scholarly journals Outcomes Following Fixed Dose Radioactive Iodine Therapy (RAI) in Hyperthyroid Patients with Grave’s Disease and Toxic Nodular Disease

2016 ◽  
Vol 3 (6) ◽  
Author(s):  
Cheah Seong Keat
Keyword(s):  
Radioactive Iodine ◽  
Fixed Dose ◽  
Radioactive Iodine Therapy ◽  
Grave’S Disease ◽  
Grave's Disease ◽  
Hyperthyroid Patients

scholarly journals MON-590 Outcomes Following Radioactive Iodine Therapy (RAI) in Hyperthyroid Patients with Grave’s Disease and Toxic Nodular Disease

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Khaled Aljenaee ◽  
Sulaiman Ali ◽  
Jennie Cooke ◽  
Niamh Phelan ◽  
Agnieszka Pazderska ◽  
...  
Keyword(s):  
Radioactive Iodine ◽  
Radioactive Iodine Therapy ◽  
Grave’S Disease ◽  
Grave's Disease ◽  
Hyperthyroid Patients

Persistent hyperthyroidism in a patient after total thyroidectomy: the thyroid anatomy has implications for treatment

2021 ◽  
Vol 19 (2) ◽  
pp. 186-188
Author(s):  
Aleksandra Młodożeniec ◽  
◽  
Agnieszka Gala-Błądzińska ◽  
◽  
Keyword(s):  
Nuclear Medicine ◽  
Case Report ◽  
Total Thyroidectomy ◽  
Radioactive Iodine ◽  
Radioactive Iodine Therapy ◽  
Thyroid Scintigraphy ◽  
Grave’S Disease ◽  
Grave's Disease ◽  
Pyramidal Lobe ◽  
Tracer Accumulation

Introduction. Grave’s disease (GD) can be treated using three modalities: anti-thyroid medications, radioactive iodine therapy (RAI), or surgery. If surgery is selected, total thyroidectomy is the procedure of choice. Patients with hyperthyroidism frequently have an enlarged thyroid gland, occasionally with a pyramidal lobe. Aim. We point the usefulness of thyroid scintigraphy, which provides valuable information regarding the thyroid anatomy. Description of the case. The manuscript presents a case report of 43-year-old woman with unstable Grave’s disease, who underwent thyroidectomy and developed persistent hyperthyroidism postoperatively. She was referred by an endocrinologist to a nuclear medicine outpatient clinic for RAI therapy. I-iodide scintigraphy revealed two foci with excessive tracer accumulation. One of the foci in the middle of the neck corresponded to the pyramidal lobe. Conclusion. The thyroid anatomy anomalies can lead to unnecessary implications for treatment. Identifying the pyramidal lobe preoperatively and removing it from patients requiring total thyroidectomy may decrease the recurrence rate of hyperthyroidism. Thyroid scintigraphy is a useful diagnostic tool to visualize the pyramidal lobe.

scholarly journals Outcome of Fixed Dose of Radioiodine Therapy in Hyperthyroid Patients at NINMAS

2018 ◽  
Vol 20 (1) ◽  
pp. 37
Author(s):  
Sharmin Quddus ◽  
Fatima Begum ◽  
Nasreen Sultana ◽  
Rahima Perveen ◽  
Tapati Mandal ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Single Dose ◽  
Thyroid Function ◽  
Radioactive Iodine ◽  
Radioiodine Therapy ◽  
Thyroid Stimulating Hormone ◽  
Fixed Dose ◽  
Free Triiodothyronine ◽  
Toxic Goiter ◽  
Hyperthyroid Patients

<p><strong>Objective:</strong> The modified fixed doses of radioactive iodine (RAI) in different types of hyperthyroidism had been practiced at National Institute of Nuclear Medicine &amp; Allied Science (NINMAS) according to Society of Nuclear Medicine Bangladesh (SNMB) protocol since 2002 which was upgraded in 2015. The objective of the study was to observe the treatment outcome in modified fixed dose on previous protocol. Patients and Methods: In the present study the outcome of radioiodine therapy of hyperthyroid patients was retrospectively evaluated in 1349 consecutive primary hyperthyroid patients treated from January 2010 to December 2014 at NINMAS. Diagnosis of hyperthyroidism was done by thyroid function test; thyroid stimulating hormone (TSH), free triiodothyronine (FT3)   &amp; free thyroxine (FT4), 99m Technetium scan, thyroid radioiodine uptake and ultrasound imaging of thyroid gland. All patients received a fixed dose (8-29 m Ci) of radioactive iodine (RAI) depending on types of hyperthyroidism, visual assessment of gland size and severity of disease at diagnosis. They were followed up at 2 months of therapy, then every three months intervals for first year and thereafter 6 monthly up to 5 years or as needed during fluctuation of thyroid function.</p><p><strong>Results:</strong> Among the study population, 832 patients had diffuse toxic goiter (Graves’ disease), 369 patients were diagnosed as toxic multinodular goiter and 148 patients with single toxic nodule. At one year follow-up, permanent hypothyroidism occurred in 61.62% of patients and the cumulative incidence of hypothyroidism progressively increased up to 79.25% after 5 years. Cure or success of RAI therapy was considered as attainment of euthyroid state or hypothyroid state. About 11.26 % patients received more than single dose.</p><p><strong>Conclusion:</strong> Fixed dose RAI therapy is very much cost effective mode of treatment for primary hyperthyroidism with ~89% success by giving single dose.</p><p>Bangladesh J. Nuclear Med. 20(1): 37-40, January 2017</p>

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 A Case for Lithium Pretreatment Prior to Radioactive Iodine Ablation in Grave’s Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A906-A907
Author(s):  
Aditi Thakkar ◽  
Constance Lee Chen
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Radioactive Iodine ◽  
Hormone Release ◽  
Iodide Uptake ◽  
Radioiodine Uptake ◽  
Grave’S Disease ◽  
Grave's Disease ◽  
Radioiodide Therapy ◽  
Radioactive Iodine Ablation

Abstract Radioactive iodine ablation (RAIA) therapy with Iodine-131 (I-131) is an established treatment for grave’s thyrotoxicosis. However, there is 10 to 20% chance of treatment failure. Lithium, a drug used to treat bipolar disorder, has significant effects on thyroid function. The most clinically relevant is the inhibition of thyroid hormone release. It is also known to inhibit colloid formation, and is involved in blocking organic iodine as well as thyroid hormone release from the thyroid gland without an effect on radioiodine uptake. This leads to increased radioiodine retention in the thyroid gland. Here, we present a case which exemplifies this action of lithium. A 46 year old male with a history of atrial fibrillation and grave’s disease presented to the endocrine clinic. TSH was &lt;0.01 and FT4 was 36. RAI uptake (RAIU) scan showed diffusely increased uptakes with 4 and 24 hour values of 61.2 and 54.6 %. He subsequently underwent RAI ablation with 18 mCi of I 131. He then presented three years later with persistent hyperthyroid symptoms. TSH &lt;0.01 and FT4 4.3. RAIU showed 24-h thyroid uptake of 41%. Patient opted for a second treatment with RAIA and was treated with 30 millicuries of I 131. He however continued to have clinical and biochemical evidence of thyrotoxicosis and was started on methimazole (MMI). Although he was biochemically euthyroid on MMI, he continued to complain of hyperthyroid symptoms such as palpitations, tremors and weight loss. When methimazole was briefly held six months after initiation, TSH was undetectable and FT4 had increased from 0.83 to 1.42. He subsequently underwent a third RAIU off MMI which showed normal 4 and 24 hour uptake, measuring 15.7% and 28% respectively. Patient subsequently opted for third trial of RAI ablation with lithium pretreatment. He declined surgery. He was started on lithium 900mg/day for 6 days, starting on the day of RAI ablation. He underwent RAI ablation with 45 mCi I-131. Patient tolerated the procedure well with subsequent tests indicating hypothyroidism requiring levothyroxine supplementation. Patient’s hyperthyroid symptoms resolved. Several factors affect the efficacy of radioiodide therapy for hyperthyroidism including the short persistence of radioiodide in the thyroid gland. In hyperthyroid Graves’ patients, radioactive iodide uptake is enhanced due to presence of TSH receptor antibody, however, radioiodide is also rapidly discharged because of its increased turnover. Lithium can significantly reduce the release of iodine from the thyroid gland and thus increase iodine retention. There is evidence to suggest that adjuvant lithium can increase thyroidal radioiodine uptake in patients with a low baseline RAIU (&lt; 30%). This case demonstrate that lithium can be used safely prior to RAI therapy in cases of RAI ablation failure even with low baseline RAIU.

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