Radioiodine Therapy for Multinodular Toxic Goiter

Objective: The modified fixed doses of radioactive iodine (RAI) in different types of hyperthyroidism had been practiced at National Institute of Nuclear Medicine & Allied Science (NINMAS) according to Society of Nuclear Medicine Bangladesh (SNMB) protocol since 2002 which was upgraded in 2015. The objective of the study was to observe the treatment outcome in modified fixed dose on previous protocol. Patients and Methods: In the present study the outcome of radioiodine therapy of hyperthyroid patients was retrospectively evaluated in 1349 consecutive primary hyperthyroid patients treated from January 2010 to December 2014 at NINMAS. Diagnosis of hyperthyroidism was done by thyroid function test; thyroid stimulating hormone (TSH), free triiodothyronine (FT3) & free thyroxine (FT4), 99m Technetium scan, thyroid radioiodine uptake and ultrasound imaging of thyroid gland. All patients received a fixed dose (8-29 m Ci) of radioactive iodine (RAI) depending on types of hyperthyroidism, visual assessment of gland size and severity of disease at diagnosis. They were followed up at 2 months of therapy, then every three months intervals for first year and thereafter 6 monthly up to 5 years or as needed during fluctuation of thyroid function.Results: Among the study population, 832 patients had diffuse toxic goiter (Graves’ disease), 369 patients were diagnosed as toxic multinodular goiter and 148 patients with single toxic nodule. At one year follow-up, permanent hypothyroidism occurred in 61.62% of patients and the cumulative incidence of hypothyroidism progressively increased up to 79.25% after 5 years. Cure or success of RAI therapy was considered as attainment of euthyroid state or hypothyroid state. About 11.26 % patients received more than single dose.Conclusion: Fixed dose RAI therapy is very much cost effective mode of treatment for primary hyperthyroidism with ~89% success by giving single dose.Bangladesh J. Nuclear Med. 20(1): 37-40, January 2017

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Gender and age features of changes in the immunological parameters in patients with thyroid cancer and persons with toxic goiter after radioiodine therapy

INTERNATIONAL JOURNAL OF ENDOCRINOLOGY ◽

10.22141/2224-0721.15.8.2019.191684 ◽

2019 ◽

Vol 15 (8) ◽

pp. 610-618

Author(s):

T.F. Zakharchenko ◽

S.V. Gulevaty ◽

I.P. Volinets

Keyword(s):

Thyroid Cancer ◽

Radioiodine Therapy ◽

Immunological Parameters ◽

Gender And Age ◽

Age Features ◽

Toxic Goiter

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Therapy for non-toxic multinodular goiter

Nuklearmedizin ◽

10.1055/s-0038-1623928 ◽

2006 ◽

Vol 45 (01) ◽

pp. 21-34 ◽

Cited By ~ 13

Author(s):

B. Dederichs ◽

C. Kobe ◽

P. Theissen ◽

M. Schmidt ◽

H. Schicha ◽

...

Keyword(s):

Radioiodine Therapy ◽

Clinical Symptoms ◽

Nodular Goiter ◽

Dose Finding ◽

Attractive Alternative ◽

Therapeutic Effects ◽

Invasive Treatment ◽

Co Morbidity ◽

Definitive Therapy ◽

Toxic Goiter

SummaryThe need for therapy for nodular goiter results from the growth of thyroid nodules over decades and from the possibility of tracheal compression and worsening of respiratory function. Given the high prevalence of non-toxic goiter, the epidemiologically low incidence of clinically apparent thyroid cancer justifies non-surgical strategies. Randomised studies have shown that levothyroxine offers limited therapeutic effects and is inferior to radioiodine therapy regarding goiter shrinkage. When indication for a definitive therapy is given, the choice between resection and radioiodine therapy should consider volume of goiter, severity of clinical symptoms, thyroid uptake, patient’s age, co-morbidity, previous resection of goiter, patient’s profession and patient’s wish. Even in large goiters between 100 and 300 ml radioiodine therapy showed consistent results with goiter size reduction from 35-40% one year and 40-60% two years after radioiodine therapy. Thyroid hormones to prevent recurrence of goiter are not necessary. Recurrent goiters were seldom observed after radioiodine therapy and resulted from initially very large goiters or uptake in dominante nodules or from low 131I activities. Recombinant human TSH (rhTSH) offers the opportunity to enhance the effect of radioiodine therapy. Observational studies have shown that rhTSH increases low 131I uptake in case of high alimentary iodine-supply by the factor 4, causes a more homogenous 131I distribution within the goiter and improves goiter reduction. A phase I study for dose finding is running in the USA. Conclusion: Radioiodine therapy for shrinkage of large non-toxic goiter should not be restricted to elderly patients, or to patients with co-morbidity or high operative risk, but is an attractive alternative to surgery in patients with special professions (singer, teacher, speaker) or with the wish for a non-invasive treatment modality.

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The induction of hyperthyroidism in patient with non-toxic goiter after radioiodine therapy: a case report

Endocrine Abstracts ◽

10.1530/endoabs.35.p1041 ◽

2014 ◽

Author(s):

Saeid Abdelrazek ◽

Janusz Mysliwiec ◽

Piotr Szumowski ◽

Anna Kraszynska

Keyword(s):

Case Report ◽

Radioiodine Therapy ◽

Toxic Goiter

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Assessment of Inferior Thyroid Artery by Color Doppler Ultrasound in Diffuse Toxic GoiterExperience at NINMAS

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v20i1.36854 ◽

2018 ◽

Vol 20 (1) ◽

pp. 41

Author(s):

Nasreen Sultana ◽

Sharmin Quddus ◽

Rahima Perveen ◽

Mohammad Simoon Salekin ◽

Md Bashir ◽

...

Keyword(s):

Blood Flow ◽

Thyroid Gland ◽

Radioiodine Therapy ◽

Color Doppler ◽

Peak Systolic Velocity ◽

Inferior Thyroid Artery ◽

Group A ◽

Group B ◽

Toxic Goiter ◽

Anterior Posterior

Objective: The aim of this study was to compare the B mode ultrasonography findings of thyroid gland and peak systolic velocity of inferior thyroid artery by color Doppler application, in patients with diffuse toxic goiter at the time of diagnosis and 6-8 months after radioiodine 131-I therapy.Patients and Methods: This was a prospective observational study conducted in National Institute of Nuclear Medicine & Allied Sciences (NINMAS) between June 2015 and October 2016. Forty consecutive diagnosed diffuse toxic goiter patients were selected at the time of diagnosis prior to radioiodine therapy. An ultrasonography evaluation of thyroid gland (measurement of anterior posterior diameter for convenience) and measurement of peak systolic velocity of inferior thyroid artery in both sides of thyroid gland were performed before and after 131-I therapy (6-8 months). The examination was performed in thyroid division of NINMAS by advanced ultrasound machine with a linear transducer (5-12 MHz). The patients were divided into two groups. Group A-diffuse toxic goiter prior to radioiodine therapy and group B- same patients 6-8 months after radioiodine therapy.Results: A reduction in the anterior –posterior diameter of the thyroid gland was observed from pre to post treatment evaluation, performed at 6 and or 8 months after radioiodine therapy. Color Doppler showed increased parenchymal vascularity at the time of diagnosis which gradually declined after radioiodine therapy. Thyroid blood flow, as assessed by PSV of ITA, was significantly higher in Group A than in Group B respectively (70.5 ± 15.5 cm/ sec versus 22.2 ± 12.9 cm/sec). PSV was measured in 10 healthy euthyroid adults & their PSV ranged 13-20 cm/Sec. Parenchymal vascularity of the thyroid gland was higher in hyperthyroid patients than in euthyroid patients.Conclusion: Assessment of thyroid gland by B-mode ultrasound and blood flow by color Doppler study (CDS) is an effective marker in the initial diagnosis of diffuse toxic goiter.Bangladesh J. Nuclear Med. 20(1): 41-44, January 2017

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Management of thyrotoxicosis in children and adolescents: 35 years’ experience in 304 patients

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2017-0394 ◽

2018 ◽

Vol 31 (2) ◽

pp. 159-165 ◽

Cited By ~ 9

Author(s):

Fereidoun Azizi ◽

Atieh Amouzegar

Keyword(s):

Children And Adolescents ◽

Treatment Modality ◽

Radioiodine Therapy ◽

Thyroid Stimulating Hormone ◽

Antithyroid Drugs ◽

Graves Disease ◽

The Mean ◽

Toxic Goiter ◽

Original Treatment

Abstract Background: Diffuse toxic goiter accounts for about 15% of all childhood thyroid diseases. There is great controversy over the management of Graves’ disease in children and adolescents. This article reports our experience in 304 children and juvenile patients with Graves’ disease. Methods: Between 1981 and 2015, 304 patients aged 5–19 years with diffuse toxic goiter were studied, of whom 296 patients were treated with antithyroid drugs (ATD) for 18 months. Patients with persistent or relapsed hyperthyroidism who refused ablative therapy with surgery or radioiodine were managed with continuous methimazole (MMI) treatment. Results: In 304 patients (245 females and 59 males), the mean age was 15.6±2.6 years. After 18 months of ATD therapy, 37 remained in remission and of the 128 who relapsed, two, 29 and 97 patients chose surgery, continuous ATD and radioiodine therapy, respectively. Of the 136 patients who received radioiodine, 66.2% became hypothyroid. Twenty-nine patients received continuous ATD therapy for 5.7±2.4 years. The mean MMI dose was 4.6±12 mg daily, no serious complications occurred and all of them remained euthyroid during the follow-up. Less abnormal thyroid-stimulating hormone (TSH) values were observed in these patients, as compared to patients who were on a maintenance dose of levothyroxine after radioiodine induced hypothyroidism. Conclusions: Original treatment with ATD and subsequent radioiodine therapy remain the mainstay of treatment for juvenile hyperthyroidism. Continuous ATD administration may be considered as another treatment modality for hyperthyroidism.

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