Favourable course of disease after incomplete remission on 131I therapy in children with pulmonary metastases of papillary thyroid carcinoma: 10 years follow-up

  • Johannes Biko
  • Christoph ReinersEmail author
  • Michael C. Kreissl
  • Frederik A. Verburg
  • Yuri Demidchik
  • Valentina Drozd
Short Communication



The aim of this study is to report on a collective of 20 children from Belarus who had developed papillary thyroid carcinoma with pulmonary metastases after the Chernobyl disaster. In all children fractionated radioiodine therapy (RIT) was ceased before achieving complete remission due to a lack of further effects of 131I therapy and an increased risk of pulmonary fibrosis.


The 20 children (12 girls) were treated with 131I using 50 MBq/kg body weight for thyroid remnant ablation and 100 MBq/kg for further therapy in intervals of 5–12 months. After five to six courses and a cumulative activity of about 24 GBq 131I no further RIT was conducted; the median thyroglobulin (TG) was 56 μg/l at this time. All patients were followed for at least 10 years after cessation of RIT using diagnostic whole-body scintigraphy, CT of the chest, lung function testing and stimulated TG measurements every 1–3 years.


During follow-up after the last RIT a continuous decline of values for TG levels of ∼35% per year was observed between individual visits. The median Tg level at the time of cessation of 131I therapy was 56 µg/l; however, at the last visit 16 of 20 patients had a TG level ≤10 μg/l (median 2.4 μg/l). Neither on diagnostic radioiodine whole-body scan nor on CT was progression of lung metastases observed. No significant pulmonary fibrosis developed.


In spite of incomplete remission of thyroid cancer at cessation of RIT, a continuing spontaneous decline of TG and clinically stable partial remissions were observed in this collective of children. Therefore, if RIT does not show further effects, the administration of further courses should be handled restrictively.


Radiation-induced thyroid carcinoma Childhood thyroid carcinoma Metastases 131I therapy Follow-up 


Conflicts of interest



  1. 1.
    American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167–214.PubMedCrossRefGoogle Scholar
  2. 2.
    Reiners C, Demidchik YE, Drozd VM, Biko J. Thyroid cancer in infants and adolescents after Chernobyl. Minerva Endocrinol 2008;33:381–95.PubMedGoogle Scholar
  3. 3.
    Demidchik YE, Demidchik EP, Reiners C, Biko J, Mine M, Saenko VA, et al. Comprehensive clinical assessment of 740 cases of surgically treated thyroid cancer in children of Belarus. Ann Surg 2006;243:525–32.PubMedCrossRefGoogle Scholar
  4. 4.
    Farahati J, Demidchik EP, Biko J, Reiners C. Inverse association between age at the time of radiation exposure and extent of disease in cases of radiation-induced childhood thyroid carcinoma in Belarus. Cancer 2000;88:1470–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Dottorini ME, Vignati A, Mazzucchelli L, Lomuscio G, Colombo L. Differentiated thyroid carcinoma in children and adolescents: a 37-year experience in 85 patients. J Nucl Med 1997;38:669–75.PubMedGoogle Scholar
  6. 6.
    Baudin E, Do Cao C, Cailleux AF, Leboulleux S, Travagli JP, Schlumberger M. Positive predictive value of serum thyroglobulin levels, measured during the first year of follow-up after thyroid hormone withdrawal, in thyroid cancer patients. J Clin Endocrinol Metab 2003;88:1107–11.PubMedCrossRefGoogle Scholar
  7. 7.
    Newman KD, Black T, Heller G, Azizkhan RG, Holcomb GW, Sklar C, et al. Differentiated thyroid cancer: determinants of disease progression in patients <21 years of age at diagnosis: a report from the Surgical Discipline Committee of the Children’s Cancer Group. Ann Surg 1998;227:533–41.PubMedCrossRefGoogle Scholar
  8. 8.
    Alessandri AJ, Goddard KJ, Blair GK, Fryer CJ, Schultz KR. Age is the major determinant of recurrence in pediatric differentiated thyroid carcinoma. Med Pediatr Oncol 2000;35:41–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Song H, He B, Prideaux A, Du Y, Frey E, Kasecamp W, et al. Lung dosimetry for radioiodine treatment planning in the case of diffuse lung metastases. J Nucl Med 2006;47:1985–94.PubMedGoogle Scholar
  10. 10.
    Luster M, Lassmann M, Freudenberg LS, Reiners C. Thyroid cancer in childhood: management strategy, including dosimetry and long-term results. Hormones (Athens) 2007;6:269–78.Google Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Johannes Biko
    • 1
  • Christoph Reiners
    • 1
    Email author
  • Michael C. Kreissl
    • 1
  • Frederik A. Verburg
    • 1
  • Yuri Demidchik
    • 2
  • Valentina Drozd
    • 3
  1. 1.Department of Nuclear MedicineUniversity of WürzburgWürzburgGermany
  2. 2.Thyroid Cancer CentreMinskBelarus
  3. 3.International Belarusian-German Foundation “Help for radiation-induced thyroid cancer patients”: “Arnica”MinskBelarus

Personalised recommendations