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Query: UMLS:C0034069 (pulmonary fibrosis)
 7,050 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of thyroid cancer in childhood amounts to approximately 0,5/100.000/year. However, after exposure to ionizing irradiation, the incidence may increase more than 20 fold. In children, lymph node metastases of differentiated thyroid cancer are frequent (more than 50%); distant metastases mainly to the lung are seen in 20-30%. The method of choice for the primary diagnosis of thyroid cancer today is ultrasonography with 7,5 - 10 MHz probes, accompanied by fine-needle aspiration biopsy. Differentiated thyroid cancer has to be treated with a multidisciplinary approach comprising total thyroidectomy and lymph node dissection, post-operative radioiodine treatment and TSH-suppression by levothyroxine. The long-term results of this treatment approach are generally good with 10-year survival rates of 95% and higher. The treatment of children with disseminated pulmonary metastases however, may be complicated due to the increased risk of the induction of pulmonary fibrosis by radioiodine.
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PMID:Differentiated thyroid cancer in childhood: pathology, diagnosis, therapy. 1644 63

Thyrotoxicosis due to functioning metastases in differentiated thyroid cancer (DTC) is exceedingly rare. We report a case of follicular carcinoma in a 54-year-old manager, who presented with thyrotoxicosis, shortness of breath and lung metastases. Transbronchial biopsy of a pulmonary nodule demonstrated normal thyroid. This was interpreted as representing very well-differentiated thyroid cancer. CT, (131)I whole-body imaging and dosimetry is described following total thyroidectomy and repeated radioiodine administration (cumulative activity 34.6 GBq). The patient became asymptomatic with almost complete eradication of the pulmonary metastases. Potential complications of thyroid storm, bone marrow failure and pulmonary fibrosis following radioiodine are discussed, together with methods to minimise these risks.
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PMID:Differentiated thyroid cancer presenting with thyrotoxicosis due to functioning metastases. 1749 53

Studies in children medically exposed to external irradiation more than 50 years ago revealed a considerably increased risk for thyroid cancer. Similarly, a strongly age-dependent risk for thyroid cancer was observed in the Japanese population after the atomic bomb explosions with the highest risk in the group of children below age of 10. After the Chernobyl accident, children from Belarus living in highly exposed regions received mean thyroid doses by radioactive fallout higher by a factor of approximately 2 as compared to the survivors of the atomic bomb explosions. This lead to a radiation related increase of thyroid cancer incidence in children and adolescents with the highest incidence in age group 0-4 years up to now totally amounting to approximately 5 000 cases. For screening of thyroid cancer in children, high resolution ultrasound is the method of choice which has to be complemented by fine-needle aspiration biopsy in suspicious cases. Diagnostic criteria for malignancy in childhood thyroid cancer by ultrasound are hypoechogenicity and irregularity of the outline, subcapsular location of lesions and increased peri-intranodular vascularisation. The treatment strategy for thyroid cancer in children does not differ substantially from the approach used in adults. Primary treatment consists of thyroidectomy and lymph node dissection. Careful and complete removal of the lymph nodes is of great clinical relevance in children because of very frequent node involvement (between 40% and 90%). Because of the high prevalence of lymph node metastases, ablation of thyroid remnants is mostly indicated in children with thyroid cancer. Distant metastases which need higher activities of radioiodine are less frequent with 10-20%. Even in advanced cases of childhood thyroid cancer, long-lasting remissions can be achieved. A specific finding in children is disseminated, milliary lung metastases with intense radioiodine uptake. In this situation, pulmonary fibrosis may be a severe side-effect so that the indication for repeated courses of radioiodine therapy has to be decided thoroughly. With respect to side-effects of radioiodine therapy, the risk of developing breast cancer has to be taken into account seriously since especially the female breast is exposed to a relatively high radiation dose. Generally, young patients treated with high activities of radioiodine should be carefully followed up during their whole lifespan.
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PMID:Thyroid cancer in infants and adolescents after Chernobyl. 1892 72

Radioactive iodine (RAI) in the form of (131)I has been used to treat thyroid cancer since 1946. RAI is used after thyroidectomy to ablate the residual normal thyroid remnant, as adjuvant therapy, and to treat thyroid cancer metastases. Although the benefits of using RAI in low-risk patients with thyroid cancer are debated, it is frequently used in most patients with thyroid cancer and is clearly associated with acute and long-term risks and side effects. Acute risks associated with RAI therapy include nausea and vomiting, ageusia (loss of taste), salivary gland swelling, and pain. Longer-term complications include recurrent sialoadenitis associated with xerostomia, mouth pain, dental caries, pulmonary fibrosis, nasolacrimal outflow obstruction, and second primary malignancies. This article summarizes the common complications of RAI and methods to prevent and manage these complications.
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PMID:Complications of radioactive iodine treatment of thyroid carcinoma. 2108 84

A 46-year-old woman known with relapsing Hodgkin's lymphoma diagnosed at age 5, treated with repeated cycles of radiotherapy and chemotherapy, presented with severe symptomatic radiation-induced aortic stenosis. She also had other late sequelae of radiotherapy including thyroid cancer, mediastinal fribrosis and left pulmonary fibrosis with severe restrictive lung disease and a newly diagnosed renal carcinoma. Due to the prohibitively high surgical risk and need for urgent treatment, she underwent successful transcatheter aortic valve replacement with transfemoral implantation of a 23 mm Edwards SAPIEN-XT prosthesis, which was performed without valvuloplasty of the noncalcified fibrotic valve. The final result was excellent with reduction of the transaortic gradient and no residual aortic regurgitation.
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PMID:Percutaneous valve replacement in a young adult for radiation-induced aortic stenosis. 2245 Aug 61

Differentiated thyroid cancer (DTC) is the most common endocrine malignancy. It usually has a comparatively benign course. If properly executed, radioiodine therapy can provide an effective treatment of even advanced, metastatic DTC. A major problem in determining the right RAI for a patient with metastatic disease is a comparative lack of evidence. There are no reports on randomized controlled trials in this patient group which can aid us in determining which way to treat which patient. Few non-randomized prospective observational studies have been performed. Most available evidence is based on retrospective analyses which, although often informative, still are hampered by the selection bias inherent to retrospective studies on a small, preselected sample of the total DTC population. The aim of the present review is to provide an overview of the relevant literature on the issues pertinent to the execution of RAI. Radioiodine therapy of metastatic DTC in patients can be an effective treatment modality which will contribute significantly to a patients' life expectancy. However, much is unclear in the management of this malignancy, including which activity to use, how to determine this activity (empiric vs. dosimetric approach) as well as the potential long-term complications. In pediatric patients, special considerations apply with regard to weight-adaptation of activities as well the risk of pulmonary fibrosis in patients with diffuse miliary metastases.
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PMID:Radioactive iodine (RAI) therapy for metastatic differentiated thyroid cancer. 2891 24