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Theranostics in Endocrinology - Current Perspective

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Dr CS Bal, New Delhi    20 November 2018

  1. Theranostics refers to the treatment strategies that combine diagnostic testing with targeted therapy, which is the epitome of personalized medicine.
  2. Radioiodine imaging in Ca thyroid – Post-surgery assessment; post-therapy scanning for confirming staging; assessment of radioiodine ablation after 6-12 months; restaging when there is clinical, biochemical or radiological suspicion of recurrence.
  3. Theranostic radioiodine imaging (Dx-WBS) can provide detailed biological status for each cancerous lesion and helps in predicting the therapeutic response of every lesion to 131I treatment. Based on the imaging, ineffective 131I treatment can be avoided.
  4. Theranostic approach – Dx-WBS followed by RAI therapy: Unlike fluorodeoxyglucose (FDG)diagnostic imaging studies, radioiodine imaging can forecast response to therapy. It can also potentially alter the decision to treat or not to treat with 131I.
  5. In recurrent differentiated thyroid cancer (DTC), empiric therapy with RAI should be reserved for those with significantly elevated Tg (or rapidly rising levels) without a structural target amenable to directed therapy.
  6. Suspecting recurrence – About 20% patients will have elevated Tg levels up to 1 year after near-total thyroidectomy (NTT). Only one-third will have structural disease, rest will remain disease free and often have a decreasing Tg over time; Measurement of serum Tg coupled with neck ultrasound has become the cornerstone of surveillance strategies; Chest CT scan can detect pulmonary metastases in 80-90% cases, being able to detect lesions between 3 and 6 mm; FDG/PET is usually performed in case of elevated Tg with negative WBS; FDG PET scan can offer additional information in about 10% of these patients.
  7. Localized radioidodine refractory DTC can be treated with – Surgery; stereotactic external beam therapy; ablation (thermal, laser, alcohol); embolization (chemoembolization, radioembolization).

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