Impact of Lithium on Efficacy of Radioactive Iodine for Graves' Disease: A Cohort Study on Cure Rate, Time to Cure, and Frequency of Increased Serum Thyroxine After Antithyroid Drug Withdrawal

2010 ◽  
Vol 2010 ◽  
pp. 142-145
Author(s):  
M. Schott
Keyword(s):  
Cohort Study ◽  
Radioactive Iodine ◽  
Drug Withdrawal ◽  
Antithyroid Drug ◽  
Graves Disease ◽  
Cure Rate ◽  
Serum Thyroxine

scholarly journals Factors Affecting and Outcome of Radioactive Iodine Therapy in Hyperthyroidism: A study at Institute of Nuclear Medicine & Allied Sciences (INMAS), Sylhet

2018 ◽  
Vol 19 (1) ◽  
pp. 19-23
Author(s):  
Kamrun Nahar ◽  
Papia Akhter
Keyword(s):  
Radioactive Iodine ◽  
Antithyroid Drug ◽  
Nodular Goiter ◽  
Fixed Dose ◽  
Graves Disease ◽  
Radioactive Iodine Therapy ◽  
Cure Rate ◽  
Toxic Adenoma ◽  
Significant Difference ◽  
One Year

Objective: Radioactive iodine therapy (RIT) is the most commonly used modality to treat hyperthyroidism and is indeed in most cases, the treatment of choice. The aim of this study was to assess the clinical outcome one year after radioactive Iodine-131 (RAI -131) therapy and to identify the factors associated with response of the therapy.Patients and Methods: A total 107 hyperthyroid patients were included in this study. All patients were pre-treated with anti-thyroid drugs (ATD). A fixed dose of 8 mCi of radioiodine was given to the patients with Graves’ disease, 12 mCi to patients with single toxic adenoma and 15 mCi to patients with toxic multi-nodular goiter . The patients were done serum FT4 initially and followed up with serum T3, T4, and TSH at three months , six months and one year of RAI therapy . The clinically and biochemically euthyroid and hypothyroid patients were considered as cure of the disease.Results : The cure rate was about 94.7% seen in female patients and 93.8% in male ( P=0.92), 93.6% in younger age group (below 40 years) and 95.0% of the older patients ( P=1.51), 95.5% of the patients who were taking ATD for more than one year and 92.7% of the patients who were taking ATD for less than one year before therapy( P=1.95), 95.4 % of the patients who had initial FT4 level less than 35 pmol/L and 92.7 % of the patients who had high initial FT4 ( P=1.54). Cure rate of Graves’ disease was 45/53 (92.5%), multi-nodular goiter 41/43 (95.3% ) and for single toxic adenoma was 11/11 (100% ) (P= 0.65). The incidence of radioiodine induced hypothyroidism was 6.5 % at three months, 13.1 % at six months and 15.0 % at one year. Overall incidence of cure rate of RAI therapy after one year was 101 (94.4 %).Conclusion: No statistically significant difference was found in the cure rate when sex, age, duration of pretreatment with antithyroid drug, initial FT4 level and cause of hyperthyroidism were considered.   From this study it can be concluded that cure rate of RAI therapy is quite good and the pretreatment factors have little influence on the final outcome.Bangladesh J. Nuclear Med. 19(1): 19-23, January 2016

scholarly journals Antithyroid Drug-Induced Hematopoietic Damage: A Retrospective Cohort Study of Agranulocytosis and Pancytopenia Involving 50,385 Patients with Graves' Disease

2012 ◽  
Vol 97 (1) ◽  
pp. E49-E53 ◽  
Author(s):  
Natsuko Watanabe ◽  
Hiroto Narimatsu ◽  
Jaeduk Yoshimura Noh ◽  
Takuhiro Yamaguchi ◽  
Kazuhiko Kobayashi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Antithyroid Drug ◽  
Graves Disease ◽  
Drug Induced

scholarly journals RADIOIODINE TREATMENT OF GRAVES’ DISEASE – DOSE/RESPONSE ANALYSIS

2014 ◽  
Vol 57 (2) ◽  
pp. 49-55 ◽  
Author(s):  
Jitka Čepková ◽  
Jiří Horáček ◽  
Jaroslav Vižďa ◽  
Jiří Doležal
Keyword(s):  
Clinical Outcome ◽  
Dose Range ◽  
Antithyroid Drug ◽  
Thyroid Volume ◽  
Complete Response ◽  
Response Analysis ◽  
Graves Disease ◽  
Success Rates ◽  
Cure Rate ◽  
Significant Difference

The clinical outcome of 153 Graves’ disease patients treated with a wide dose range of radioactive iodine-131 (RAI) was analyzed retrospectively. Six to nine months after the first dose of RAI 60 patients (39%) were hypothyroid (or rather thyroxine-substituted) and 26 (17%) were euthyroid, while 67 patients (44%) did not respond properly: in 32 (21%) their antithyroid drug (ATD) dose could be reduced but not withdrawn (partial response) and 35 (23%) remained hyperthyroid or the same dose of ATD was necessary (no response). The outcome did not correspond significantly to the administered activity of RAI (medians 259, 259, 222, and 259 MBq for hypothyroid, euthyroid, partial, and no response subgroups, respectively), or the activity retained in the gland at 24 h (medians 127, 105, 143, and 152 MBq). The effect was, however, clearly, and in a stepwise pattern, dependent on initial thyroid volume (17, 26, 33 and 35 ml, P < 0.001) or activity per gram tissue retained at 24 h (6.02, 4.95, 4.75, and 4.44 MBq/g, P = 0.002). Also, higher residual level of thyrotoxicosis at the time of RAI treatment was connected with worse outcome. The dose-dependency of outcome was further analyzed. When our sample was divided into tertiles, according to the adjusted dose, the same modest success rates (47%) were seen in the lower and middle tertiles. However, doses higher than 5.88 MBq/g (the upper tertile) resulted in success rate of 75%. Finer division into decils has shown a threshold-like increase in cure rate between the 7th and the 8th decil. In the first 7 decils (doses ≤ 6 MBq/g) the complete response rate was 45 to 50%, in the 8th decil (6.0 to 7.8~MBq/g) it rose to 80% and was not further increased with increasing dose. Direct comparison of higher (> 6 MBq/g, cure rate 80%) and lower (≤ 6 MBq/g, cure rate 46%) doses gave highly significant difference (P < 0.001). With our dosing range we found a dose-dependent clinical outcome that suggests an optimum delivered dose near 6.5 MBq/g, resulting in successful treatment of ca 80% patients.

Should radioiodine be the first-line treatment for paediatric Graves’ disease?

2015 ◽  
Vol 28 (7-8) ◽  
Author(s):  
James D. West ◽  
Timothy D. Cheetham ◽  
Carole Dane ◽  
Anuja Natarajan
Keyword(s):  
Radioactive Iodine ◽  
Antithyroid Drug ◽  
District General Hospital ◽  
Graves Disease ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Younger Age ◽  
Severe Autism ◽  
Optimal Treatment Strategy

AbstractDebate exists regarding the optimal treatment strategy for paediatric Graves’ disease with radioiodine (RAI), and surgery, usually reserved for failure of medical therapy. We present our own experience to introduce a review of the published literature focussing on the predictors of remission after antithyroid drug (ATD) therapy from diagnosis, and discuss whether RAI should be considered as a first-line therapy.A retrospective analysis of all diagnosed cases of paediatric Graves’ disease presenting to a large District General Hospital.Thirteen patients were diagnosed with Graves’ disease between February 2004 and May 2013. The median age at diagnosis was 13.7 years (range 7.2–17.1 years) with a female:male ratio of 11:2. Some nine patients completed a 2-year course of carbimazole out of which 8 relapsed after a mean duration of 0.82 years (range 0.08–1.42 years); the ninth currently remains in remission. Of the eight patients who relapsed, three have undergone RAI treatment. Two patients failed to tolerate carbimazole treatment, one of whom received RAI treatment because surgery was contraindicated and one patient with severe autism proceeded to RAI treatment due to poor compliance and persistent hyperthyroidism.Prognostic factors at presentation predicting a low likelihood of remission following ATD treatment include younger age, non-Caucasian ethnicity, and severe clinical and/or biochemical markers of hyperthyroidism. Psycho-social factors including compliance also influence management decisions.In specifically selected patients presenting with paediatric Graves’ disease, the benefits and risks of radioactive iodine as a potential first-line therapy should be communicated allowing families to make informed decisions.

INCREASED RISK OF RADIOIODINE TREATMENT FAILURE ASSOCIATED WITH GRAVES DISEASE REFRACTORY TO METHIMAZOLE

2020 ◽  
Vol 26 (11) ◽  
pp. 1312-1319
Author(s):  
Jennifer J. Kwak ◽  
Rola Altoos ◽  
Alexandria Jensen ◽  
Basel Altoos ◽  
Michael T. McDermott
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Potential Risk ◽  
Radioactive Iodine ◽  
Antithyroid Drug ◽  
Graves Disease ◽  
First Line ◽  
Line Therapy ◽  
Potential Risk Factors ◽  
Iodine 131

Objective: Iodine 131 (I-131) radioactive iodine (RAI) therapy has been the preferred treatment for Graves disease in the United States; however, trends show a shift toward antithyroid drug (ATD) therapy as first-line therapy. Consequently, this would favor RAI as second-line therapy, presumably for ATD refractory disease. Outcomes of RAI treatment after first-line ATD therapy are unclear. The purpose of this study was to investigate treatment failure rates and potential risk factors for treatment failure, including ATD use prior to RAI treatment. Methods: A retrospective case control study of Graves disease patients (n = 200) after I-131 RAI therapy was conducted. Treatment failure was defined as recurrence or persistence of hyperthyroidism in the follow-up time after therapy (mean 2.3 years). Multivariable regression models were used to evaluate potential risk factors associated with treatment failure. Results: RAI treatment failure rate was 16.5%. A majority of patients (70.5%) used ATD prior to RAI therapy, predominantly methimazole (MMI) (91.9%), and approximately two-thirds of patients used MMI for >3 months prior to RAI therapy. Use of ATD prior to RAI therapy ( P = .003) and higher 6-hour I-123 thyroid uptake prior to I-131 RAI therapy ( P<.001) were associated with treatment failure. MMI use >3 months was also associated with treatment failure ( P = .002). Conclusion: More patients may be presenting for RAI therapy after failing first-line ATD therapy. MMI use >3 months was associated with RAI treatment failure. Further studies are needed to investigate the association between long-term first-line ATD use and RAI treatment failure. Abbreviations: ATD = antithyroid drug; BMI = body mass index; EMR = electronic medical record; I-123 = iodine 123; I-131 = iodine 131; MMI = methimazole; PTU = propylthiouracil; RAI = radioactive iodine; TRAb = TSH receptor antibody; TSH = thyroid-stimulating hormone

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