Influence of thyroid volume reduction on calculated dose in radioiodine therapy of Graves' hyperthyroidism

Summary Aim of this study was a characterization of radioiodine therapy (RIT) failures in Graves’ disease without simultaneous Carbimazole. Method: 226 patients with a confirmed diagnosis of Graves’ disease received 686.8 ± 376.4 MBq of iodine-131 orally for thyroid ablation. Target dose was 250 Gy. All patients were followed up for 6 months. Therapy failures were compared with successes regarding possible influencing variables initial thyroid volume, thyroid function, immune activity (TRAb), 1-131 uptake, effective half-life, absorbed energy dose, age and gender. Results: 212 of 226 patients (93.8%) were treated successfully, 14 (6.2%) showed a hyperthyroidism relapse within 6 months which required a second radioiodine therapy. A success rate of 92.5% (62/67) could also be achieved with 67 patients who were hyperthyroid at the time of RIT. Compared to the therapy successes, the 14 failures achieved significantly lower absorbed doses (223.8 ±76.6 Gyvs. 285.2 ±82.1 Gy, ρ <0.005), but with no significant differences regarding age, thyroid volume, function or TRAb (all ρ >0.2). Of the 14 failures, η = 8 reached an absorbed dose <200 Gy and η = 1 a dose <250 Gy, although 5 of the failures reached an absorbed dose of >250 Gy. Stepwise logistic regression revealed only absorbed energy dose as a variable significantly influencing therapy success (p <0.005), but no influence of initial thyroid volume, function, TRAb value, age (all ρ >0.2) or gender (p = 0.13). Two-tailed Fisher’s exact test showed no significant influence of gender on success rates (failures/successes: male 1 /36, female 13/176, ρ = 0.48). Conclusions: Except for the absorbed energy dose, no other significant variable influencing the outcome of radioiodine therapy in Graves’ disease without simultaneous Carbimazole could be found. It should be noted, though, that 5 therapy failures (2.2%) reached an absorbed energy dose of >250 Gy.

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Guideline for radioiodine therapy for benign thyroid diseases (version 3)

Nuklearmedizin ◽

10.1055/s-0038-1623919 ◽

2004 ◽

Vol 43 (06) ◽

pp. 217-220 ◽

Cited By ~ 8

Author(s):

J. Dressler ◽

F. Grünwald ◽

B. Leisner ◽

E. Moser ◽

Chr. Reiners ◽

...

Keyword(s):

Radioiodine Therapy ◽

Thyroid Volume ◽

Thyroid Diseases ◽

Antithyroid Drugs ◽

Graves Disease ◽

Co Morbidity ◽

History Of ◽

Individual Decisions ◽

Prophylactic Use ◽

Benign Thyroid

SummaryThe version 3 of the guideline for radioiodine therapy for benign thyroid diseases presents first of all a revision of the version 2. The chapter indication for radioiodine therapy, surgical treatment or antithyroid drugs bases on an interdisciplinary consensus. The manifold criteria for decision making consider the entity of thyroid disease (autonomy, Graves’ disease, goitre, goitre recurrence), the thyroid volume, suspicion of malignancy, cystic nodules, risk of surgery and co-morbidity, history of subtotal thyroidectomy, persistent or recurrent thyrotoxicosis caused by Graves’ disease including known risk factors for relapse, compression of the trachea caused by goitre, requirement of direct therapeutic effect as well as the patient’s preference. Because often some of these criteria are relevant, the guideline offers the necessary flexibility for individual decisions. Further topics are patients’ preparation, counseling, dosage concepts, procedural details, results, side effects and follow-up care. The prophylactic use of glucocorticoids during radioiodine therapy in patients without preexisting ophthalmopathy as well as dosage and duration of glucocorticoid medication in patients with preexisting ophthalmopathy need to be clarified in further studies. The pragmatic recommendations for the combined use of radioiodine and glucocorticoids remained unchanged in the 3rd version.

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Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres

Acta Endocrinologica ◽

10.1530/eje.0.1470001 ◽

2002 ◽

pp. 1-11 ◽

Cited By ~ 28

Author(s):

SJ Bonnema ◽

L Bartalena ◽

AD Toft ◽

L Hegedus

Keyword(s):

Side Effects ◽

Radioiodine Therapy ◽

Thyroid Volume ◽

Thyroid Stimulating Hormone ◽

Radioprotective Effect ◽

Antithyroid Drugs ◽

Favourable Effect ◽

Glucocorticoid Treatment ◽

Graves Ophthalmopathy ◽

First Choice

In routine use for more than 50 years, radioiodine ((131)I) is generally considered safe and devoid of major side effects. Therefore, it is surprising that relatively many aspects of radioiodine therapy are controversial, as illustrated by recent international questionnaire studies. Our review aims at highlighting three of these areas - namely, the influence of (131)I on the course of Graves' ophthalmopathy, the possible radioprotective effects of antithyroid drugs, and the use of (131)I in large goitres. (131)I therapy carries a small (but definite) risk of causing progression of Graves' ophthalmopathy. Identification of risk factors (thyroid dysfunction, high level of thyroid-stimulating hormone (TSH) receptor antibodies, cigarette smoking) allows the identification of patients at risk and the institution of concomitant glucocorticoid treatment, thereby hindering progression of eye disease. On the basis, largely, of retrospective data, it appears that carbimazole (or methimazole), if stopped 3-5 days before treatment, does not influence the outcome of (131)I therapy. Simultaneous thyrostatic medication most probably reduces the efficacy of (131)I, as does restarting it within 7 days. Propylthiouracil seems to have a more prolonged radioprotective effect than carbimazole. Surgery is the treatment of first choice in patients with a large goitre. However, in the case of patient ineligibility or preference, (131)I therapy may be an option. The treatment has a favourable effect on tracheal compression and inspiratory capacity, but the reduction in thyroid volume is only 30-40%. Inpatient treatment, necessitated by the large doses, makes the treatment cumbersome. Controversy related to radioiodine therapy is mainly based on the lack of adequate prospective randomised studies comparing efficacy, side effects, cost and patient satisfaction.

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Radioiodine therapy in Graves' disease based on tissue-absorbed dose calculations: effect of pre-treatment thyroid volume on clinical outcome

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-002-0877-3 ◽

2002 ◽

Vol 29 (9) ◽

pp. 1118-1124 ◽

Cited By ~ 58

Author(s):

Michael J. Reinhardt ◽

Ingo Brink ◽

Alexius Y. Joe ◽

Dirk von Mallek ◽

Samer Ezziddin ◽

...

Keyword(s):

Clinical Outcome ◽

Radioiodine Therapy ◽

Thyroid Volume ◽

Absorbed Dose ◽

Graves Disease ◽

Dose Calculations ◽

Pre Treatment

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Ultrasound-Guided Microwave Ablation for Benign Thyroid Nodules: A Retrospective Analysis of Safety and Efficacy Factors

10.21203/rs.3.rs-137725/v1 ◽

2021 ◽

Author(s):

Baoying Xia ◽

Boyang Yu ◽

Xiaofei Wang ◽

Yu Ma ◽

Feng Liu ◽

...

Keyword(s):

Microwave Ablation ◽

Thyroid Nodules ◽

Thyroid Volume ◽

Serum Levels ◽

Reduction Ratio ◽

Volume Reduction ◽

Invasive Technique ◽

Ultrasound Guided ◽

Benign Thyroid Nodules ◽

Benign Thyroid

Abstract ObjectiveMicrowave ablation (MWA) is a minimally invasive technique for the treatment of benign thyroid nodules. The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules, and to provide reference for future clinical work.MethodsThis study retrospectively analyzed the patients who received ultrasound-guided microwave ablation for benign thyroid nodules in our hospital from October 2018 to March 2020. A total of 214 patients were included in the study. We assessed thyroid volume changes (represented by volume reduction ratio VRR) , the serum levels of triiodide thyroid hormone (T3), thyroxine (T4) and thyrotropin (TSH) and complications after MWA treatment.ResultsThere were a total of 306 nodules in 214 patients, including 183 (85.51%) females and 31 (14.49%) males. The median diameter and volume of the nodule were 33mm and 8.01ml. The volume reduction ratio（VRR）at 1 month, 3 months, 6 months and 12 months were 40.79%, 60.37%, 74.59% and 85.60%, respectively.（P<0.05) In addition, initial nodular volume were the influencing factors of volume reduction ratio.ConclusionsUltrasound-guided MWA is effective and safe in the treatment of benign thyroid nodules. In addition, it has little damage to surrounding tissues and no effect on thyroid function. Especially for the initial small volume of nodules, treatment is better. Therefore, ultrasound-guided thyroid MWA can be used as one of the main clinical treatment methods for benign thyroid nodules.

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