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

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.

Improved dose concept for radioiodine therapy of multifocal and disseminated functional thyroid autonomy

1995 ◽  
Vol 132 (5) ◽  
pp. 550-556 ◽  
Author(s):  
Michael Reinhardt ◽  
Dieter Emrich ◽  
Thomas Krause ◽  
Peter Bräutigam ◽  
Egbert Nitzsche ◽  
...  
Keyword(s):  
Radioiodine Therapy ◽  
Antithyroid Drugs ◽  
Overt Hypothyroidism ◽  
Target Dose ◽  
Free Triiodothyronine ◽  
Thyroid Autonomy ◽  
Thyrotropin Level ◽  
Group A ◽  
Group B ◽  
Therapy Success

Reinhardt M, Emrich D, Krause T, Bräutigam P, Nitzsche E, Blattmann H, Schümichen C, Moser E. Improved dose concept for radioiodine therapy of multifocal and disseminated functional thyroid autonomy. Eur J Endocrinol 1995;132:550–6. ISSN 0804–4643 The present study analyzes the improvement of the outcome of radioiodine therapy in non-immunogenic hyperthyroidism by adapting the target dose to the 99mTc-pertechnetate thyroid uptake under suppression (TcTUs) prior to radioiodine therapy. The TcTUs is a substitute for the non-suppressible iodine turnover. The 89 patients presented with a basal thyrotropin level of <0.1 mU/l, normal values for free triiodothyronine and thyroxine and with multifocal or disseminated thyroid autonomy. These terms describe the scintigraphic distribution pattern of autonomous iodine turnover. Thirty-two patients had a TcTUs between 1.6 and 3.2% (group A) and 57 had a TcTUs > 3.2% (group B). Fifty-five patients (three of group A and 52 of group B) were treated previously for overt hyperthyroidism with antithyroid drugs. Target doses of 150 and 200 Gy were used in both groups and 300 Gy in group B only. Six months after radioiodine therapy, a basal TSH level of ≥ mU/l as criterion of therapy success was observed in 94% of group A and in 54% of group B. Further differentiation of group B shows an increasing success rate with the target dose used: 45% after 150 Gy, 50% after 200 Gy and 90% after 300 Gy. In patients with a basal TSH level of <0.5 mU/l after radioiodine therapy, the TcTUs was evaluated again. Persistence of functional thyroid autonomy, defined as TcTUs > 1.6%, was found in 89% (one patient of group A, 24 patients of group B) and still observed a high extent of autonomous function in 25% of them, evidenced by a TcTUs > 3.2% (seven patients of group B, target doses of 150 or 200 Gy). No case of overt hypothyroidism was observed within the first 6 months after radioiodine therapy and no difference was found in therapy outcome between multifocal and disseminated thyroid autonomy. As a consequence, the target dose should be adapted to the TcTUs prior to radioiodine therapy in the range of 150–300 Gy to the total thyroid gland. Michael Reinhardt, Abteilung Nuklearmedizin, Radiologische Universitätsklinik, Hugstetter Straße 55. 79106 Freiburg im Breisgau, Germany

Graves' disease and radioiodine therapy

2008 ◽  
Vol 47 (01) ◽  
pp. 13-17 ◽  
Author(s):  
W. Eschner ◽  
F. Sudbrock ◽  
I. Weber ◽  
K. Marx ◽  
M. Dietlein ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Radioiodine Therapy ◽  
Thyroid Volume ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Inclusion Criteria ◽  
Thyroid Dose ◽  
Point Measure ◽  
The Mean ◽  
Age And Sex

SummaryAim: This study was performed to determine the results of ablative radioiodine therapy (RIT) when the achieved dose in the thyroid was above 200 Gy and to characterize predictive factors for treatment outcome. Patients, methods: A total of 571 consecutive patients were observed for 12 months between July 2001 and June 2004. Inclusion criteria were a confirmed diagnosis Graves' disease, compensation of hyperthyroidism and withdrawal of antithyroid drugs two days before preliminary radioiodine-testing and RIT. The intended dose was 250 Gy and the therapeutically achieved dose was calculated from serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The relation between success rate and the achieved dose, thyroid volume, age and sex of patients, TSH- and TRAb-values and presence of ophthalmopathy was analysed. Results: Relief from hyperthyroidism was achieved in 96% of patients who received more than 200 Gy, even for thyroid volumes >40 ml. The success of ablative RIT was not influenced by age or sex of patients, or by TSH- or TRAb values or concomitant ophthalmopathy. The mean achieved dose in the thyroid was 298 Gy with a standard deviation of 74.6 Gy. Conclusion: To achieve a dose of over 200 Gy with the above standard deviation, we recommend calculating an intended dose of 250 Gy and using a dosimetric approach with early and late uptake values in the radioiodine test, to allow early therapeutic intervention should the posttherapeutic thyroid dose fall unexpectedly below 200 Gy.

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

2004 ◽  
Vol 43 (06) ◽  
pp. 217-220 ◽  
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.

Graves' disease and radioiodine therapy

2008 ◽  
Vol 47 (04) ◽  
pp. 153-166 ◽  
Author(s):  
I. Weber ◽  
W. Eschner ◽  
F. Sudbrock ◽  
M. Schmidt ◽  
M. Dietlein ◽  
...  
Keyword(s):  
Success Rate ◽  
Thyroid Function ◽  
Therapeutic Dose ◽  
Radioiodine Therapy ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Inclusion Criteria ◽  
End Point ◽  
Point Measure ◽  
The Impact

SummaryAim: This study was performed to analyse the impact of the choice of antithyroid drugs (ATD) on the outcome of ablative radioiodine therapy (RIT) in patients with Graves' disease. Patients, material, methods: A total of 571 consecutive patients were observed for 12 months after RIT between July 2001 and June 2004. Inclusion criteria were the confirmed diagnosis of Graves' disease, compensation of hyperthyroidism and withdrawal of ATD two days before preliminary radioiodine-testing and RIT. The intended dose of 250 Gy was calculated from the results of the radioiodine test and the therapeutically achieved dose was measured by serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The pretreatment ATD was retrospectively correlated with the results achieved. Results: Relief from hyperthyroidism was achieved in 96 % of patients. 472 patients were treated with carbimazole or methimazole (CMI) and 61 with propylthiouracil (PTU). 38 patients had no thyrostatic drugs (ND) prior to RIT. The success rate was equal in all groups (CMI 451/472; PTU 61/61; ND 37/38; p=0.22). Conclusion: Thyrostatic treatment with PTU achieves excellent results in ablative RIT, using an accurate dosimetric approach with an achieved post-therapeutic dose of more than 200 Gy.

scholarly journals Quality of life, clinical outcomes and safety of early prophylactic levothyroxine administration in patients with Graves' hyperthyroidism undergoing radioiodine therapy: a randomized controlled study

2016 ◽  
Vol 174 (4) ◽  
pp. 491-502 ◽  
Author(s):  
David Taïeb ◽  
Claire Bournaud ◽  
Marie-Claude Eberle ◽  
Bogdan Catargi ◽  
Claire Schvartz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Endpoint ◽  
Radioiodine Therapy ◽  
Controlled Study ◽  
Thyroid Function Tests ◽  
Randomized Controlled ◽  
Sf 36 ◽  
Group A ◽  
Group B

ObjectiveWhile radioiodine therapy is commonly used for treating Graves' disease, a prolonged and clinical hypothyroidism may result in disabling symptoms leading to deterioration of quality of life (QoL) of patients. Introducing levothyroxine (LT4) treatment in the early post-therapeutic period may be an interesting approach to limit this phenomenon.MethodsA multicenter, prospective, open-label randomized controlled trial enrolled 94 patients with Graves' hyperthyroidism randomly assigned to the experimental group (n=46) (group A: early prophylactic LT4treatment) or the control group (n=48) (group B: standard follow-up). The primary endpoint was the 6-month QoL. The secondary endpoints were other QoL scores such as Graves' ophthalmopathy (GO) outcomes, thyroid function tests and safety.ResultsThe primary endpoint at 6 months was achieved: the mental composite score (MCS) of Short Form 36 (SF-36) was significantly higher in group A compared to group B (P=0.009). Four other dimension scores of the SF-36 and four dimension scores of the thyroid-specific patient-reported outcome (ThyPRO) significantly differed between the two groups, indicating better QoL in group A. After adjustment for variables, the early LT4administration strategy was found as an independent factor for only two scores of SF-36: the MCS and the general health (GH) score. There were no differences in GO, final thyroid status and changes in the anti-TSH receptor antibodies (TRAbs) levels between the two groups. No adverse cardiovascular event was reported.ConclusionEarly LT4administration post-radioactive iodine (RAI) could represent a safe potential benefit for patients with regard to QoL. The optimal strategy taking into account administered RAI activities and LT4treatment dosage and timing remains to be determined.

scholarly journals Delayed Citrus Stimulation and Prevention of Salivary Glands Damage in Patients of Thyroid Carcinoma Treated by Radioiodine Therapy

2019 ◽  
Vol 21 (2) ◽  
pp. 92-96
Author(s):  
Sharmin Reza ◽  
Sadia Sultana ◽  
Fatima Begum ◽  
Rahima Perveen ◽  
Zeenat Jabin ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Side Effects ◽  
Thyroid Carcinoma ◽  
Salivary Glands ◽  
Radioiodine Therapy ◽  
Delayed Initiation ◽  
History Of ◽  
Group A ◽  
Group B ◽  
Taste Dysfunction

Objective: It is well established that citrus stimulation has a definite role in preventing salivary gland damage after radioiodine therapy. The aim of this study was to observe how effectively this stimulation can be used to prevent salivary gland damage and whether the timing of sucking citrus substances play any role in preventing this damage more effectively. Patients and Methods: A total of 128 differentiated thyroid cancer (DTC) patients who received radioiodine treatment for thyroid carcinoma were divided into two groups- group-A and group-B. Group-A patients started citrus stimulation 1 hour after radioiodine ingestion and group-B patients started 24 hours after RAIT. Patients were followed-up at 5th day, 3rd month, and 6th month after RAIT. Follow up procedure consisted of physical examination and history of pain and swelling in salivary gland regions, taste dysfunction and dryness of mouth. Result: The incidence of different types of salivary glands side effects and abnormal scan findings were significantly high in the group of patients who were advised to start citrus stimulation 1 h after radioiodine ingestion. On the other hand, patients who started citrus stimulation 24 h after RAIT suffered less from salivary gland side effects.  Conclusion: This study showed that delayed initiation of citrus stimulation was more effective in reducing salivary gland damage after RAIT. Bangladesh J. Nuclear Med. 21(2): 92-96, July 2018

scholarly journals Convergence, Accommodation, Fusion, and Stereopsis: What Keeps the Eyes Aligned in Intermittent Exotropia?

Scientifica ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Costantino Schiavi ◽  
Valentina Di Croce ◽  
Laura Primavera ◽  
Filippo Tassi
Keyword(s):  
Patient Group ◽  
Control Group ◽  
Intermittent Exotropia ◽  
Myopic Shift ◽  
Infrared Video ◽  
Group A ◽  
Angle Of Deviation ◽  
Convergence And Divergence ◽  
Group B

Purpose. To investigate the relationships between angle of deviation, fusional convergence and divergence amplitude, AC/A ratio, near point of convergence (NPC), and myopia-phoria in intermittent exotropia (IXT). Methods. 93 patients with IXT, divided into two groups, were recruited in the study. In Group A (73 patients), fusional convergence and divergence amplitudes, NPC, and AC/A ratio were studied and compared with a control group. In Group B (in 20 patients), myopia-phoria while switching from monocular to binocular view was studied with an infrared video retinoscopy and compared with a control group. Results. In Group A, positive fusional amplitudes, NPC, and AC/A ratio of IXT patients did not differ from those of normals. Negative fusional amplitudes were significantly higher in the patient group than in the control group. In Group B, myopic shift was statistically significantly higher in the patient group and there was a statistically significant positive correlation between myopic shift and angle of strabismus. Conclusions. Apart from the role of fusional convergence which accounts for myopia-phoria, that of the other binocular functions in the control at near of IXT and conversely their specific role in the pathogenesis of IXT remain unclear and the cause of divergent infantile strabismus is still unknown.

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