Outcome of radioactive iodine therapy in Toxic Nodular Goiter in Pakistan

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

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Benign and Malignant Thyroid Diseases

DeckerMed Surgery ◽

10.2310/surg.2409 ◽

2018 ◽

Author(s):

Lindsay EY Kuo ◽

Matthew A. Nehs

Keyword(s):

Thyroid Cancer ◽

Thyroid Disease ◽

Medullary Thyroid Cancer ◽

Radioactive Iodine ◽

Nodular Goiter ◽

Anaplastic Thyroid Cancer ◽

Cell Types ◽

Follicular Cells ◽

Toxic Nodular Goiter ◽

Carbohydrate And Lipid Metabolism

The thyroid is key to numerous metabolic and homeostatic processes, including thermomodulation, protein synthesis, carbohydrate and lipid metabolism, and adrenergic regulation. A normal thyroid gland weighs 15 to 25 g and is firm, mobile, and smooth to palpation. There are two distinct physiologically active cell types: follicular cells, which synthesize thyroid hormone, and parafollicular or C cells, which produce calcitonin. Surgery is indicated for three broad categories of thyroid disease: (1) a hyperfunctioning gland, (2) an enlarged gland (goiter) causing compressive symptoms, and (3) diagnosing or treating malignancy. These indications may overlap in a patient presenting for surgical consultation. Regardless of the indication, a thorough discussion with the patient about the thyroid disease and other diagnostic or therapeutic options (if any) should be conducted. This reviews contains 3 figures, 13 tables, and 56 references. Key Words: anaplastic thyroid cancer, antithyroid medications, Bethesda classification, follicular thyroid cancer, Graves disease, medullary thyroid cancer, nontoxic multinodular goiter, papillary thyroid cancer, radioactive iodine, toxic nodular goiter

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Graves’ Disease

10.5772/intechopen.97578 ◽

2021 ◽

Author(s):

Paula Aragão Prazeres de Oliveira ◽

Beatriz Nayara Muniz de Oliveira ◽

Eduarda da Silva Souza Paulino ◽

Fernanda Carolinne Marinho de Araujo ◽

Paula Gabriele Tabosa Lyra

Keyword(s):

Thyroid Gland ◽

Thyroid Hormones ◽

Radioactive Iodine ◽

Clinical Manifestations ◽

Nodular Goiter ◽

Graves Disease ◽

Decompression Surgery ◽

Excessive Sweating ◽

Toxic Nodular Goiter ◽

Diffuse Goiter

DG presents with three main presentations: hyperthyroidism with diffuse goiter, infiltrative ophthalmopathy and pre-tibial myxedema. Patients with Graves’ disease can rarely develop severe hyperthyroidism. The hyperthyroidism of Graves’ disease is characterized immunologically by the lymphocytic infiltration of the thyroid gland and by the activation of the immune system with elevation of the circulating T lymphocytes. In GD, goiter is characteristically diffuse. May have asymmetric or lobular character, with variable volume. The clinical manifestations of hyperthyroidism are due to the stimulatory effect of thyroid hormones on metabolism and tissues. Nervousness, eye complaints, insomnia, weight loss, tachycardia, palpitations, heat intolerance, damp and hot skin with excessive sweating, tremors, hyperdefecation and muscle weakness are the main characteristics. In the laboratory diagnosis, biochemical and hormonal exams will be done to assess thyroid hormones and the antithyroid antibodies. Additionally, imaging tests may be performed, such as radioactive iodine capture in 24 hours, ultrasonography, thyroid scintigraphy and fine needle aspiration. It is necessary to make the differential diagnosis of Graves’ disease for thyrotoxicosis, subacute lymphocytic thyroiditis and toxic nodular goiter. The treatment of DG aims to stop the production of thyroid hormones and inhibit the effect of thyroid hormones on the body. Hyperthyroidism caused by DG can be treated in the following ways: it may be the use of synthetic antithyroid medicines, thionamides, MMI being a long-term medicine, it allows a single daily dose, and adherence to treatment occurs, a disadvantage is that it cannot be used in pregnant women; beta-blockers, preferably used in the initial phase of DG with thionamides; radioactive iodine therapy (RAI), being the best cost–benefit and preventing DG recurrence; finally the total thyroidectomy, causing the withdrawal of the thyroid gland. Therefore, it should be discussed with the patient what is the best treatment for your case, with a view to the post and against each approach. If the patient develops Graves ophthalmopathy, in lighter cases the artificial tears should be used, and in more severe cases can be used as treatment, corticosteroids, orbital decompression surgery, prisms and orbital radiotherapy. In addition, the patient should keep their body healthy, doing exercise and healthy eating, following the guidance of their doctor.

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Biochemical Outcome of Repeated Radioactive Iodine Therapy in Patients with Primary Hyperthyroidism– Follow Up of a Decade

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v22i2.51762 ◽

2021 ◽

Vol 22 (2) ◽

pp. 119-124

Author(s):

Sharmin Reza ◽

Azmal Kabir Sarker ◽

Farhana Haque ◽

Mohammed Mehedi Al Zahid Bhuiyan ◽

Simoon Salekin ◽

...

Keyword(s):

Radioactive Iodine ◽

Nodular Goiter ◽

Descriptive Statistics ◽

Fixed Dose ◽

Radioactive Iodine Therapy ◽

Clinical Reality ◽

Demographic Traits ◽

Primary Hyperthyroidism ◽

Incremental Dose

Background: Whileradioactive iodine therapy (RAIT) in patients with primary hyperthyroidism results in euthyreosis or hypothyreosis, requirement of repeated therapy in a proportion of patients is a clinical reality. This study describesbiochemical outcomeof patients requiring repeated RAIT and the dose profiles across the demographic traits. Patients and Methods: The study retrospectively included the patients who underwent RAIT for Primary hyperthyroidism from January to December of 2006, using a modified fixed dose protocol following an institutional guideline which was adopted as the national guideline in 2007. Persistence of biochemical features of hyperthyroidism six months after RAIT was an indication for repeated therapy. Follow up data of eligible patients till December of 2016 was included in the descriptive statistics. Results: One, Two, three and four instances of RAIT were given to 83%, 14%, 2% and ≤ 1% of patients resulting in hypothyroidism to 58%, 67%, 67% and 100% of patients after each instance of therapy with incremental dose. Apparently more females than males ended up as biochemically hypothyroid, though not significant (OR 1.15, p=0.56).Younger females became significantly hypothyroid (p = 0.03).Patients with euthyroid outcome received higher dose-1of RAIT (P=0.007) which was found significant in females (p=0.005), in patients with Graves’ disease (GD) (p=0.018) and in patients receiving two instances of RAIT (p=0.03). Among the patients with GD, Single Toxic Nodule (STN) and Multi-Nodular Goiter (MNG), the proportion of hypothyroid outcome were 61%, 67% and 35%, at ten years following first dose. GD and STN required RAIT for up to four instances.MNG received an apparently higher mean of dose -1 and apparently less steep increment of doses, in comparison to GD and STN. Conclusion: Thisobservationof patient outcome over a decade was a scope to compare the mentioned guideline’s performance with the targets set by influential guidelines and recent reports around the globe. Bangladesh J. Nuclear Med. 22(2): 119-124, Jul 2019

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Long Term Follow-Up of Patients with Nontoxic Benign Nodular Goiter Treated with 131Iodine Therapy

Series of Endocrinology, Diabetes and Metabolism ◽

10.54178/jsedmv3i1003 ◽

2021 ◽

Vol 3 (1) ◽

pp. 20-26

Author(s):

Karren L Antonio ◽

Keyword(s):

Radioactive Iodine ◽

Treatment Options ◽

Nodular Goiter ◽

Size Reduction ◽

Surgical Removal ◽

Radioactive Iodine Therapy ◽

Thyroid Lobe ◽

Size Number

Background: With the advancement of diagnostic modalities, there is an increase in the number of individuals detected with thyroid nodules. There are multiple treatment options for the management of nontoxic benign nodular goiter. Radioactive iodine results in effective goiter size reduction which can be administered as out-patient basis and is an appropriate alternative for patients with higher risk for surgery. Our group have shown the effectiveness of 131Iodine therapy for nodular nontoxic goiters. We aim to determine the long-term effectiveness of radioactive iodine therapy among patients with nodular nontoxic goiter. Methods: This is a retrospective cohort study of patients with nontoxic benign nodular goiter, negative for malignancy on biopsy who underwent radioactive therapy with a follow-up of ≥36months using ultrasound studies. Thyroid size, number of nodules and size of nodules pre-treatment and ≥36months post-treatment were compared. Results: 63 patients were included with an average follow-up of 73.14 ± 34.87 months. Mean age during radioactive therapy and last follow-up was 41 ± 14 and 47 ± 14 respectively. Significant thyroid size reduction was noted in 92.06% of patients (right thyroid lobe: 47.54 ± 31.25%, left thyroid lobe 47.44 ± 31.82%) while significant reduction in number and size of nodules were noted in 96.82% and 98.41% of patients respectively. No increase in the number of nodules and no development of new nodules were noted among all patients. Conclusion: Radioactive iodine therapy for nontoxic benign nodular goiter produces a sustained reduction in thyroid size, number and size of nodules even after a long follow-up period. Hence, it is a viable alternative to surgical removal of the thyroid offering a lower risk for complication especially among patients who refuse surgery or has a contraindication to surgical management.

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The occurrence of hypothyroidism following radioactive iodine treatment of toxic nodular goiter is related to the TSH level

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-007-0059-1 ◽

2007 ◽

Vol 176 (3) ◽

pp. 199-203 ◽

Cited By ~ 8

Author(s):

H. I. Adamali ◽

J. Gibney ◽

D. O’Shea ◽

M. Casey ◽

T. J. McKenna

Keyword(s):

Radioactive Iodine ◽

Nodular Goiter ◽

Toxic Nodular Goiter ◽

Iodine Treatment

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Benign and Malignant Thyroid Diseases

10.2310/ot.2409 ◽

2018 ◽

Author(s):

Lindsay EY Kuo ◽

Matthew A. Nehs

Keyword(s):

Thyroid Cancer ◽

Thyroid Disease ◽

Medullary Thyroid Cancer ◽

Radioactive Iodine ◽

Nodular Goiter ◽

Anaplastic Thyroid Cancer ◽

Cell Types ◽

Follicular Cells ◽

Toxic Nodular Goiter ◽

Carbohydrate And Lipid Metabolism

The thyroid is key to numerous metabolic and homeostatic processes, including thermomodulation, protein synthesis, carbohydrate and lipid metabolism, and adrenergic regulation. A normal thyroid gland weighs 15 to 25 g and is firm, mobile, and smooth to palpation. There are two distinct physiologically active cell types: follicular cells, which synthesize thyroid hormone, and parafollicular or C cells, which produce calcitonin. Surgery is indicated for three broad categories of thyroid disease: (1) a hyperfunctioning gland, (2) an enlarged gland (goiter) causing compressive symptoms, and (3) diagnosing or treating malignancy. These indications may overlap in a patient presenting for surgical consultation. Regardless of the indication, a thorough discussion with the patient about the thyroid disease and other diagnostic or therapeutic options (if any) should be conducted. This reviews contains 3 figures, 13 tables, and 56 references. Key Words: anaplastic thyroid cancer, antithyroid medications, Bethesda classification, follicular thyroid cancer, Graves disease, medullary thyroid cancer, nontoxic multinodular goiter, papillary thyroid cancer, radioactive iodine, toxic nodular goiter

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