MON-624 Follow-Up within the First Year after Radioiodine Therapy for Graves' Disease

Objective: To investigate the long-term outcomes of radioiodine therapy (RIT) for juvenile Graves disease (GD) and the ultrasonographic changes of the thyroid gland. Methods: All of 117 juvenile patients (25 males and 92 females, aged 10 to 18 [median 16] years) who had undergone RIT for GD at our clinic between 1999 and 2018 were retrospectively reviewed. Each RIT session was delivered on an outpatient basis. The maximum 131I dose per treatment was 13.0 mCi, and the total 131I dose per patient was 3.6 to 29.8 mCi (median, 13.0 mCi). 131I administration was performed once in 89 patients, twice in 26, and three times in 2 patients. Ultrasonography of the thyroid gland was regularly performed after RIT. The duration of follow-up after the initial RIT ranged from 4 to 226 (median 95) months. Results: At the latest follow-up more than 12 months after RIT (n = 111), the patients' thyroid functions were overt hypothyroidism (91%), subclinical hypothyroidism (2%), normal (5%), or subclinical hyperthyroidism (2%). New thyroid nodules were detected in 9 patients, 4 to 17 years after initial RIT. Patients with newly detected thyroid nodules underwent RIT with lower doses of 131I and had larger residual thyroid volumes than those without nodules. None of the patients were diagnosed with thyroid cancer or other malignancies during the follow-up period. Conclusion: Over a median follow-up period of 95 months (range, 4 to 226 months), RIT was found to be effective and safe in juvenile GD. However, cumulative evidence from further studies is required to confirm the long-term safety of RIT for juvenile GD. Abbreviations: ATD = antithyroid drug; GD = Graves disease; KI = potassium iodide; LT4 = levothyroxine; MMI = methimazole; PTU = propylthiouracil; RAIU = radio-active iodine uptake; RIT = radioiodine therapy; 99mTc = technetium-99m; TSH = thyrotropin

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Lithium Carbonate in the Treatment of Graves’ Disease with ATD-Induced Hepatic Injury or Leukopenia

International Journal of Endocrinology ◽

10.1155/2015/694023 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Rendong Zheng ◽

Kemian Liu ◽

Kun Chen ◽

Wen Cao ◽

Lin Cao ◽

...

Keyword(s):

Liver Function ◽

Blood Cells ◽

Hepatic Injury ◽

Clinical Effect ◽

Radioiodine Therapy ◽

White Blood Cells ◽

Lithium Carbonate ◽

Graves Disease ◽

Blood Cell Count

Objective. GD with ATD-induced hepatic injury or leukopenia occurs frequently in clinical practice. The purpose of the present study was to observe the clinical effect of lithium carbonate on hyperthyroidism in patients with GD with hepatic injury or leukopenia.Methods. Fifty-one patients with GD with hepatic injury or leukopenia participated in the study. All patients were treated with lithium carbonate, in addition to hepatoprotective drugs or drugs that increase white blood cell count. Thyroid function, liver function, and white blood cells were measured. Clinical outcomes were observed after a 1-year follow-up.Results. After treatment for 36 weeks, symptoms of hyperthyroidism and the level of thyroid hormones were improved and liver function, and white blood cells returned to a normal level. Twelve patients (23.5%) obtained clinical remission, 6 patients (11.8%) relapsed after withdrawal, 25 patients (49.0%) received radioiodine therapy, and 8 patients (15.7%) underwent surgical procedures after lithium carbonate treatment.Conclusion. Lithium carbonate has effects on the treatment of mild-to-moderate hyperthyroidism caused by GD, and it is particularly suitable for patients with ATD-induced hepatic injury or leukopenia.

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Thyroid Echogenicity Predicts Outcome of Radioiodine Therapy in Patients with Graves’ Disease

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-0879 ◽

2007 ◽

Vol 92 (9) ◽

pp. 3547-3552 ◽

Cited By ~ 25

Author(s):

Vinko Marković ◽

Davor Eterović

Keyword(s):

Radioiodine Therapy ◽

Independent Predictor ◽

Prospective Trial ◽

Absorbed Dose ◽

University Hospital ◽

Graves Disease ◽

Hospital Outpatient Clinic ◽

Increased Radioresistance ◽

Hypothyroid Patients

Abstract Context: Despite accounting for variations in gland size and iodine kinetics, the success of radioiodine therapy in patients with Graves’ disease remains moderately common and unpredictable. Objectives: We hypothesized that hypoechogenic glands, with large, densely packed cells, are more radiosensitive than normoechogenic glands, in which much radiation is wasted on more abundant colloid. We evaluated this hypothesis in a cohort of patients with Graves’ disease. Design: This was a prospective trial of patients recruited during 4 yr and followed up 1 yr after radioiodine therapy. Setting: This trial was held in a university hospital-outpatient clinic. Patients: A total of 177 consecutive patients with first presentation of Graves’ disease (28 males), 23–76 yr old, who relapsed after antithyroid therapy were included in the study. Intervention: The patients were assigned to an ablative target-absorbed dose of 200 Gy (n = 78) or randomly to 100 or 120 Gy of nonablative dose (n = 99). Main Outcome Measures: The measures were incidences of hyperthyroidism, euthyroidism, and hypothyroidism at 12-month follow-up. Results: At follow-up there were 25 hyperthyroid, 44 euthyroid, and 108 hypothyroid patients. Compared with 96 patients with a hypoechogenic gland, in 81 patients with a normoechogenic gland, there were more hyperthyroid (22 vs. 7%) and euthyroid (41 vs. 11%), but less hypothyroid outcomes (37 vs. 81%; P < 0.0001). The other independent predictor of increased radioresistance was the large gland volume. Conclusion: In patients with Graves’ disease, normoechogenic and large glands are associated with increased radioresistance.

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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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Results of a risk adapted and functional radioiodine therapy in Graves’ disease

Nuklearmedizin ◽

10.1055/s-0038-1625320 ◽

2005 ◽

Vol 44 (06) ◽

pp. 238-242 ◽

Cited By ~ 8

Author(s):

V. Neumann ◽

U. Staub ◽

P. Groth ◽

H. Künstner ◽

C. Schümichen ◽

...

Keyword(s):

Radioiodine Therapy ◽

Thyroid Volume ◽

Therapeutic Failure ◽

Graves Disease ◽

Clinical Parameters ◽

Target Dose ◽

Therapeutic Success ◽

Thyroid Metabolism ◽

First Time

SummaryAim of this study was to find out, if results of a functional orientated radioiodine therapy in Graves’ disease could be optimized using a risk adopted dose concept. Patients, method: 351 patients with Graves’ disease were treated for the first time between 11/97 and 8/01. The basic dose was 125 Gy, which was increased up to 250 Gy in a cumulative manner depending on clinical parameters (initial thyroid metabolism, thyroid volume, immunoreactivity). Two different methods of dosimetry were used. Occasional thyreostasis was withdrawn two days before the radioiodine test was started. Follow up was done on average 8 ± 2,4 (4-17,2) months. TSH ≥0,27 μIU/mL confirmed as a measure of the success. Results: With improved pretherapeutic dosimetry and a mean target dose of 178 ± 31 Gy (n=72) therapeutic success occurred in 66,7%, in 51,4% euthyreosis was restalled and in 15,3% of patients hypothyroidism was seen (TSH >4,20 μIU/mL). With simplified pretherapeutic dosimetry and a mean target dose of 172 ± 29 Gy (n=279) results were moderately impaired (63,8%, 40,1% and 23,7%). With increasing target dose therapeutic failure increased, as unsufficiently adopted risk factors for therapeutic failure turned out the initial thyroid metabolism, the TcTU(s) as the (h)TRAb titer. Conclusion: Functional orientated RIT can be optimized by including illness specific characteristics, principal limitations are a high initial thyroid metabolism, a large thyroid volume and a high (h)TRAb-titer.

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Pertechnetate Uptake in the Prediction of Early Outcome after Radioiodine Therapy

Nuklearmedizin ◽

10.1055/s-0038-1629465 ◽

1989 ◽

Vol 28 (01) ◽

pp. 21-25

Author(s):

T. M. D. Gimlette

Keyword(s):

Positive Predictive Value ◽

Radioiodine Therapy ◽

In Vitro Tests ◽

First Year ◽

Thyroid Antibodies ◽

Early Outcome ◽

Before And After ◽

Uptake Test

99mTc-pertechnetate uptake was estimated 8-13 weeks after radioiodine therapy for hyperthyroidism in 132 patients in order to evaluate the usefulness of the uptake test in predicting both persisting hyperthyroidism and the early onset of hypothyroidism during the first year after therapy. The estimation was simple, the result immediately available, and its sensitivities, positive predictive value and its overall accuracy (83%) compared favourably with that of in-vitro tests, FT4I (75%) and FT3I (80%), carried out on the same occasions during the early follow-up period. Pertechnetate uptake can be a useful guide to management by promptly identifying patients likely to need further radioiodine therapy and those with transient or permanent hypothyroidism. The study confirmed some previous findings that hypothyroidism was more frequent in patients with thyroid antibodies and less frequent in patients with nodular thyroids, and it also indicated that hypothyroidism was more frequent in those treated with carbimazole before and after radioiodine, and that hyperthyroidism was more likely to persist in those treated with carbimazole before or after radioiodine.

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Goitre size and outcome of medical treatment of Graves' disease

Acta Endocrinologica ◽

10.1530/acta.0.1110039 ◽

1986 ◽

Vol 111 (1) ◽

pp. 39-43 ◽

Cited By ~ 58

Author(s):

Peter Laurberg ◽

Poul Erik Buchholtz Hansen ◽

Eigil Iversen ◽

Sigurd Eskjær Jensen ◽

Jørgen Weeke

Keyword(s):

Medium Size ◽

First Year ◽

Graves Disease ◽

Newly Diagnosed ◽

Multinodular Goitre ◽

Remission Rates ◽

Table Analysis ◽

Reasonable Choice ◽

Large Goitre

Abstract. One hundred and twenty-four patients with newly diagnosed hyperthyroidism received a combined thionamid-thyroxine medical therapy for approximately 2 years. According to the estimated goitre size before therapy and the type of goitre the patients were divided into 4 groups: Graves' disease no goitre (n = 19). Graves' disease small goitre (n = 57), Graves' disease medium or large goitre (n = 23), multinodular goitre (n = 25). The median follow-up period after cessation of medication was 64 (range 11–141) months. The remission rates in the different groups during follow-up were calculated using life table analysis. Graves' patients with no goitre or a small goitre had a significantly better outcome (remission % after 5 years 82.5 ± 15.4 (se) and 71.5 ± 7.8, respectively) than Graves' patients with a medium size or large goitre (remission % after 5 years 37.0 ± 11.1) (P <0.025). Most patients with multinodular goitre had a relapse within the first year after stop of medication (remission % after 5 years 15.5 ± 10.1). Hence patients with Graves' disease having a small thyroid gland should be treated medically while surgery or radioiodine may be a more reasonable choice in Graves' patients with medium size or large goitres. Medically treated patients with toxic multinodular goitres have a very small chance of prolonged remission if medication is stopped.

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Cigarette Smoking Has no Impact on the Effect of Radioiodine Therapy in Patients with Graves Disease / Pušenje cigareta nema uticaj na ishod radiojodne terapije kod bolesnika sa Grejvsovom bolešću

Acta Facultatis Medicae Naissensis ◽

10.1515/afmnai-2015-0007 ◽

2015 ◽

Vol 32 (1) ◽

pp. 67-75

Author(s):

Vladan Sekulić ◽

Milena P. Rajić ◽

Marina Vlajković ◽

Slobodan Ilić ◽

Miloš Stević ◽

...

Keyword(s):

Cigarette Smoking ◽

Radioiodine Therapy ◽

Response To Therapy ◽

Stressful Events ◽

Antithyroid Drugs ◽

Graves Disease ◽

Significant Difference ◽

Iodine 131 ◽

The Impact

Summary Presently, there is very little data on the impact of nicotine and other components of tobacco smoking on the outcome of radioiodine therapy (RIT) in Graves’ disease (GD). Thus, this study was aimed to analyze a possible impact of cigarette smoking on the effect of radioiodine therapy in the patients with Graves’ disease. The study included 31 patients (16 smokers and 15 non-smokers) with GD, aged from 22 to 73 years, who were treated with a single dose of iodine-131 sodium iodide (131I-NaI) and subjected to a 12-month follow-up, thereafter. Patients were treated with antithyroid drugs (ATDs) before RIT and described very intense stressful events occurring prior to diagnosing Graves’ hyperthyroidism. A successful response to RIT was defined as euthyroidism and subclinical or clinical hypothyroidism, while an unsuccessful response was defined as persistent hyperthyroidism. Comparison of age (47.4±9.41 vs. 49.5±13.8 years, p=0.628) at the time of RIT, applied activity of 131I-NaI (372±78.4 vs. 363±43.7 MBq, p=0.675), and duration of ATDs therapy (3.47±3.33 vs. 4.94±5.62 years, p=0.387) between smokers and non-smokers showed no significant difference. The cumulative incidence of successful response to therapy in smokers and non-smokers was 31.2 vs. 46.7% (p<0.05), 50.0 vs. 60.0% (p>0.05), 56.2 vs. 60.0% (p>0.05), and 56.2 vs. 66.7% (p>0.05) after 3, 6, 9 and 12 months, respectively. The results showed that cigarette smoking has no impact on the effect of radioiodine therapy after twelve-month period in patients who had experienced stressful events before the occurrence of Graves’ disease. However, patients with smoking habits achieved successful response later than non-smokers.

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Short- and Long-Term Results of Total vs Subtotal Thyroid- ectomies in the Surgical Treatment of Graves' Disease

Swiss Surgery ◽

10.1024/1023-9332.7.1.20 ◽

2001 ◽

Vol 7 (1) ◽

pp. 20-24 ◽

Cited By ~ 14

Author(s):

Robert ◽

Mariéthoz ◽

Pache ◽

Bertin ◽

Caulfield ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Long Term Results ◽

Graves Disease ◽

Laryngeal Nerve Palsy ◽

Short And Long Term

Objective: Approximately one out of five patients with Graves' disease (GD) undergoes a thyroidectomy after a mean period of 18 months of medical treatment. This retrospective and non-randomized study from a teaching hospital compares short- and long-term results of total (TT) and subtotal thyroidectomies (ST) for this disease. Methods: From 1987 to 1997, 94 patients were operated for GD. Thirty-three patients underwent a TT (mostly since 1993) and 61 a ST (keeping 4 to 8 grams of thyroid tissue - mean 6 g). All patients had received propylthiouracil and/or neo-mercazole and were in a euthyroid state at the time of surgery; they also took potassium iodide (lugol) for ten days before surgery. Results: There were no deaths. Transient hypocalcemia (< 3 months) occurred in 32 patients (15 TT and 17 ST) and persistent hypocalcemia in 8 having had TT. Two patients developed transient recurrent laryngeal nerve palsy after ST (< 3 months). After a median follow-up period of seven years (1-15) with five patients lost to follow-up, 41 patients having had a ST are in a hypothyroid state (73%), thirteen are euthyroid (23%), and two suffered recurrent hyperthyroidism, requiring completion of thyroidectomy. All 33 patients having had TT - with follow-ups averaging two years (0.5-8) - are receiving thyroxin substitution. Conclusions: There were no instances of persistent recurrent laryngeal nerve palsy in either group, but persistent hypoparathyroidism occurred more frequently after TT. Long after ST, hypothyroidism developed in nearly three of four cases, whereas euthyroidy was maintained in only one-fourth; recurrent hyperthyroidy was rare.

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The First Year Experience of Ankara Child Follow up Center

PsycEXTRA Dataset ◽

10.1037/e516542013-276 ◽

2012 ◽

Author(s):

Fadime Yuksel ◽

Safa Celik ◽

Filiz Daskafa ◽

Nilufer Keser ◽

Elif Odabas ◽

...

Keyword(s):

First Year Experience ◽

First Year

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