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Long-term efficacy of current thyroid prophylaxis and future perspectives on thyroid protection during 131I-metaiodobenzylguanidine treatment in children with neuroblastoma

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Treatment with 131I-MIBG is associated with significant thyroid damage. This study was undertaken to investigate the long-term efficacy of current thyroid prophylaxis, to explore the relationship between thyroid dysfunction and thyroid volume after exposure to 131I-MIBG and to evaluate the possible negative effects of 131I− on the parathyroid glands.

Methods

Of 81 long-term surviving patients with neuroblastoma treated with 131I-MIBG during the period 1999–2012, 24 were finally evaluated. Patients received thyroxine (T4), methimazole and potassium iodide as thyroid protection. In all patients (para)thyroid function was evaluated and ultrasound investigation of the (para)thyroid gland(s) was performed. Thyroid dysfunction was defined as a plasma thyrotropin concentration >5.0 mU/L (thyrotropin elevation, TE) or as the use of T4 at the time of follow-up. Hyperparathyroidism was defined as a serum calcium concentration above the age-related reference range in combination with an inappropriately high parathyroid hormone level.

Results

At a median follow-up of 9.0 years after 131I-MIBG treatment, thyroid disorders were seen in 12 patients (50 %; 9 with TE, 5 with a thyroid nodule and 1 patient was subsequently diagnosed with differentiated thyroid carcinoma). No significant risk factors for the occurrence of thyroid damage could be identified. In 14 of 21 patients (67 %) in whom thyroid volume could be determined, the volume was considered small (<−2SD) for age and gender. Patients treated with T4 at the time of follow-up had significantly smaller thyroid volumes for age than patients without T4 treatment (p = 0.014). None of the patients was diagnosed with hyperparathyroidism.

Conclusion

Thyroid protection during treatment with 131I-MIBG needs attention and must be further improved, as thyroid disorders are still frequently seen despite current thyroid prophylaxis. Reduced thyroid volume in neuroblastoma survivors may be related to previous 131I-MIBG therapy or current T4 treatment. No deleterious effects of 131I-MIBG on the parathyroid glands could be found.

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Acknowledgments

We thank Prof. dr. W.M. Wiersinga and Dr. J. Podoba for providing the reference value data on thyroid volumes in healthy Dutch schoolchildren.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Pediatric Endocrinology, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands

    S. C. Clement & A. S. P. van Trotsenburg

  2. Department of Pediatric Oncology, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    S. C. Clement, H. N. Caron & G. A. M. Tytgat

  3. Department of Radiology, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    R. R. van Rijn

  4. Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    B. L. F. van Eck-Smit

  5. Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands

    H. M. van Santen

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  1. S. C. Clement
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  3. B. L. F. van Eck-Smit
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  7. H. M. van Santen
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Correspondence to S. C. Clement.

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Clement, S.C., van Rijn, R.R., van Eck-Smit, B.L.F. et al. Long-term efficacy of current thyroid prophylaxis and future perspectives on thyroid protection during 131I-metaiodobenzylguanidine treatment in children with neuroblastoma. Eur J Nucl Med Mol Imaging 42, 706–715 (2015). https://doi.org/10.1007/s00259-014-2967-4

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  • DOI: https://doi.org/10.1007/s00259-014-2967-4

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