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67 patients (44%) did not respond properly: in 32 (21%) their antithyroid drug (ATD) dose could be reduced but not withdrawn (partial response) and 35 (23%) remained hyperthyroid or the same dose of ATD was necessary (no response).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.

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 Standardized grey scale ultrasonography in Graves' disease: correlation to autoimmune activity

1999 ◽  
pp. 332-336 ◽  
Author(s):  
U Schiemann ◽  
R Gellner ◽  
B Riemann ◽  
G Schierbaum ◽  
J Menzel ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Antithyroid Drug ◽  
Thyroid Volume ◽  
Control Group ◽  
Graves Disease ◽  
Laboratory Findings ◽  
Grey Scale ◽  
Antithyroid Drug Treatment ◽  
Student’S T ◽  
A Prospective Study

OBJECTIVE: Graves' disease leads to thyroid enlargement and to reduction of tissue echogenicity. Our purpose was to correlate grey scale ultrasonography of the thyroid gland with clinical and laboratory findings in patients with Graves' disease. DESIGN: Fifty-three patients with Graves'disease were included in our study, 100 euthyroid volunteers served as control group. Free thyroxine (FT(4)), TSH and TRAb (TSH receptor antibodies) values were measured and correlated with sonographic echogenicity of the thyroid gland. METHODS: All patients and control persons underwent ultrasonographical histogram analyses under standardized conditions. Mean densities of the thyroid tissues were determined in grey scales (GWE). RESULTS: Compared with controls with homogeneous thyroid lobes of normal size (25.6 +/- 2.0GWE, mean +/- S.D.) echogenicity in patients with Graves' disease was significantly lower (21.3 +/- 3. 3GWE, mean +/- S.D., P < 0.0001). Among the patients with Graves' disease significant differences of thyroid echo levels were revealed for patients with suppressed (20.4 +/- 3.1 GWE, mean +/- S.D., n=34) and normalized TSH values (22.5 +/- 3.6GWE, mean +/- S.D., n=19, P < 0.02). Significantly lower echogenicities were also measured in cases of persistent elevated TRAb levels (19.9 +/- 2.9GWE, mean +/- S.D., n=31) in comparison with normal TRAb levels (22.9 +/- 3.5 GWE, mean +/- S.D., n=22, P < 0.0015). No correlation could be verified between echogenicity and either still elevated or already normalized FT(4) values or the thyroid volume. In coincidence of hyperthyroidism and Graves' ophthalmopathy (19.7 +/- 3.5GWE, mean +/- S.D., n=23) significantly lower echogenicity was measured than in the absence of ophthalmological symptoms (22.3 +/- 3.3GWE, mean +/- S.D., n=30, P < 0.016). Patients needing active antithyroid drug treatment revealed significantly lower thyroid echogenicity (20.3 +/- 3.1 GWE, mean +/- S.D., n=40) than patients in remission (23.7 +/- 3.4 GWE, mean +/- S.D., n=13, P < 0.001). Statistical evaluation was carried out using Student's t-test. CONCLUSIONS: Standardized grey scale histogram analysis allows for supplementary judgements of thyroid function and degree of autoimmune activity in Graves' disease. Whether these values help to estimate the risk of recurrence of hyperthyroidism after withdrawal of antithyroid medication should be evaluated in a prospective study.

Erratum

1989 ◽  
Vol 121 (2) ◽  
pp. 304
Author(s):  
H. Schleusener ◽  
J. Schwander ◽  
C. Fischer ◽  
R. Holle ◽  
G. Holl ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Relapse Rate ◽  
Clinical Course ◽  
Antithyroid Drug ◽  
Graves Disease ◽  
Trh Test ◽  
Prospective Multicentre Study ◽  
Antithyroid Drug Therapy ◽  
Significant Difference ◽  
The Individual

Abstract. Graves' disease is an autoimmune disease characterized by a course of remission and relapse. Since the introduction of antithyroid drug treatment, various parameters have been tested for their ability to predict the clinical course of a patient with Graves' disease after drug withdrawal. Nearly all these studies were retrospective and often yielded conflicting results. In a prospective multicentre study with a total of 451 patients, we investigated the significance of a variety of routine laboratory and clinical parameters for predicting a patient's clinical course. Patients who had positive TSH receptor antibodies activity at the end of therapy showed a significantly higher relapse rate than those without (P < 0.001). However, the individual clinical course cannot be predicted exactly (sensitivity 0.49, specificity 0.73, N = 391). The measurement of microsomal (P = 0.99, sensitivity 0.37, specificity 0.63, N = 275) or thyroglobulin antibodies (P = 0.76, sensitivity 0.18, specificity 0.84, N = 304) at the end of antithyroid drug therapy did not show a statistically significant difference in the antibody titre between the patients of the relapse and those of the remission group. Additionally, HLA-DR typing (HLA-DR3: P = 0.37, sensitivity 0.36, specificity 0.58, N = 253) was proven to be unsuitable for predicting a patient's clinical course. Patients with abnormal suppression or an abnormal TRH test at the end of antithyroid drug therapy relapse significantly more often (P< 0.001) than patients with normal suppression or normal TRH test. Patients with a large goitre also have a significantly (P< 0.001) higher relapse rate than those with only a small enlargement. The sensitivity and specificity values of all these parameters, however, were too low to be useful for daily clinical decisions in the treatment of an individual patient. This is also true for the combinations of different parameters. Though the highest sensitivity value (0.94) was found for a combination of the suppression and the TRH test at the end of therapy, the very low specificity value (0.13) for this combination reduced its clinical usefulness.

scholarly journals Parameters affecting the period for being euthyroid in newly-diagnosed Graves’ disease treated with antithyroid agent

2020 ◽  
Vol 8 (9) ◽  
pp. 3165
Author(s):  
Iskender Ekinci ◽  
Hande Peynirci
Keyword(s):  
Thyroid Function ◽  
Smoking Status ◽  
Antithyroid Drug ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Newly Diagnosed ◽  
Function Tests ◽  
Significant Difference ◽  
Stimulating Hormone

Background: There are limited data about the factors affecting the response time to medical treatment in Graves’ disease (GD) although many studies examined the predictors of the relapse after drug withdrawal. The aim of the current study was to evaluate the time for becoming euthyroid under antithyroid drug (ATD) therapy and the parameters influencing this period in patients diagnosed as GD.Methods: Patients with newly-diagnosed GD and decided to treat with ATD initially between March 2017 and September 2018 were retrieved retrospectively. Sociodemographic features as well as laboratory parameters like thyroid function tests and thyroid-stimulating hormone-receptor antibody (TRab) at the time of diagnosis were recorded.Results: Out of 41 patients, 63.4% (n=26) were female. The mean age was 36.1±11.7 years and 43.9% (n=18) of them were smoking. The time between the initiation of treatment and the duration of becoming euthyroid was 2.4±1.8 months. No significant difference was noted between age, gender, and smoking status and the time to become euthyroid under ATD treatment. This period was significantly positively correlated with levels of free triiodothyronine, free thyroxine, and negatively correlated with thyroid-stimulating hormone. Response to ATD therapy was higher in patients with pre-treatment TRab levels <10 IU/l than TRab ≥10 IU/l (p=0.011).Conclusions: Pretreatment thyroid function tests and TRab levels may be taken into consideration before deciding treatment in patients with newly diagnosed GD. It would be useful to design more comprehensive studies so that this proposal can find a response in clinical practice.

scholarly journals Predictors of the efficacy of radioiodine therapy of Graves’ disease in children and adolescents

2020 ◽  
Vol 66 (4) ◽  
pp. 68-76
Author(s):  
Pavel O. Rumyantsev ◽  
Vladimir A. Saenko ◽  
Dali S. Dzeytova ◽  
Alexey A. Trukhin ◽  
Marina S. Sheremeta ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Statistical Analysis ◽  
Children And Adolescents ◽  
Radioiodine Therapy ◽  
Antithyroid Drug ◽  
Thyroid Volume ◽  
Tsh Receptor ◽  
Rank Test ◽  
Graves Disease ◽  
Fisher Exact Test

RATIONALE: Insufficient world–wide clinical experience in radioiodine therapy (RIT) for Graves’ disease (GD) in children and adolescents, and limited knowledge of the predictors of RIT efficacy.AIMS: Analysis and identification of the most significant predictors of the efficacy of RIT in children and adolescents with Graves’ disease.MATERIALS AND METHODS: A total of 55 patients (48 females and 7 males) aged from 8 to 18 years receiving primary RIT for GD were enrolled. RIT planning was based on the dosimetric method. Analyzed parameters included gender, age, ultrasound thyroid volume before and 6 months after treatment, the presence of endocrine ophthalmopathy, duration of antithyroid drug (ATD) therapy, relapse of thyrotoxicosis after ATD dose reduction, blood fT3, fT4 and TSH levels initially and at 1, 3, 6 months after treatment, TSH receptor Ab initially and at 3 and 6 months after treatment, thyroid 99mTc–pertechnetate uptake at 10–20 minutes (%), maximum thyroid 131I uptake (%), specific 131I uptake (MBq/g) and therapeutic 131I activity (MBq). Fisher exact test, non–parametric Mann–Whitney test, Wilcoxon signed–rank test, logistic regression modelling, ROC–analysis, proportional hazard model (the Cox regression), the Kaplan–Meier method and log–rank test were used for statistical analysis as appropriate.RESULTS: Six months after RIT, hypothyroidism was achieved in 45 (81.8%), euthyroid state – in 2 (3.6%), and in 8 (14.6%) patients thyrotoxicosis persisted. On univariate statistical analysis, the smaller thyroid volume, higher fT4 and lower TSH receptor Ab levels, lower 99mTc–pertechnetate uptake and higher specific 131I uptake were associated with hypothyroidism. On multivariate logistic regression analysis, the older patient’s age (p=0.011), smaller thyroid volume (p=0.003) and higher fT4 (p=0.024) were independent predictors of RIT efficacy. Thyroid volume was also the only variable associated with achievement of hypothyroidism in time after RIT (p=0.011).CONCLUSION: The efficacy of dosimetry–based RIT in children and adolescents with GD 6 months after treatment was 81.2%. Older patients’ age, smaller thyroid volume and higher fT4 level were independent predictors of therapy success. Smaller thyroid volume was also a predictor of the favorable time–related outcome. Statistical models obtained in this work may be used to prospectively estimate the chance of efficient RIT for GD in pediatric patients.

scholarly journals Anticlastogenic Effect of Ginkgo Biloba Extract in Graves’ Disease Patients Receiving Radioiodine Therapy

2007 ◽  
Vol 92 (11) ◽  
pp. 4286-4289 ◽  
Author(s):  
A. Dardano ◽  
M. Ballardin ◽  
M. Ferdeghini ◽  
E. Lazzeri ◽  
C. Traino ◽  
...  
Keyword(s):  
Placebo Group ◽  
Clinical Outcome ◽  
Ginkgo Biloba ◽  
Radioiodine Therapy ◽  
Statistical Significance ◽  
Ginkgo Biloba Extract ◽  
131I Therapy ◽  
Graves Disease ◽  
Egb 761 ◽  
Significant Difference

Abstract Background: Chromosomal damage, as assessed by clastogenic factors (CFs) and micronuclei (MN) appearance, after radioiodine therapy of Graves’ disease has been reported. Objective and Methods: Our objective was to evaluate the effect of Ginkgo biloba extract (EGb 761) supplementation on the time course (up to 120 d) of CFs and MN appearance in lymphocytes from patients with Graves’ disease after iodine-131 (131I) therapy. Patients were randomly assigned to EGb 761 or placebo, in a blinded manner. Results: In the placebo group, MN increased early (P &lt; 0.001) after 131I, peaking at the 21st day (P = 0.0003) and declining thereafter. In EGb 761-treated patients, MN increased early (P &lt; 0.05), while returning toward baseline value thereafter. Therefore, mean MN increment was significantly higher in the placebo group as compared with EGb 761-treated patients (P &lt; 0.01). Moreover, an early (P &lt; 0.0001) and sustained (up to 35 d; P &lt; 0.001) MN increase induced by CFs was observed in the placebo group. Conversely, in EGb 761-treated patients, MN increase induced by CFs never reached the statistical significance; therefore, the mean of the MN increments was significantly lower than in placebo (P &lt; 0.05). A significant positive correlation between MN maximum increment and the bone marrow dose was observed in the placebo group only (P = 0.03). No significant difference was observed in clinical outcome between the two groups. Conclusions: EGb 761 supplementation neutralized genotoxic damage induced by radioiodine treatment, without affecting the clinical outcome. Although 131I therapy is generally safe, our data suggest that Gingko biloba extracts may prevent genetic effects of radioiodine therapy for hyperthyroid Graves’ disease.

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