Utility of outpatient fractionated radioiodine therapy for Graves disease involving a large goiter measuring more than 100 mL in volume

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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Low Dose Radioiodine Therapy for Graves' disease: comparison of outcomes following administration of different doses across two centres

Endocrine Abstracts ◽

10.1530/endoabs.59.p212 ◽

2018 ◽

Author(s):

Natasha Sawhney ◽

Carmen Diaz-Ortega ◽

Sam Philip ◽

Fraser Gibb ◽

Prakash Abraham ◽

...

Keyword(s):

Low Dose ◽

Radioiodine Therapy ◽

Graves Disease ◽

Different Doses

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The outcome of radioiodine therapy of hyperthyroidism: comparison of patients with a toxic nodular goiter and with Graves' disease

Annales UMCS Medicina ◽

10.2478/v10079-008-0053-8 ◽

2008 ◽

Vol 63 (2) ◽

pp. 74-78

Author(s):

Jolanta Kijek ◽

Jerzy S. Tarach ◽

Maria Kurowska ◽

Bożena Szymanek

Keyword(s):

Radioiodine Therapy ◽

Nodular Goiter ◽

Graves Disease ◽

Toxic Nodular Goiter

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Graves' disease and radioiodine therapy

Nuklearmedizin ◽

10.3413/nukmed-0145 ◽

2008 ◽

Vol 47 (04) ◽

pp. 153-166 ◽

Cited By ~ 10

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.

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Radioiodine therapy in Graves’ disease

Nuclear Medicine Communications ◽

10.1097/mnm.0b013e3283559ba1 ◽

2012 ◽

Vol 33 (8) ◽

pp. 859-863 ◽

Cited By ~ 6

Author(s):

Serkan Isgoren ◽

Gozde Daglioz Gorur ◽

Hakan Demir ◽

Fatma Berk

Keyword(s):

Radioiodine Therapy ◽

Graves Disease

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Prognostic Value ofTc99m-Pertechnetate Thyroid Scintigraphy in Radioiodine Therapy in a Cohort of Chinese Graves’ Disease Patients: A Pilot Clinical Study

BioMed Research International ◽

10.1155/2015/974689 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Haifeng Hou ◽

Shu Hu ◽

Rong Fan ◽

Wen Sun ◽

Xiaofei Zhang ◽

...

Keyword(s):

Single Dose ◽

Prognostic Value ◽

Low Dose ◽

Radioiodine Therapy ◽

Treatment Success ◽

Serum Levels ◽

Graves Disease ◽

Thyroid Scintigraphy ◽

Thyroid Mass ◽

Pilot Clinical Study

Objectives. This study is to assess the prognostic value ofTc99m-pertechnetate thyroid scintigraphy for predicting the outcomes of fixed low dose of radioiodine therapy (RIT) in a cohort of Chinese Graves’ disease (GD) patients.Materials and Methods. This is a retrospective study of GD patients who received RIT with a single dose of radioiodine (5 mCi). All the patients receivedTc99m-pertechnetate thyroid scintigraphy prior to RIT. Thyroid mass,Tc99m-pertechnetate uptake, gender, age at diagnosis, duration of the disease, ophthalmopathy, and serum levels of FT4, FT3, TT4, and TT3 prior to RIT were analyzed as potential interference factors for outcomes of RIT.Results. One hundred and eighteen GD patients who completed RIT were followed up for 12 months. The outcomes (euthyroidism, hypothyroidism, and hyperthyroidism) were found to be significantly associated with thyroid mass andTc99m-pertechnetate uptake. Patients with thyroid mass ≤ 40.1 g orTc99m-pertechnetate uptake ≤ 15.2% had higher treatment success.Conclusions. A fixed low dose of 5 mCi radioiodine seems to be practical and effective for the treatment of Chinese GD patients with thyroid mass ≤ 40.1 g andTc99m-pertechnetate uptake ≤ 15.2%. This study demonstratesTc99m-pertechnetate thyroid scintigraphy is an important prognostic factor for predicting the outcomes of RIT.

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A case of basid disease cured by removal of 2 lower parathyroid glands

Kazan medical journal ◽

10.17816/kazmj72201 ◽

1934 ◽

Vol 30 (5) ◽

pp. 467-467

Author(s):

E. Auslander

Keyword(s):

Emergency Surgery ◽

Severe Form ◽

Parathyroid Glands ◽

Graves Disease ◽

Large Goiter

A 38-year-old woman with a severe form of Graves' disease (large goiter, exophthalmos, tremor, tachycardia-pulse 140, nervousness, and severe emaciation) is indicated for emergency surgery.

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