Real-time quantitation of thyroidal radioiodine uptake in thyroid disease with monitoring by a collar detection device

Abstract

Radioactive iodine (RAI) is safe and effective in most patients with hyperthyroidism but not all individuals are cured by the first dose, and most develop post-RAI hypothyroidism. Postoperative RAI therapy for remnant ablation is successful in 80-90% of thyroid cancer patients and sometimes induces remission of nonresectable cervical and/or distant metastatic disease but the effective tumor dose is usually not precisely known and must be moderated to avoid short- and long-term adverse effects on other tissues. The Collar Therapy Indicator (COTI) is a radiation detection device embedded in a cloth collar secured around the patient's neck and connected to a recording and data transmission box. In previously published experience, the data can be collected at multiple time points, reflecting local cervical RAI exposure and correlating well with conventional methods. We evaluated the real-time uptake of RAI in patients with hyperthyroid Graves' disease and thyroid cancer. We performed a pilot feasibility prospective study. Data were analyzed using R© (version 4.0.3, The R Foundation for Statistical Computing, 2020), and Python (version 3.6, Matplotlib version 3.0.3). The COTI was able to provide a quantitative temporal pattern of uptake within the thyroid in persons with Graves' disease and lateralized the remnant tissue in persons with thyroid cancer. The study has demonstrated that the portable collar radiation detection device outside of a healthcare facility is accurate and feasible for use after administration of RAI for diagnostic studies and therapy to provide a complete collection of fractional target radioactivity data compared to that traditionally acquired with clinic-based measurements at one or two time-points.Clinical Trials Registration NCT03517579, DOR 5/7/2018.

Conflict of interest statement

PS, LS, TN, EF, GS and PWL have nothing to declare. JPS and DG are employed by AG Medical, the maker of the device. However, they had no role in the research protocol formulation, gathering and analysis of data or manuscript preparation. They provided the technical details of the device during the analysis. It has been elaborated in the beginning.

© 2021. The Author(s).

Figures

Figure 1

(Graves Patient 1) (a) 123 scan showing diffuse heterogenous uptake in both the lobes (b) superimposed uptake in the right and left side showing near similarity (c) Uptake (absolute counts) in the right lobe with counts and trend over time (in seconds) (d) Uptake (absolute counts) in the left lobe with counts and trend over time (in seconds) (loess curves are shown above).

Figure 2

(Graves Patient 2) (a) 123 scan showing diffuse heterogenous uptake in both the lobes (b) superimposed uptake in the right and left side showing near similarity but with different pattern of uptake (c) Uptake (absolute counts) in the right lobe with counts and trend over time (in seconds) (d) Uptake (absolute counts) in the left lobe with counts and trend over time (in seconds) (loess curves are shown above).

Figure 3

(a) First DTC Patient (Patient 3) Whole body planar image showing intense uptake in the neck at the site of remnant and physiological uptake in the bowel, nasopharynx and bladder. (b) First DTC Patient (Patient 3)-I-123 COTI measurements : Left- Superimposed right and left side over time points, right upper- left side COTI measurements over time in seconds, right lower—right side COTI measurements over time in seconds. (c) First DTC Patient (Patient 3): Left—Post-131 planar image, Right-Post-131 SPECT/CT showing bilateral areas of intense uptake. (d) First DTC Patient (Patient 3)-I-131 COTI measurements : Left- Superimposed right and left side over time points, right upper- left side COTI measurements over time in seconds, right lower—right side COTI measurements over time in seconds.

Figure 3

(a) First DTC Patient (Patient 3) Whole body planar image showing intense uptake in the neck at the site of remnant and physiological uptake in the bowel, nasopharynx and bladder. (b) First DTC Patient (Patient 3)-I-123 COTI measurements : Left- Superimposed right and left side over time points, right upper- left side COTI measurements over time in seconds, right lower—right side COTI measurements over time in seconds. (c) First DTC Patient (Patient 3): Left—Post-131 planar image, Right-Post-131 SPECT/CT showing bilateral areas of intense uptake. (d) First DTC Patient (Patient 3)-I-131 COTI measurements : Left- Superimposed right and left side over time points, right upper- left side COTI measurements over time in seconds, right lower—right side COTI measurements over time in seconds.

Figure 4

(a) Second DTC Patient (Patient 4) Whole body planar image showing intense uptake in the neck at the site of remnant on the left side with extension medially with suppression of the rest of the body. (b) Second DTC Patient (Patient 4)-I-123 COTI measurements : Left- Superimposed right and left side over time points, right upper- left side COTI measurements over time in seconds, right lower—right side COTI measurements over time in seconds(absolute counts shown). (c) Second DTC Patient (Patient 4): Left—Post-131 planar image, Right-Post-131 SPECT/CT showing left sided intense uptake with minimal uptake on the right. (d) Second DTC Patient (Patient 4)-I-131 COTI measurements : Left- Superimposed right and left side over time points(high uptake in the left compared to right), right upper—left side COTI measurements over time in seconds, right lower—right side COTI measurements over time in seconds (left sided uptakes are significantly higher as seen by the scaling in the Y axis).

Figure 4

(a) Second DTC Patient (Patient 4) Whole body planar image showing intense uptake in the neck at the site of remnant on the left side with extension medially with suppression of the rest of the body. (b) Second DTC Patient (Patient 4)-I-123 COTI measurements : Left- Superimposed right and left side over time points, right upper- left side COTI measurements over time in seconds, right lower—right side COTI measurements over time in seconds(absolute counts shown). (c) Second DTC Patient (Patient 4): Left—Post-131 planar image, Right-Post-131 SPECT/CT showing left sided intense uptake with minimal uptake on the right. (d) Second DTC Patient (Patient 4)-I-131 COTI measurements : Left- Superimposed right and left side over time points(high uptake in the left compared to right), right upper—left side COTI measurements over time in seconds, right lower—right side COTI measurements over time in seconds (left sided uptakes are significantly higher as seen by the scaling in the Y axis).