scholarly journals Focus on radioiodine-131 biokinetics: the influence of methylprednisolone on intratherapeutic effective half-life of 131I during radioiodine therapy of Graves’ disease

Endocrine ◽  
2021 ◽  
Author(s):  
C. Happel ◽  
W. T. Kranert ◽  
D. Gröner ◽  
J. Baumgarten ◽  
J. Halstenberg ◽  
...  
Keyword(s):  
Half Life ◽  
Radioiodine Therapy ◽  
Comparable Result ◽  
Graves Disease ◽  
Radioiodine Uptake ◽  
Significant Difference ◽  
Glucocorticoid Administration ◽  
The Mean ◽  
Uptake Test ◽  
Protective Treatment

Abstract Aim Radioiodine therapy (RIT) may trigger the development of Graves’ ophthalmopathy (GO) or exacerbate pre-existing subclinical GO. Therefore, glucocorticoid administration is recommended for patients with pre-existing GO. Aim of this study was to analyze the influence of glucocorticoid therapy with methylprednisolone on intratherapeutic effective half-life (EHL) of radioiodine-131 in patients with Graves’ disease (GD) as recent studies showed an effect for prednisolone. Methods In a retrospective study, 264 patients with GD who underwent RIT without any additional antithyroid medication were evaluated. Intrathyroidal EHL was determined pre- and intratherapeutically. Patients with co-existing GO (n = 43) received methylprednisolone according to a fixed scheme starting 1 day prior to RIT, patients without GO (n = 221) did not receive any protective glucocorticoid medication. The ratios of EHL during RIT and during radioiodine uptake test (RIUT) were compared. Results Patients receiving methylprednisolone showed a slight decrease of the mean EHL from 5.63 d (RIUT) to 5.39 d (RIT) (p > 0.05). A comparable result was obtained in patients without glucocorticoids (5.71 d (RIUT) to 5.47 d (RIT); p > 0.05). The ratios of the EHL between RIT and RIUT failed to show a significant difference between the two groups. EHL is therefore not significantly influenced by an additional protective treatment with methylprednisolone. Conclusions In the present study a decreased intrathyroidal EHL under glucocorticoid medication with methylprednisolone could not be detected. Therefore, co-medication with methylprednisolone in patients with GO may be preferred to avoid an intratherapeutic decrease of EHL by accompanying protective glucocorticoides.

Clinical and pathological significance of sibling Graves' disease

1980 ◽  
Vol 94 (4) ◽  
pp. 498-502 ◽  
Author(s):  
Toshio Tanaka ◽  
Shoichi Katayama ◽  
Kanji Kuma ◽  
Hajime Tamai ◽  
Fumio Matsuzuka ◽  
...  
Keyword(s):  
Subtotal Thyroidectomy ◽  
Graves Disease ◽  
Lymphoid Follicles ◽  
Mean Values ◽  
Significant Difference ◽  
Thyroid Glands ◽  
History Of ◽  
The Mean ◽  
And Control ◽  
Age And Sex

Abstract. The clinical picture and serum antithyroid antibodies in 16 pairs of siblings with Graves' disease were compared with an age and sex matched group of 32 patients with Graves' disease who did not have a family history of any thyroid disease (control patients). There was a significant difference in frequency and mean titres of antibodies to thyroglobulin between sibling patients. (positive 76.0%) and control patients (positive 40.0%), but not in microsomal antibodies (sibling; positive 92.0%, control; 92.0%). There were no significant differences in the mean values of 24 h 131I-thyroidal uptake, serum T3U, serum T4 and T3 concentrations before treatment between the two groups. Lymphoid follicles and degeneration of the epithelia were more often found in the thyroid glands of sibling patients than in those of the control patients, when 32 (16 sibling, 16 control) thyroid glands from the same groups in the clinical study, including antibody series, were examined pathologically after subtotal thyroidectomy for Graves' disease. Moreover, there was a strong tendency to increased lymphocyte and plasma cell infiltration in the thyroid glands of sibling patients with Graves' disease. The findings might indicate that Graves' disease is closely related to Hashimoto's thyroiditis, especially in sibling patients with Graves' disease.

Comparison of thyroid stimulating activities measured by cyclic AMP production, those by radioiodine uptake in FRTL-5 cells and TSH-binding inhibitory activities in patients with hyperthyroid and euthyroid Graves' diseases

1988 ◽  
Vol 117 (3) ◽  
pp. 365-372 ◽  
Author(s):  
Kanji Kasagi ◽  
Hiroto Hatabu ◽  
Yasutaka Tokuda ◽  
Keisuke Arai ◽  
Yasuhiro Iida ◽  
...  
Keyword(s):  
Graves Disease ◽  
Camp Production ◽  
Thyroid Cells ◽  
Radioiodine Uptake ◽  
Significant Difference ◽  
Thyroid Uptake ◽  
Similar Range ◽  
Inhibitory Activities

Abstract. By using an assay measuring cAMP production in FRTL-5 thyroid cells, thyroid stimulating antibodies (TSab) were detected in all of 15 patients with euthyroid Graves' disease (EG) and of 26 patients with hyperthyroid Graves' disease (HG). There was no significant difference between TSab activities in EG and in HG. In an effort to elucidate why EG patients remain euthyroid in spite of having TSab, we investigated the effect of the patient's crude immunoglobulin fractions on 125I uptake in FRTL-5 thyroid cells, one of the indices of stimulation subsequent to cAMP production. The 125I uptake stimulating (IUS) activity was positive in 46.7% (7/15) of EG patients and 88.5% (23/26) of HG patients, being significantly lower in the former than in the latter (P < 0.02). Although the IUS activities significantly correlated with TSab activities in 41 patients with EG and HG (r = 0.784, P < 0.001), the ratio of IUS to TSab in EG tended to be lower than that in HG. TSH-binding inhibitor immunoglobulins (TBII) activities in EG patients were negative or weakly positive, being significantly lower than those in HG patients (P < 0.001). Thus, the ratios of TBII to both TSab and IUS activities were significantly higher in HG than in EG (P < 0.01, P < 0.001, respectively). The in vitro IUS activities also correlated with TBII activities (r = 0.441, P < 0.001) and in vivo 99mTc thyroid uptake (r = 0.401, P < 0.001) in both EG and HG patients. The EG patients with positive IUS activities displayed smaller goitre size and lower 99m thyroid uptake in comparison to 19 HG patients with a similar range of IUS activities. There was a good correlation between thyroid weight and 99mTc thyroid uptake (r = 0.827, P < 0.001). In conclusion, lower IUS activity and/or smaller goitre size in EG than in HG, which may lead to lower thyroidal uptake of 99mTc and presumably radioiodine in vivo, might be a factor responsible for keeping EG patients euthyroid despite the presence of TSab.

Combination of ultrasound guided percutaneous microwave ablation and radioiodine therapy in benign thyroid diseases

2015 ◽  
Vol 54 (03) ◽  
pp. 118-124 ◽  
Author(s):  
H. Korkusuz ◽  
D. A. Koch ◽  
F. Grünwald ◽  
W. T. Kranert ◽  
C. Happel
Keyword(s):  
Microwave Ablation ◽  
Thyroid Nodules ◽  
Radioiodine Therapy ◽  
Combined Therapy ◽  
Thyroid Volume ◽  
Relative Reduction ◽  
Radioiodine Uptake ◽  
Hospitalization Time ◽  
Uptake Test ◽  
Benign Thyroid

SummaryAim: Goiters and thyroid nodules are an ongoing problem in healthcare. There has not been any treatment of goiters and thyroid nodules based on the combined therapy of microwave ablation (MWA) and radioiodine therapy (RIT) until now. In this study the potential benefit of a combined therapy versus single RIT is evaluated in order to achieve improvements concerning 131I-dose and hospitalization time. Patients, material, methods: Ten patients with goiter and benign thyroid nodules or Graves' disease were included. Pre-ablation assessments included sonographical imaging, functional imaging with 99mTc and FNAB to collect data of nodules and total thyroid volume and to exclude malignancy. Prior to treatment, radioiodine uptake test was performed. MWA was operated under local anesthesia with a system working in a wavelength field 902–928 MHz. Post-MWA, thyroid volume was recalculated ultrasonically. Due to reduced vital volume, changes of 131I-dose and hospitalization time could be monitored. Results: Mean absolute thyroid volume reduction by MWA before applying RIT was 22 ± 11 ml, meaning a relative reduction of 24 ± 6% (p < 0.05). Thereby, administered activity could be reduced by 393 ± 188 MBq using the combined therapy, reflecting a relative reduction of 24 ± 6% (p < 0.05). Additionally, mean hospitalization time was decreased by 2.1 ± 0.8 days using MWA prior to RIT, implying a relative reduction of 28 ± 6% (p < 0.05). Conclusion: Depending on ablated volume by MWA, RITmonotherapy requires on average 31.2% more 131I-activity than the combined therapy. The combined therapy remarkably decreases 131I-dose and hospitalization time. The combined MWA and RIT therapy is a considerable, effective and safer alternative to surgery for the treatment of very large benign nodular goiters.

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

2018 ◽  
Vol 31 (2) ◽  
pp. 159-165 ◽  
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.

scholarly journals Anticlastogenic Effect of Ginkgo Biloba Extract in Graves’ Disease Patients Receiving Radioiodine Therapy

2007 ◽  
Vol 92 (11) ◽  
pp. 4286-4289 ◽  
Author(s):  
A. Dardano ◽  
M. Ballardin ◽  
M. Ferdeghini ◽  
E. Lazzeri ◽  
C. Traino ◽  
...  
Keyword(s):  
Placebo Group ◽  
Clinical Outcome ◽  
Ginkgo Biloba ◽  
Radioiodine Therapy ◽  
Statistical Significance ◽  
Ginkgo Biloba Extract ◽  
131I Therapy ◽  
Graves Disease ◽  
Egb 761 ◽  
Significant Difference

Abstract Background: Chromosomal damage, as assessed by clastogenic factors (CFs) and micronuclei (MN) appearance, after radioiodine therapy of Graves’ disease has been reported. Objective and Methods: Our objective was to evaluate the effect of Ginkgo biloba extract (EGb 761) supplementation on the time course (up to 120 d) of CFs and MN appearance in lymphocytes from patients with Graves’ disease after iodine-131 (131I) therapy. Patients were randomly assigned to EGb 761 or placebo, in a blinded manner. Results: In the placebo group, MN increased early (P &lt; 0.001) after 131I, peaking at the 21st day (P = 0.0003) and declining thereafter. In EGb 761-treated patients, MN increased early (P &lt; 0.05), while returning toward baseline value thereafter. Therefore, mean MN increment was significantly higher in the placebo group as compared with EGb 761-treated patients (P &lt; 0.01). Moreover, an early (P &lt; 0.0001) and sustained (up to 35 d; P &lt; 0.001) MN increase induced by CFs was observed in the placebo group. Conversely, in EGb 761-treated patients, MN increase induced by CFs never reached the statistical significance; therefore, the mean of the MN increments was significantly lower than in placebo (P &lt; 0.05). A significant positive correlation between MN maximum increment and the bone marrow dose was observed in the placebo group only (P = 0.03). No significant difference was observed in clinical outcome between the two groups. Conclusions: EGb 761 supplementation neutralized genotoxic damage induced by radioiodine treatment, without affecting the clinical outcome. Although 131I therapy is generally safe, our data suggest that Gingko biloba extracts may prevent genetic effects of radioiodine therapy for hyperthyroid Graves’ disease.

Radioiodine therapy of Graves’ disease — a dosimetric comparison of different strategies concerning antithyroid drugs

2001 ◽  
Vol 40 (04) ◽  
pp. 111-115 ◽  
Author(s):  
V. Urbannek ◽  
E. Voth ◽  
D. Moka ◽  
H. Schicha
Keyword(s):  
Half Life ◽  
Radioiodine Therapy ◽  
Thyroid Volume ◽  
Absorbed Dose ◽  
The Body ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Thyroid Metabolism ◽  
Group A ◽  
Group B

SummaryAim: Premedication with antithyroid drugs (ATD) compared to patients not pretreated with ATD causes a higher failure rate of radioiodine therapy (RITh) or demands higher therapeutical dosage of radioiodine (Rl). For clinical reasons and because of accelerated iodine metabolism in hyperthyreosis a compensated thyroid metabolism is desirable. Aim of this study was to investigate the influence of ATD on the biokinetics of Rl in case of Graves’ disease in order to improve RITh of patients pretreated with ATD. Methods: 385 consecutive patients who underwent RITh because of Graves’ disease for the first time were included: Group A (n = 74): RITh under continuous medication with ATD; Group B (ç = 111): Application of Rl under continuous medication with ATD, in case of insufficient Rl-uptake or shortened effective Rl-half-life ATD were stopped 1-5 days after RITh; Group C (n = 200): ATD were stopped 2 days prior to RITh in all patients. We examined the influence of ATD on Rl-uptake and effective Rl-half-life as well as the absorbed dose achieved on the thyroid in dependence of thyroid volume and applied Rl-dosage [TEQ - therapy efficiency quotient, (2)]. Results: In the Rl-pretest (all patients under ATD) the Rl-uptake was comparable in all three groups. During RITh Rl-uptake, effective Rl-half-life and therefore the TEQ were significantly higher in Group C as compared to Groups A and B (ñ <0,001, respectively). In Group B the medication with ATD was stopped in 61 of 111 cases 1-5 days after RITh. In this subgroup the effective Rl-half-life increased from 4,4 ± 1,7 d to 5,1 ± 1,6 d after stopping of ATD (ñ = 0,001). Conclusion: Stopping of ATD 2 days prior to RITh leads to an increased efficiency of about 50% compared to RITh carried out under ATD and therefore to a clear reduction of radiation exposure to the rest of the body with equal absorbed doses of the thyroid. Stopping of ATD shortly after RITh increases efficiency in case of short effective Rl-half-life, but it is inferior to stopping ATD 2 days prior to RITh.

Administration of additional inactive iodide during radioiodine therapy for Graves' disease

2007 ◽  
Vol 46 (03) ◽  
pp. 77-84 ◽  
Author(s):  
D. Moka ◽  
U. Reinholz ◽  
M. Schmidt ◽  
K. Schomäcker ◽  
H. Schicha ◽  
...  
Keyword(s):  
Patient Group ◽  
Half Life ◽  
Radioiodine Therapy ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
131I Activity ◽  
Short Half Life ◽  
Thyroid Dose ◽  
Group A ◽  
Group B

Summary Aim: Graves' hyperthyroidism and antithyroid drugs empty the intrathyroid stores of hormones and iodine. The consequence is rapid 131I turnover and impending failure of radioiodine therapy. Can administration of additional inactive iodide improve 131I kinetics? Patients, methods: Fifteen consecutive patients, in whom the 48 h post-therapeutically calculated thyroid dose was between 150 and 249 Gy due to an unexpectedly short half-life, received 3 × 200 μg inactive potassium-iodide (127I) daily for 3 days (Group A), while 17 consecutive patients with a thyroid dose of ≥ 250 Gy (Group B) served as the non-iodide group. 48 hours after 131I administration (M1) and 4 or 5 days later (M2) the following parameters were compared: effective 131I half-life, thyroid dose, total T3, total T4, 131I-activity in the T3- and T4-RIAs. Results: In Group A, the effective 131I half-life M1 before iodine (3.81 ± 0.93 days) was significantly (p <0.01) shorter than the effective 131I half-life M2 (4.65 ± 0.79 days). Effective 131I half-life M1 correlated with the benefit from inactive 127I (r = –0.79): Administration of 127I was beneficial in patients with an effective 131I half-life M1 of <3 or 4 days. Patients from Group A with high initial specific 131I activity of T3 and T4 showed lower specific 131I activity after addition of inactive iodine compared with patients from the same group with a lower initial specific 131I activity of T3 and T4 and compared with the patient group B who was given no additional inactive iodide. This correlation was mathematically described and reflected in the flatter gradient in Group A (y = 0.5195x + 0.8727 for 131I T3 and y = 1.0827x – 0.4444 for 131I T4) and steeper gradient for Group B (y = 0.6998x + 0.5417 for 131I T3 and y = 1.3191x – 0.2901 for 131I T4). Radioiodine therapy was successful in all 15 patients from Group A. Conclusion: The administration of 600 μg inactive iodide for three days during radioiodine therapy in patients with Graves' hyperthyroidism and an unexpectedly short half-life of <3 or 4 days was a safe and effective alternative to the administration of a second radioiodine capsule

High Diagnostic Value of a Radioiodine Uptake Test With and Without Iodine Restriction in Graves' Disease and Silent Thyroiditis

Thyroid ◽  
2004 ◽  
Vol 14 (7) ◽  
pp. 531-535 ◽  
Author(s):  
Tetsuya Hiraiwa ◽  
Mitsuru Ito ◽  
Akihisa Imagawa ◽  
Haruhiko Isotani ◽  
Junta Takamatsu ◽  
...  
Keyword(s):  
Diagnostic Value ◽  
Graves Disease ◽  
Radioiodine Uptake ◽  
Silent Thyroiditis ◽  
Uptake Test

scholarly journals Is 99mTechnetium Pertechnetate Thyroid Uptake accurate in Thyrotoxicosis Evaluation?

2020 ◽  
Author(s):  
kusai al-muqbel ◽  
Reema Tashtoush ◽  
Fadia Mayyas ◽  
Wael Marashdeh ◽  
Amr Tashtoush ◽  
...  
Keyword(s):  
Predictive Value ◽  
Nodular Goiter ◽  
Subacute Thyroiditis ◽  
Graves Disease ◽  
Radioiodine Uptake ◽  
Toxic Nodular Goiter ◽  
Thyroid Uptake ◽  
Normal Mean ◽  
Uptake Test ◽  
Hyperthyroid Patients

Abstract BackgroundThis study aimed to evaluate the 99mTc thyroid uptake (TcTU) in terms of (1) normal mean and range, (2) level of uncertainty in thyrotoxic patients and (3) effectiveness of adding radioiodine uptake in patients with uncertain TcTU values.MethodsPatients referred for TcTU test were included and categorized into groups: euthyroid, Graves’ disease, toxic nodular goiter and subacute thyroiditis. Mean and range of TcTU were obtained separately for each group. Second radioiodine uptake test was performed in patients who had uncertain TcTU (overlap with normal range). Results209 patients were included (54 euthyroid, 112 Graves’ disease, 29 toxic nodules and 17 subacute thyroiditis patients). Normal mean and range of TcTU were 1.5 +/- 1.1% and 0.17-4.8%, respectively. Mean TcTU was high in hyperthyroid patients and was extremely low in subacute thyroiditis patients, however, uncertain values was noted in about 30% of the patients. TcTU was uncertain in 39 hyperthyroid patients and in 10 subacute thyroiditis patients, while second radioiodine uptake was high in the former and extremely low in the latter.Test sensitivity was 68%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 52% and accuracy was 76%. ConclusionTcTU major disadvantage is the uncertainty seen in third of patients degrading test sensitivity and accuracy. We managed to overcome this uncertainty by adding second radioiodine thyroid uptake test. Accordingly, single visit TcTU was accurate and sufficient in about two thirds of patients while the remainder required second radioiodine uptake to reach accurate diagnosis.

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