Vol 49 (02) ◽  
pp. 49-57 ◽  
Author(s):  
M. Dietlein ◽  
C. Reiners ◽  
R. Lorenz
Keyword(s):  
Nuclear Medicine ◽  
Thyroid Cancer ◽  
Inpatient Treatment ◽  
Radioiodine Therapy ◽  
Main Diagnosis ◽  
Medical Inpatient ◽  
Iodine Prophylaxis ◽  
Iodine Supply ◽  
Quality Report ◽  
Quality Reports

SummaryAll public licensed hospitals of Germany are obligated since 2004 to establish and to publish a structured biennial quality report. The aim of this study was to analyse the quality reports from 2008 of clinics with nuclear-medicine therapy ward and to investigate developments for the inpatient nuclear-medicine therapy by comparing the results with the quality reports of the years 2004 and 2006. Methods: All available structured quality reports of clinics with a nuclear-medicine therapy ward of the years 2004, 2006 and 2008 were evaluated. Results: The total number of inpatient treatment cases in 2008 amounted to 54 190 (2006: 54 884; 2004: 57 366). This corresponds to a decrease of 5.5% in comparison to 2004. The number of the therapy wards decreased at the same time to currently 117 (2006: 120; 2004: 124). Remarkable changes were found in the spectrum of the main diagnosis. Thus, the most frequent diagnosis with the ICD-code E05 (hyperthyroidism) decreased continuously from 37 747 treatments in 2004 and 34 764 in 2006 to 31 756 in the year 2008. In contrast, the ICD-diagnoses for thyroid cancer (C73, Z08) with 14 761 cases in 2008 increased with time (2006: 13 426; 2004: 12 581). Conclusions: In analogy to the observations from Europe after introduction of an iodine prophylaxis the improved iodine supply in Germany has led to a decline of the radioiodine therapy due to hyperthyroidism.

scholarly journals Outcome of Fixed Dose of Radioiodine Therapy in Hyperthyroid Patients at NINMAS

2018 ◽  
Vol 20 (1) ◽  
pp. 37
Author(s):  
Sharmin Quddus ◽  
Fatima Begum ◽  
Nasreen Sultana ◽  
Rahima Perveen ◽  
Tapati Mandal ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Single Dose ◽  
Thyroid Function ◽  
Radioactive Iodine ◽  
Radioiodine Therapy ◽  
Thyroid Stimulating Hormone ◽  
Fixed Dose ◽  
Free Triiodothyronine ◽  
Toxic Goiter ◽  
Hyperthyroid Patients

<p><strong>Objective:</strong> The modified fixed doses of radioactive iodine (RAI) in different types of hyperthyroidism had been practiced at National Institute of Nuclear Medicine &amp; Allied Science (NINMAS) according to Society of Nuclear Medicine Bangladesh (SNMB) protocol since 2002 which was upgraded in 2015. The objective of the study was to observe the treatment outcome in modified fixed dose on previous protocol. Patients and Methods: In the present study the outcome of radioiodine therapy of hyperthyroid patients was retrospectively evaluated in 1349 consecutive primary hyperthyroid patients treated from January 2010 to December 2014 at NINMAS. Diagnosis of hyperthyroidism was done by thyroid function test; thyroid stimulating hormone (TSH), free triiodothyronine (FT3)   &amp; free thyroxine (FT4), 99m Technetium scan, thyroid radioiodine uptake and ultrasound imaging of thyroid gland. All patients received a fixed dose (8-29 m Ci) of radioactive iodine (RAI) depending on types of hyperthyroidism, visual assessment of gland size and severity of disease at diagnosis. They were followed up at 2 months of therapy, then every three months intervals for first year and thereafter 6 monthly up to 5 years or as needed during fluctuation of thyroid function.</p><p><strong>Results:</strong> Among the study population, 832 patients had diffuse toxic goiter (Graves’ disease), 369 patients were diagnosed as toxic multinodular goiter and 148 patients with single toxic nodule. At one year follow-up, permanent hypothyroidism occurred in 61.62% of patients and the cumulative incidence of hypothyroidism progressively increased up to 79.25% after 5 years. Cure or success of RAI therapy was considered as attainment of euthyroid state or hypothyroid state. About 11.26 % patients received more than single dose.</p><p><strong>Conclusion:</strong> Fixed dose RAI therapy is very much cost effective mode of treatment for primary hyperthyroidism with ~89% success by giving single dose.</p><p>Bangladesh J. Nuclear Med. 20(1): 37-40, January 2017</p>

Classroom Management 3.0

2021 ◽  
pp. 185-202
Author(s):  
Annette G. Walters
Keyword(s):  
Classroom Management ◽  
Management Strategies ◽  
Daily Practice ◽  
Well Being ◽  
Classroom Management Strategies ◽  
Management Processes ◽  
Critical Issues ◽  
Consistent Manner ◽  
The Impact ◽  
Educational Delivery

The impact of a poorly managed classroom on the health, well-being, and instruction of students, along with commensurate effects on the educational delivery and teacher efficacy has expanded nationally across school systems. There are often dire consequences of a poorly managed classroom, which includes teacher burnout, missed educational opportunities, increase absences of both students and teachers, poor test scores, educator fatigue, increase discipline and referrals, and reports of job dissatisfaction. While information about classroom management has proliferated, the art of implementing effective classroom management strategies across multitiered grades, content areas, and activities has not occurred in a seamless consistent manner. In this chapter, the literature on effective classroom management processes with multi-system approaches for delivery are suggested for providing cogent actions and strategies to educators in their daily practice. Critical issues and trends, perceptible strategies, and methods for implementation are covered.

scholarly journals Malformations in the offspring of women with thyroid cancer treated with radioiodine for the ablation of thyroid remnants

2006 ◽  
Vol 50 (5) ◽  
pp. 930-933 ◽  
Author(s):  
Pedro Weslley S. do Rosário ◽  
Álvaro Luís Barroso ◽  
Leonardo Lamego Rezende ◽  
Eduardo Lanza Padrão ◽  
Michelle A. Ribeiro Borges ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Ovarian Function ◽  
Radioiodine Therapy ◽  
Unfavorable Outcome ◽  
Favorable Outcome ◽  
Spontaneous Abortions ◽  
Radioiodine Treatment ◽  
Ablative Therapy ◽  
One Year

RATIONALE: Since ovarian function is only temporarily compromised by radioiodine therapy, many women with thyroid cancer treated with radioiodine can become pregnant. The present study evaluated the evolution of these pregnancies and the consequences for the offspring. PATIENTS AND METHODS: We retrospectively analyzed 78 pregnancies of 66 women submitted to total thyroidectomy, followed by radioiodine therapy (3.75.5 GBq 131I, mean 4.64 GBq). In all patients, conception occurred one year after ablative therapy (mean of 30 months). Age ranged form 19 to 36 years (mean of 30.6 years) at the time of radioiodine treatment and from 23 to 39 years (mean of 32.8 years) at the time of conception. RESULTS: Four (5.1%) of the 78 pregnancies resulted in spontaneous abortions. Three (4%) of the 74 deliveries were preterm and there was no case of stillbirth. The birthweight was > 2500 g in 94.6% of the children (mean ± SD: 3350 ± 450 g) and only one infant (1.3%) presented an apparent malformation at birth (intraventricular communication). No difference in the age at the time of radioiodine therapy or conception or in radioiodine dose was observed between pregnancies with an unfavorable outcome and those with a favorable outcome. CONCLUSION: We conclude that pregnancies that occur 12 months after ablative therapy are safe.

scholarly journals Time course of Graves’ orbitopathy after total thyroidectomy and radioiodine therapy for thyroid cancer

Medicine ◽  
2016 ◽  
Vol 95 (48) ◽  
pp. e5474 ◽  
Author(s):  
Camille Louvet ◽  
Annamaria De Bellis ◽  
Bruno Pereira ◽  
Claire Bournaud ◽  
Antony Kelly ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Time Course ◽  
Radioiodine Therapy ◽  
Graves Orbitopathy

Guideline-orientated Diagnosis of Thyroid Nodules

2009 ◽  
Vol 05 (0) ◽  
pp. 59 ◽  
Author(s):  
Ralf Paschke ◽  
Enrico Papini ◽  
Hossein Gharib ◽  
◽  
◽  
...  
Keyword(s):  
Rating Scales ◽  
Thyroid Nodules ◽  
Consensus Statement ◽  
Practice Patterns ◽  
American Association ◽  
Positive Impact ◽  
Management Strategies ◽  
American Thyroid Association ◽  
Recommendations For Practice ◽  
Genetic And Environmental Factors

Thyroid nodules are very common. Their aetiology is due to the interaction between genetic and environmental factors. In 2006, two major society-sponsored guidelines and one major consensus statement for thyroid diagnosis and management were published by the American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi (AACE/AME), the American Thyroid Association (ATA) and the European Thyroid Association (ETA). A careful review of these guidelines reveals that despite many similarities, significant differences are also present, likely reflecting differences in practice patterns, interpretation of existing data and availability of resources in different regions. The methodology of the guidelines is similar, but a few differences in the rating scales make a rapid comparison of the strength of both evidence and recommendations difficult for use in current clinical practice. Some recommendations are based mostly on expert opinion. The same recommendation may be based on different evidence; on the other hand, sometimes the same evidence may induce a different recommendation. A survey performed during an interactive symposium at the 32nd annual meeting of the ETA in Leipzig, Germany, was carried out to investigate whether these guidelines were able to affect the divergent management strategies for thyroid nodules that have previously been documented. The thyroid nodule guidelines obviously provide useful information and recommendations for practice and have a positive impact on patient care; however, guidelines should be considered as suggestions rather than a rigid formula for practice. With further accumulating evidence, these guidelines will need revision and updating.

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