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Pediatric differentiated thyroid cancer (DTC) patients frequently present with lymph node and/or distant (lung) metastases. Such patients warrant an aggressive treatment consisting of surgical removal of all surgically accessible local metastases as well as further treatment with one or more courses of radioiodine therapy (RAI). It is still a subject of debate in literature how much I-131 should be administered to pediatric patients. Patients can either be given a fixed (possibly body weight-adjusted) activity or a dosimetry-based activity, which is often considerably higher.




Here, we will present a typical case of a pediatric patient who was treated using a dosimetric approach. Then we will discuss the basics of the dosimetry and the procedures involved, followed by a discussion of when to use dosimetric RAI as well as the pros and cons of the various approaches in pediatric patients.




In general, two opposite approaches to dosimetry exist: either the activity that is as high as safely administrable (AHASA) is determined based on the radiation exposure to the critical organs at risk (in pediatric patients these are the bone marrow and, in patients with lung metastases, the lungs), or a lesion-based approach in which the activity that is required to deliver a certain radiation dose to the metastatic lesion(s) is determined.




Because the latter approach requires an accurate volumetry of the target lesion(s), which is not possible in children with disseminated pulmonary metastases, which are often not visible with morphologic imaging techniques, we advocate using the AHASA approach in children with extensive metastatic DTC.


Frederik A. Verburg, Christoph Reiners, and Heribert Hänscheid



Received: May 16, 2013

Accepted: July 19, 2013

Published Online: December 04, 2013



Target Audience

Endocrinologists/Pediatric  Endocrinologists



Learning Objectives

  • Have an understanding of different approaches to dosimetry of radioiodine therapy
  • Determine the best approach for treating a patient


Course summary
Available credit: 
  • 2.00 Participation
  • 4.00 Training
    Training Credit
    • 1.00 Training Course Child Credit
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Authors, editors, and Endocrine Society staff involved in planning this JCEM Journal-based CME activity are required to disclose to The Endocrine Society and to learners any relevant financial relationship(s) of the individual or spouse/partner that has occurred within the last 12 months with any commercial interest(s) whose products or services are discussed in the CME content. The Endocrine Society has reviewed all disclosures and resolved all identified conflicts of interest.


The following authors reported relevant financial relationships:


Frederik A. Verburg, M.D., Ph.D., has received speakers' fees and research support from Genzyme Corp. and is a paid member of an advisory board for Roche Healthcare. Christoph Reiners, M.D., has received speakers' fees and research support from Genzyme Corp.


The following author reported no relevant financial relationships:


Heribert Hänscheid, M.D., has no relevant financial relationships.


The following JCEM Editors reported relevant financial relationships:


The (NAME OF YOUR ORGANIZATION) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.


Available Credit

  • 2.00 Participation
  • 4.00 Training
    Training Credit
    • 1.00 Training Course Child Credit


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