REPOST: Dr. Ain: Re: LID --> Pamela

[Guest guest]

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(Dr. Ain)

Date: Tue, 10 Dec 2002 10:36:59 -0500

Subject: Re: LID for Thyrogen WBS

>Thanks for all the replies to my question. New endo returned my

>call last night and said since I won't be going off Unithroid

>there isn't much logic in doing the LID.

Dear ThyCa Members:

The statement above is absolutely wrong. The Low Iodine Diet (LID)

is necessary for radioiodine scanning independent of whether

Thyrogen® or a hypothyroid preparation is used. There are several

important components critical for an accurate and sensitive

radioactive iodine nuclear scan. Among them are TSH (whether

injected into your body in the form of Thyrogen® or generated

naturally from your pituitary gland from being hypothyroid) and

eliminating non-radioactive iodine from being taken up by thyroid

cancer cells instead of the radioactive iodine (thus the LID). These

are two separate and independent parameters. Simple calculations can

demonstrate at least an 8-10-fold increased uptake of radioactive

iodine by thyroid cancer cells, merely by being on a LID (despite

using Thyrogen® or hypothyroid preparation). No one should give up

such an advantage unknowingly.

--

**************PLEASE BE ADVISED*********************

THE INFORMATION CONTAINED IN THIS COMMUNICATION IS INTENDED

FOR EDUCATIONAL PURPOSES ONLY. IT IS NOT INTENDED, NOR SHOULD

IT BE CONSTRUED, AS SPECIFIC MEDICAL ADVICE OR DIRECTIONS. ANY

PERSON VIEWING THIS INFORMATION IS ADVISED TO CONSULT THEIR OWN

PHYSICIAN(S) ABOUT ANY MATTER REGARDING THEIR MEDICAL CARE.

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B. Ain, M.D.

Professor of Medicine

Director, Thyroid Nodule & Oncology Clinical Service

Director, Thyroid Cancer Research Laboratory

Division of Endocrinology and Molecular Medicine

Department of Internal Medicine, Room MN524

University of Kentucky Medical Center

800 Rose Street, Lexington, Kentucky 40536-0298

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Date: Wed, 10 Oct 2001 11:16:24 -0400

Subject: LID doesn't vary with doctors. Rather,

> Seems that your doctor(s) are not well versed on/in/with ThyCa

treatment-care.

>

>THE _single_ most important thing that a person with ThyCa can do on their

own behalf.. is the LID!

>

> Please read the following posts. And I would certainly show them to your

doctor(s) as well!

>

> _Most_ doctors do-not know/understand the information necessary for the

proper management of ThyCa.

_________________________________

> Please read Dr. , too!

>

>

>

>

>

>> " As for the LID, I have read that many people went on LID for 2

>>weeks prior. I only did it for 3 days. I guess it varies with docs. "

>

>

>

>

> Sorry,

>

> But, LID doesn't vary with doctors. Rather, that the less well educated doc's

vary the LID.

>

>

>

>

> LID is a biological process of iodine elimination, of which in Dr. Ain's (and

that of others) research studies, proves maximum benefit after 1 week in most

cases.

>

> He recommends LID for 2 weeks.. just so you will have a better chance of

" getting it right " , in which case it will be of more benefit than if adhering to

it for only 1 week and making serious mistakes as to iodine in-take amount.

>

> Aside from the after surgery healing process that is the responsibility of

our own body; the treatment process for ThyCa is a system of mathematics

including the math of time(ing). The " when " to do " what " step, in it's

management.

>

>

> Some examples of timing.

>Type of ThyCa: <treatment course will vary.

>

>LID serves no purpose _after_ (48hrs.) following RAI; only, before it.

>

>

>With a difficult case of ThyCa; dosimetry testing must be performed _before_

RAI. The reason for dosimetry testing is for the determination of a/the safe RAI

dosage level to be administered with regard to bone marrow affect.

>

> Timing, timing,

>Taken into account along the path of treatment, there is also a need to know tg

levels both on and off the meds. And is it with or without antibodies.

>

> Timing.

>

> The time(ing for LID is 2 weeks prior to RAI.

>

>

>

Nick

>

>

>

>*******************************************************************************\

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>

>(Dr. Ain)

> " Long term experience demonstrates that close adherence to a simple low iodine

diet, as I attach below, will result in a 24-hour iodine excretion of less than

50 mcg and result in significant enhancement of radioactive iodine uptake in

thyroid cancer cells. "

>

>(Dr. Ain)

> " Proper compliance with a low-iodine diet (either a standard one or the

tube-feeding diet) can be verified by obtaining a 24-hour urine sample and

having it assayed for total free iodide. On the diet, the level should be less

than 50 mcg iodide in a day -- frequently it is much lower. Off the diet, the

iodide excretion is typically 250-400 mcg daily, depending on the nature of the

person's typical diet. "

>

> " Ain KB, DeWitt PA, Gardner TG, & Berryman SW. Low-iodine tube-feeding diet

for iodine-131 scanning and therapy. Clinical Nuclear Medicine 19: 504-7,

1994. "

>

>

>

>

>

>

>

>

>

>

>*******************************************************************************\

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>

>(Dr. Ain)

>

>

>Date: Mon, 03 Jan 2000 09:18:52 -0400

>

>Subject: Where's the Beef??!!

>

>>I did not have to go on a low iodine diet - Doc said that

>>studies have shown that the effects of a diet are practically nil.

>

>

>I would be extremely interested in seeing ANY such study. As a

>thyroid oncologist who has carefully examined the medical literature

>regarding thyroid cancer for more than 15 years, I have NEVER seen

>even one such study. I wonder if this statement, above, reflects a

>cavalier attitude towards patient questions or intellectual

>dishonesty.

>

>**************PLEASE BE ADVISED**********************

>THE INFORMATION CONTAINED IN THIS COMMUNICATION IS INTENDED

>FOR EDUCATIONAL PURPOSES ONLY. IT IS NOT INTENDED, NOR SHOULD

>IT BE CONSTRUED, AS SPECIFIC MEDICAL ADVICE OR DIRECTIONS. ANY

>PERSON VIEWING THIS INFORMATION IS ADVISED TO CONSULT THEIR OWN

>PHYSICIAN(S) ABOUT ANY MATTER REGARDING THEIR MEDICAL CARE.

>*************************************************

> B. Ain, M.D.

>Associate Professor of Internal Medicine

>Director, Thyroid Nodule & Oncology Clinical Service

>Director, Thyroid Cancer Research Laboratory

>Division of Endocrinology and Molecular Medicine

>Department of Internal Medicine, Room MN520

>University of Kentucky Medical Center

>800 Rose Street, Lexington, Kentucky 40536-0084

>

>*******************************************************************************\

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>

>

>

>

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>

>(Dr. )

>

>Date: Tue, 16 May 2000 18:15:36 -0400

>

>Subject: Re: Dr. -one more question

>

>,

>

>Normal liver uptake is diffuse, that is it involves the entire liver in a

>uniform fashion. Metastatic disease to the liver is focal, so there are " hot

>spots " seen in the liver.

>

>The distinction between normal uptake and uptake due to metastatic disease can

>be usually determined by knowing the typical normal appearance of a scan, using

>special or delayed views and in rare cases obtaining a correlative procedure

>like a thallium or PET scan. Nuclear medicine physicians with experience in

>reading radioiodine total body scans rarely have trouble in distinguishing

>normal from abnormal uptake. I find that physicians with little experience

often

>have difficulty distinguishing normal from abnormal uptake and " err " on the

side

>of calling uptake abnormal. I am sometimes asked to provide a second

>interpretation of " positive " scans from other hospitals that infrequently

>perform total body scans. About half of these scans are so poorly performed

that

>no interpretation is possible. On the other half, almost all of the areas of

> " lung mets " , " liver mets " , " bowel mets " , etc. represent normal uptake that were

>not recognized by the original interpreting physician.

>

>Bottom line: Have your total body scans performed by facilites that do a lot of

>I-131 scans for thyroid cancer and have your scan interpreted by someone with a

>lot of experience in performing and interpreting these scans. By " a lot " I mean

>at least 25 I-131 total body scans for thyroid cancer each year and preferably

>more than 100 per year. For comparison, my clinic performs about 500/year and I

>read about 400/year.

>

>One common rule of medicine is that physicians who do a lot of something are

>almost always much better than those who do a small amount of something,

whether

>it be total body scans, thyroidectomies, or managing thyroid hormone in

patients

>with thyroid cancer. The scientific literature has documented that there is a

>ten-fold difference in complication rates among surgeons who perform

>thyroidectomies that is inversely related to the number of thyroidectomies

>performed each year. Unfortunately, neither insurers, government, hospitals nor

>physicians themselves have had the courage to tell physicians who read only 3

>total body scans a year or perform only 8 thyroidectomies a year that they have

>no business performing those procedures, will not be referred to, will not be

>allowed to do so, and will not be paid to do so.

>

>Jeff

>

>CaneWrites@... wrote:

>

>> Dr. ,

>>

>> Thanks for your speedy reply to my question about normal uptake. Given the

>> fact that so many places typically have uptake without having mets, how then

>> are mets found when they occur in a place such as the liver? Is there more

>> than usual uptake? Or some other indication?

>>

>> Thanks,

>> G.

>

>--

> A. , MD

>Nuclear Medicine, A-72 (Fax)

>Albany Medical Center (Beeper)

>Albany, NY 12203 cooperj@...

>

>

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>

>

>

>At 8/31/01 04:47 PM, you wrote:

>>I've been bracing myself for going low idodine (is this the LID

>>you've all been refering to?) but my endo said it wasn't really

>>necessary, just to lay off the sushi, seafood. I'm curious if anyone

>>else has had similar advice. She said the amount of normal idodine in

>>my diet won't really affect the scan. I'm cutting back anyway,

>>however I'm not sure I understand the why's or why not's on this. Jen

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>Date: Tue, 05 Nov 2002 19:41:05 +0000

>

>Subject: What a difference a LID makes :-)

>Greetings all,

>

>I am preparing for my first post-TT scan & abalative RAI treatment.

>For various reasons, my endo ordered pre-LID and post-LID analyses

>of my iodine level from 24-hour urine collections (the ones they

>ship off to the Mayo Clinic).

>

>Pre-LID, my iodine level was 384 (I apologize for not having the

>unit of measurement), which was above the " high normal " range (which

>tops at 350, according to my endo). After doing the LID for about

>eight days (and being off Cytomel for same), a second " collection "

>was taken and analyzed. My iodine level dropped from 384 to 51! My

>endo is a fan of the LID, but was amazed at the drop.

>

>Even while not on the LID, I'm not a seafood eater, so that's *not*

>why my pre-LID iodine level was so high. I do tend to eat a lot of

>processed foods while not on LID (hmmm ... may be time to re-think

>some of those), as well as a lot of soy.

>

>THANK YOU to kabob, and others here, who posted and/or archived

>LID recipies and LID-friendly commercial products that even a

>culinary doofus like me can work with in lieu of real cooking!

>

>Suzy

>Age 44

>FNA, July 2002 (papillary cancer found in lymph node)

>TT, September 2002 (all 18 lymph nodes removed positive for papca)

>Scheduled for scan/ablative RAI doses shortly

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>Date: Thu, 19 Jul 2001 06:59:42 -0400

>

>Subject: Re: Documents to show advantadges of LID

>Hi Beckie,

>Thyca.org site under " radiation " link has some info and the diet outline

>on it. You certainly don't need a doctors permission to go on LID tho

>it is nice to have his support. I have even run into radiology tech's

>who are adamant about the benefits of LID for better isotope uptake.

>

>The Carcinoma 2001 paper refers to LID " ...A low-iodine diet is consumed

>for 2-4 weeks before radioidoine scanning. ... " (pg 209)

>http://www.aace.com/clinguideindex.htm

>

>Hope this helps

>Alyn

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At 12/18/2002 02:37 PM, you wrote:

>

>

>> I know you know all the reasons by now, why the LID is a good thing

>to do.

>>

>> The message you may not be getting from our letters, though, is

>that it really isn't that bad. <

>

>Thanks , I although my endo doesn't think an LID is necessary I

>will give it a shot, although I can't imagine starting until after

>Christmas. My birthday is 5 days later and my friends had planned to

>take me out to dinner so that may have to be cancelled, since the RAI

>will probably begin January 6 or 7. Well, I have birthdays every

>year but hopefully will not have ablation doses of RAI every year. I

>will start reading up on LID. My TSH is 29 and the endo does not

>plan to give me cytomel.

>

>Pamela in Miami

>TT 12/7/02