scholarly journals Optimized radioiodine therapy of Graves' disease: analysis of the delivered dose and of other possible factors affecting outcome

1999 ◽  
Vol 141 (2) ◽  
pp. 117-121 ◽  
Author(s):  
B Catargi ◽  
F Leprat ◽  
M Guyot ◽  
N Valli ◽  
D Ducassou ◽  
...  
Keyword(s):  
Radioiodine Therapy ◽  
Urinary Iodine ◽  
Organ Dose ◽  
First Episode ◽  
Urinary Iodine Excretion ◽  
Graves Disease ◽  
Therapeutic Success ◽  
Number Of Patients ◽  
The Relationship ◽  
Delivered Dose

The best approach to radioiodine dose selection in the treatment of Graves' hyperthyroidism remains highly controversial. The formula to calculate the individual dose of (131)I to be delivered has been used for half a century and takes into account the thyroid mass, the effective half-life and the maximum uptake of (131)I. The objective of the present study was to evaluate the accuracy of this formula by determining the relationship between the administered dose of (131)I calculated to deliver a target dose of 50Gy to the thyroid and the actual exact organ dose. We further analyzed if therapeutic success, defined by euthyroidism following the individually calculated dose, can be predicted by different pretreatment parameters and particularly by organ dose. One hundred patients with a first episode of Graves' disease and who had received optimal thyroid irradiation after precise dosimetry were retrospectively reviewed. The patients were categorized according to their thyroid function (plasma free thyroxine (T(4)) serum concentration) as eu-, hyper- or hypothyroid during and 1 year after treatment. The relationship between the administered dose and organ dose was assessed by simple regression. We compared free T(4), free tri-iodothyronine, thyroid weight, the number of patients with antithyroperoxidase antibodies and TSH receptor autoantibodies, 24h urinary iodine excretion, (131)I uptake, and the exact dose of (131)I delivered to the thyroid as pretreatment variables. Although we found a correlation between administered dose (mCi) and organ dose (Gy) (r=0.3, P=0.003), the mean coefficient of variation for organ dose was 45%. Individualized radioiodine therapy enabled euthyroidism in 26% of patients and failed in 74% of patients (33% had persistent or recurrent hyperthyroidism and 41% permanent hypothyroidism). (131)I uptake was significantly higher in the hyperthyroidism group in comparison with the euthyroid group. However, organ dose and other pretreatment variables did not differ among the three groups. In conclusion, these results confirm the low performance of individual dosimetry using what are established ratios, since the delivered dose to the gland, although correlated to the intended dose, is highly variable. The finding that other usual pretreatment variables are not different between groups, gives little hope for improving the way of calculating the ideal dose of radioiodine. We suggest to those not yet ready to give a standard or an ablative dose for Graves' hyperthyroidism that they abandon this way to calculate the (131)I dose.

Does an individual estimation of halflife improve the results of radioiodine therapy of Graves’ disease?

2002 ◽  
Vol 41 (06) ◽  
pp. 240-244 ◽  
Author(s):  
C. Körber ◽  
N. Körber-Hafner ◽  
H. Hänscheid ◽  
Chr. Reiners ◽  
P. Schneider
Keyword(s):  
Radioiodine Therapy ◽  
Dose Calculation ◽  
Multiple Regression Model ◽  
Therapeutic Outcome ◽  
Graves Disease ◽  
Therapeutic Success ◽  
Logit Transformation ◽  
Therapy Success ◽  
The Impact ◽  
Delivered Dose

SummaryAim: The impact of our dosimetry concept on radioiodine therapy success in Graves’ disease (GD) was analysed. Three questions arised: Did individual estimation of pretherapeutic halflife improve therapeutic success?. Did individual dosimetry result in accurate dose calculation?. Did antithyroid medication have a measurable influence on therapeutic success under the prevailing conditions?. Methods: 126 consecutive patients were treated with 200 Gy I-131 in our therapy ward for GD and followed-up six to nine months after therapy. Success quote was assessed using a standardized protocol and treatment was classified as successful when the patient was eu- or hypothyroid, or unsuccessful when he or she presented with a suppressed TSH-level or in hyperthyroid condition after antithyroid medication withdrawel. Antithyroid medication, activity I-131, dose, concentration of fT3 and fT4, specific delivered dose and halflife were put into a multiple regression model to assess their influence on therapeutic success. In order to assess possible factors disturbing the therapeutic outcome, relevant parameters were analyzed using Logit transformation. Results: Out of 126 patients 84 were classified as successfully treated and 42 (33,3%) as failures. A significant influence on the outcome only was found for thyroid mass. However, therapeutic success appeared to be more distinctly determined by the specific delivered dose using an estimated halflife of 5.5 days (Odds: 10.0, p <0.001). Accurate intratherapeutic dosimetry did not play a significant role to enhance therapeutic success. Neither did antihyroid medication during radioiodine therapy exert any significant impact. Conclusions: Measurement of individual intratherapeutic halflife as opposed to an estimate using a standard halflife did not provide improved results concerning the target dose. Retrospectively, the therapeutic outcome on the basis of a measured halflife as compared to a standard halflife did not significantly improve. In addition, no influence of antithyroid medication on therapy success was found.

Influence of Radioiodine Therapy on Urinary Iodine Excretion

1998 ◽  
Vol 37 (03) ◽  
pp. 107-112 ◽  
Author(s):  
I. Lauer ◽  
M. Bähre ◽  
E. Richter ◽  
B. Melier
Keyword(s):  
Time Course ◽  
Radioiodine Therapy ◽  
Urinary Iodine ◽  
Target Volume ◽  
Urinary Iodine Excretion ◽  
Urinary Creatinine ◽  
Iodine Excretion ◽  
Kinetics Of ◽  
Persistent Elevation ◽  
Benign Thyroid

Summary Aim: In 214 patients with benign thyroid diseases the time-course of urinary iodine excretion (UIE) was investigated in order to identify changes after radioiodine therapy (RITh). Method: UIE was measured photometrically (cerium-arsenite method) and related to urinary creatinine on the first and last day of the radioiodine test and then three days, seven days, four weeks, and six months after 1311 administration. Results: As compared with the level found immediately before radioiodine therapy, median UIE had almost doubled four weeks after therapy and was still significantly elevated six months after therapy. This increase correlated significantly with the target volume as measured by scintigraphy and sonography. Conclusions: The persistent elevation of UIE for months after RITh is a measure of treatment-induced damage to thyrocytes. Therefore, in view of the unfavourable kinetics of iodine that follow it, RITh should if possible be given via a single-dose regime.

scholarly journals TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study

2008 ◽  
Vol 158 (1) ◽  
pp. 69-75 ◽  
Author(s):  
Peter Laurberg ◽  
Göran Wallin ◽  
Leif Tallstedt ◽  
Mirna Abraham-Nordling ◽  
Göran Lundell ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Radioiodine Therapy ◽  
Randomized Study ◽  
Tsh Receptor ◽  
Graves Disease ◽  
Number Of Patients ◽  
The Common ◽  
Initiation Of Therapy ◽  
Receptor Antibodies ◽  
Tsh Receptor Antibodies

IntroductionAutoimmunity against the TSH receptor is a key pathogenic element in Graves' disease. The autoimmune aberration may be modified by therapy of the hyperthyroidism.ObjectiveTo compare the effects of the common types of therapy for Graves' hyperthyroidism on TSH-receptor autoimmunity.MethodsPatients with newly diagnosed Graves' hyperthyroidism aged 20–55 years were randomized to medical therapy, thyroid surgery, or radioiodine therapy (radioiodine was only given to patients ≥35 years of age). l-thyroxine (l-T4) was added to therapy as appropriate to keep patients euthyroid. Anti-thyroid drugs were withdrawn after 18 months of therapy. TSH-receptor antibodies (TRAb) in serum were measured before and for 5 years after the initiation of therapy.ResultsMedical therapy (n=48) and surgery (n=47) were followed by a gradual decrease in TRAb in serum, with the disappearance of TRAb in 70–80% of the patients after 18 months. Radioiodine therapy (n=36) led to a 1-year long worsening of autoimmunity against the TSH receptor, and the number of patients entering remission of TSH-receptor autoimmunity with the disappearance of TRAb from serum during the following years was considerably lower than with the other types of therapy.ConclusionThe majority of patients with Graves' disease gradually enter remission of TSH-receptor autoimmunity during medical or after surgical therapy, with no difference between the types of therapy. Remission of TSH-receptor autoimmunity after radioiodine therapy is less common.

Iodine prophylaxis intensification

2005 ◽  
Vol 44 (05) ◽  
pp. 197-199 ◽  
Author(s):  
M. Baczyk ◽  
K. Ziemnicka ◽  
J. Sowixnski ◽  
R. Junik
Keyword(s):  
Urinary Iodine ◽  
Iodine Content ◽  
Significant Negative Correlation ◽  
Urinary Iodine Excretion ◽  
Graves Disease ◽  
Radioiodine Uptake ◽  
131I Uptake ◽  
Iodine Excretion ◽  
Average Activity ◽  
Hyperthyroid Patients

Summary:Poland, a country with mild/moderate iodine deficiency introduced an obligatory iodination salt system in 1996. Aim: To compare the results of radioiodine (131I) uptake after 5 h and 24 h with the activity of radioiodine used in the treatment of hyperthyroid patients with Graves’ disease in the years 1995 and 2003. Patients, methods: The marker of iodine content in the diet was urinary iodine excretion. 1000 randomly chosen patients (average age: 46 ± 12 years) were included in the study. Every patient had routinely estimated radioiodine uptake after 5 h and 24 h and the activity of 131I was calculated using scintigraphy and ultrasonography of the thyroid gland. Urinary iodine excretion in samples from year 1995 and 2003 was also determined in some patients and healthy volunteers. Results: The iodine load in the diet increased from 66 μg (average) in the year 1995 to 115 μg in the year 2003. Thyroid radioiodine uptake was 40% lower in comparison with the results from 1995. The average activity of 131I given in the year 2003 (10 mCi) was about 40% higher than in the year 1995 (7 mCi). Conclusion: There was significant negative correlation between higher iodine content in the diet and lower values of radioiodine uptake, which led to the application of the higher activity of 131I during treatment.

scholarly journals Impact of Moderate Sodium Restriction and Hydrochlorothiazide on Iodine Excretion in Diabetic Kidney Disease: Data from a Randomized Cross-Over Trial

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 2204
Author(s):  
Binnenmars ◽  
Corpeleijn ◽  
Kwakernaak ◽  
Touw ◽  
Kema ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Sodium Intake ◽  
Combined Therapy ◽  
Urinary Iodine ◽  
Urinary Iodine Excretion ◽  
Sodium Restriction ◽  
Diabetic Kidney ◽  
Number Of Patients ◽  
Iodine Excretion

Sodium restriction may potentially reduce iodine intake. This study aimed to determine the effect of sodium restriction (dietary counseling) on 24-h urinary iodine excretion. Diuretics provide an alternative to sodium restriction and are frequently added to sodium restriction, so the effects of hydrochlorothiazide (50 mg daily) and combined therapy were also studied. We performed a post-hoc analysis of a Dutch multi-center, randomized cross-over trial in 45 patients with diabetic kidney disease with a mean age of 65 ± 9 years, mean eGFR of 65 ± 27 mL/min/1.73 m2, median albuminuria of 648 [230–2008] mg/24 h and 84% were male. During regular sodium intake with placebo, mean 24 h urinary sodium and iodine excretion were 224 ± 76 mmol/24 h and 252 ± 94 ug/24 h, respectively (r = 0.52, p < 0.001). Mean iodine excretion did not change significantly if sodium restriction and hydrochlorothiazide were applied separately; mean difference −8 ug/day (95% CI −38, 22; p = 0.6) and 14 ug/day (95% CI −24, 52; p = 0.5), respectively. Combined therapy induced a significant decrease in mean iodine excretion (−37 ug/day; 95% CI −67, −7; p = 0.02), yet this was not seen to a clinically meaningful level. The number of patients with an estimated intake below recommended daily allowances did not differ significantly between the four treatment periods (p = 0.3). These findings show that sodium restriction is not a risk factor for iodine deficiency.

THE RELATIONSHIP BETWEEN SERUM PROTEIN-BOUND IODINE LEVELS AND URINARY IODINE EXCRETION AND SERUM THYROTROPHIN CONCENTRATIONS IN SUBJECTS FROM AN ENDEMIC GOITRE AREA IN CENTRAL JAVA

1978 ◽  
Vol 88 (3) ◽  
pp. 474-481 ◽  
Author(s):  
G. Hennemann ◽  
R. Djokomoeljanto ◽  
R. Docter ◽  
B. M. Goslings ◽  
C. van Hardeveld ◽  
...  
Keyword(s):  
Urinary Excretion ◽  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Serum Levels ◽  
Iodine Intake ◽  
Urinary Iodine Excretion ◽  
Central Java ◽  
Iodine Excretion ◽  
The Relationship ◽  
Serum Tsh

ABSTRACT Urinary 127I excretion, 24 h thyroid 131I uptake and serum values of thyrotrophin (TSH), triiodothyronine (T3) and protein-bound iodine (PBI) were measured in subjects from an area with severe (Segni) and moderate (Londjong) iodine deficiency. In Segni, 90 non-cretinous subjects and 40 cretins were studied. In both sub-groups from Segni non-compensated iodine deficiency was found. Although iodine excretion in these sub-groups was the same (mean: ± sd, 127I μg per g creatinine; non-cretins 16.9 ± 10.1 and cretins 15.2 ± 8.0) thyroid hormone serum levels were less in the cretins probably due to additional primary thyroid failure. In the subjects (non-cretins plus cretins) from Segni a positive relationship (r=0.39, P < 0.001) was found between urinary 127I excretion and serum PBI. Moreover in the same subjects a negative correlation was found between serum PBI and TSH (r=0.43; P < 0.001) while serum T3 did not correlate with TSH. In the Londjong area (mean ± sd 127I urinary excretion: 41.6 ± 18.6 μg per g creatinine) iodine deficiency appeared to be compensated in 52 subjects studied since mean serum levels of TSH, PBI and T3 were within normal range. No correlation between PBI and serum TSH was found. PBI too did not correlate with iodine excretion despite the fact that 37 subjects excreted less than 48 μg 127I per g creatinine below which value iodine excretion varied in all but one of the studied subjects from Segni. It is suggested on the basis of a difference in the average iodine intake between the groups from Segni and Londjong, that lack of "iodine buffer capacity" of the thyroid gland in the Segni subjects leads to a situation where changes in iodine intake are readily reflected in T4 production resulting in the correlation found between PBI and urinary excretion in this group.

scholarly journals Radioiodine therapy for Graves' disease as a risk factor of endocrine ophthalmopathy

2009 ◽  
Vol 55 (1) ◽  
pp. 51-55
Author(s):  
M S Sheremeta ◽  
I M Belovalova ◽  
N Yu Sviridenko
Keyword(s):  
Elevated Level ◽  
Radioactive Iodine ◽  
Radioiodine Therapy ◽  
Clinical Symptoms ◽  
Thyroid Stimulating Hormone ◽  
External Irradiation ◽  
Graves Disease ◽  
Endocrine Ophthalmopathy ◽  
Eye Symptoms ◽  
The Relationship

In 1973 and 1976 R. Wasnich and R. Jackson described 2 cases of endocrine ophthalmopathy (EO) that occurred after external irradiation of the anterior surface of the neck due to a tumor (Hodgkin's lymphoma). Further observations showed that treatment of Graves' disease with radioactive iodine (131I) can worsen the course of EO. So, L. De Groot et al., Observing 264 patients after exposure to 131I for Graves' disease, found progression of EO in 4% of patients after the 1st course of therapy and in 12% after subsequent sessions. L. Bartalena et al. observed the appearance or significant progression of EO in 15% of 150 patients treated with 131I. At the same time, against the background of glucocorticoid therapy, only 10% of patients worsened the course of EO. Other studies have shown that the progression of EO after treatment with 131I without glucocorticoid administration was observed in 18-30% of cases. Along with this, it is believed that 131I does not affect the incidence of clinical symptoms in the orbit, and hypothyroidism that occurs after it does not lead to the progression of eye symptoms. The relationship between treatment and the onset or progression of EO is not clear. Nevertheless, there is evidence of an adverse effect of an elevated level of antibodies to the thyroid stimulating hormone receptor (TSH) in the blood serum after 1131I training for EO. This review is devoted to a review of the problem presented.

Exhalation of 1-131 after radioiodine therapy: time dependence and chemical form

2001 ◽  
Vol 40 (01) ◽  
pp. 15-22 ◽  
Author(s):  
K. Schomäcker ◽  
T. Fischer ◽  
W. Eschner ◽  
M.I. Gaidouk ◽  
H. Schicha
Keyword(s):  
Radioiodine Therapy ◽  
Chemical Form ◽  
Graves Disease ◽  
Chemical Forms ◽  
Direct Proportion ◽  
Iodine Species ◽  
Thyroid Uptake ◽  
Exponential Decrease ◽  
The Relationship ◽  
Well Counter

Summary Aim: The change of both amount and chemical forms of radioiodine exhaled in the air of rooms with patients on the therapy ward should be investigated depending on radioactivity applied, time after application, and kind of thyroid disease. Methods: The air of ward-rooms of 62 patients with thyroid carcinoma, Graves’ Disease, and autonomy which received different therapy doses, was investigated with an portable constant air flow sampler. Different chemical iodine species (organic, elemental, aerosol bound) were collected during 8 hr in various filters until 3 days after application of the radioiodine capsule, according to their chemical form. The radioactivity in the filters was measured with a well counter on defined time points after application. Results: The radioactivity exhaled was between 0,008 and 0,03% related to activity of radioiodine applied. The percentage of radioiodine exhaled related to the activity applied, differed significantly depending on disease and changed as follows: Grave’s Disease > autonomy > carcinoma. The exhalation of radioiodine became stronger with increasing applied activities and showed an exponential decrease with time. The most part of radioiodine was present in organic bound form. This organic portion decreased with time in favour of the other iodine species. Conclusion: The degree of accumulation of radioiodine orally applied within thyroid seems to be in direct proportion to the extend of its exhalation. Further measurements directly in the breathing air of RIT-patients are necessary, in order to clarify the relationship between degree of thyroid uptake and quantity as well as chemical form of radioiodine exhaled.

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

2005 ◽  
Vol 44 (06) ◽  
pp. 238-242 ◽  
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.

scholarly journals Medical therapy of Graves' disease: effect on remission rates of methimazole alone and in combination with triiodothyronine

2000 ◽  
pp. 117-124 ◽  
Author(s):  
W Raber ◽  
E Kmen ◽  
W Waldhausl ◽  
H Vierhapper
Keyword(s):  
Randomized Study ◽  
Urinary Iodine ◽  
Antithyroid Drug ◽  
Iodine Intake ◽  
Fixed Dose ◽  
Urinary Iodine Excretion ◽  
Graves Disease ◽  
Significant Difference ◽  
Remission Rates ◽  
Iodine Excretion

In a prospective, randomized study of 135 newly diagnosed patients with hyperthyroidism due to Graves' disease we compared the effect on remission rates of additional triiodothyronine (T3) with conventional antithyroid drug therapy. To this end 114 patients were followed for at least 12 months (15.7+/-4.9, mean+/-s.d.) after the discontinuation of any therapy. After return of thyroid function to normal (8.5+/-7.4 weeks, mean+/-s.d.) patients were maintained on antithyroid medication for 9.0+/-2.5 months. They were then randomly assigned to one of three groups: group 1 (n=44) stopped methimazole, groups 2 (n=39) and 3 (n=31) continued with exogenous T3 (not exceeding 75 microgram/day in any patient) for a further 6 months either with (group 2) or without (group 3) a fixed dose of 10mg methimazole daily. The T3 dose was kept variable to keep TSH suppressed (<0. 1mU/l), which could be achieved in 82% of patients on 100% of their monthly visits. No serious side-effect requiring the discontinuation of the study occurred in any patient. Total T3, TSH-receptor antibodies and some previously suggested potential predictors of relapse including thyroid size by ultrasound, 24h urinary iodine excretion, history of cigarette smoking and ophthalmopathy were determined at the outset of the study and subsequently every 6 months (and total T3 every 4 weeks). No significant difference (P>0.05, Chi square) was seen in relapse of hyperthyroidism after a mean follow-up of 16 months (range: 12-31 months; groups 1:52%, 2:44% and 3:42%) in an area of low-to-moderate iodine intake (prevalence of 24h urinary iodine excretion <100 microgram/24h: 17 and 25% at two different measurements respectively). Concomitantly, no predictor of recurrence of disease could be identified, irrespective of treatment modality.

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