scholarly journals Success Rate of Radioactive Iodine Therapy in Graves’ Disease Using Dose Corrected for Thyroid Gland Size

2021 ◽  
Vol 72 (2) ◽  
pp. 108-113
Author(s):  
Yutapong Raruenrom
Keyword(s):  
Thyroid Gland ◽  
Drug Use ◽  
Success Rate ◽  
Successful Treatment ◽  
Radioactive Iodine ◽  
Multivariable Analysis ◽  
Antithyroid Drug ◽  
Outcome Analysis ◽  
Graves Disease ◽  
Gland Size

Objective: Dose corrected for thyroid gland size is one of the methods used to determine I-131 activity for patients with Graves’ disease. This study aimed to find the success rate of this method and the predictors for successful I-131 treatment. Methods: This retrospective descriptive study conducted was in patients with Graves’ disease who received the first dose of radioactive iodine (RAI) therapy. Patients received a fixed RAI dose of either 10, 15, 20, 25, or 30 mCi for corresponding thyroid gland size of ≤ 50, 51-100, 101-150, 151-200, and >200 grams, respectively. The treatment outcome assessed was between 6 to 9 months after the therapy based on serum free thyroxine and serum thyroid stimulating hormone. Successful treatment was defined as euthyroid and hypothyroid. Results: A total number of 179 patients (126 females; mean age: 40.8 years) were enrolled. There was one patient exclusion from the outcome analysis due to undetermined laboratory results. The success rate of RAI therapy was 50% (95% CI: 42.4-57.6). Patients with gland size ≤ 50 gm had the highest success rate of 59.6%. Multivariable analysis showed no significant association between sex, thyroid gland size, prior antithyroid drug use and successful treatment. Conclusion: First RAI therapy using dose corrected for thyroid gland size had a modest success rate of 50% in patients with Grave’s disease. Sex, thyroid gland size, and prior antithyroid drug use were not significantly associated with the treatment outcomes.

Successful Treatment of Graves Disease in Pregnancy with Lugol's Iodine

2000 ◽  
Vol 45 (1) ◽  
pp. 20-21 ◽  
Author(s):  
A. Jamieson ◽  
C.G. Semple
Keyword(s):  
Drug Therapy ◽  
Successful Treatment ◽  
Surgical Intervention ◽  
Antithyroid Drug ◽  
Primary Treatment ◽  
Graves Disease ◽  
Lugol’S Iodine ◽  
Organic Iodine ◽  
Antithyroid Drug Therapy ◽  
In Pregnancy

We report a case of Grave's disease in pregnancy complicated by intolerance of standard antithyroid drug therapy. We describe the success of prolonged use of organic iodine as a primary treatment prior to surgical intervention.

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.

LONG-TERM OUTCOMES OF RADIOIODINE THERAPY FOR JUVENILE GRAVES DISEASE WITH EMPHASIS ON SUBSEQUENTLY DETECTED THYROID NODULES: A SINGLE INSTITUTION EXPERIENCE FROM JAPAN

2020 ◽  
Vol 26 (7) ◽  
pp. 729-737 ◽  
Author(s):  
Tetsuya Mizokami ◽  
Katsuhiko Hamada ◽  
Tetsushi Maruta ◽  
Kiichiro Higashi ◽  
Junichi Tajiri
Keyword(s):  
Thyroid Gland ◽  
Thyroid Nodules ◽  
Radioiodine Therapy ◽  
Antithyroid Drug ◽  
Overt Hypothyroidism ◽  
Graves Disease ◽  
Outpatient Basis ◽  
Long Term Outcomes

Objective: To investigate the long-term outcomes of radioiodine therapy (RIT) for juvenile Graves disease (GD) and the ultrasonographic changes of the thyroid gland. Methods: All of 117 juvenile patients (25 males and 92 females, aged 10 to 18 [median 16] years) who had undergone RIT for GD at our clinic between 1999 and 2018 were retrospectively reviewed. Each RIT session was delivered on an outpatient basis. The maximum 131I dose per treatment was 13.0 mCi, and the total 131I dose per patient was 3.6 to 29.8 mCi (median, 13.0 mCi). 131I administration was performed once in 89 patients, twice in 26, and three times in 2 patients. Ultrasonography of the thyroid gland was regularly performed after RIT. The duration of follow-up after the initial RIT ranged from 4 to 226 (median 95) months. Results: At the latest follow-up more than 12 months after RIT (n = 111), the patients' thyroid functions were overt hypothyroidism (91%), subclinical hypothyroidism (2%), normal (5%), or subclinical hyperthyroidism (2%). New thyroid nodules were detected in 9 patients, 4 to 17 years after initial RIT. Patients with newly detected thyroid nodules underwent RIT with lower doses of 131I and had larger residual thyroid volumes than those without nodules. None of the patients were diagnosed with thyroid cancer or other malignancies during the follow-up period. Conclusion: Over a median follow-up period of 95 months (range, 4 to 226 months), RIT was found to be effective and safe in juvenile GD. However, cumulative evidence from further studies is required to confirm the long-term safety of RIT for juvenile GD. Abbreviations: ATD = antithyroid drug; GD = Graves disease; KI = potassium iodide; LT4 = levothyroxine; MMI = methimazole; PTU = propylthiouracil; RAIU = radio-active iodine uptake; RIT = radioiodine therapy; 99mTc = technetium-99m; TSH = thyrotropin

scholarly journals Papillary thyroid carcinoma in cervical lymph nodes with vanished thyroid gland after ablation of Graves’ disease by radioactive iodine

2019 ◽  
Vol 101 (5) ◽  
pp. e122-e124
Author(s):  
O Hamdy ◽  
S Raafat ◽  
GA Saleh ◽  
K Atallah ◽  
Mahmoud M Saleh ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Gland ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Radioactive Iodine ◽  
Rare Condition ◽  
Graves Disease ◽  
Papillary Thyroid ◽  
Cervical Lymph Nodes ◽  
Thyroid Ablation

Primary thyroid carcinoma after thyroid ablation by radioactive iodine is rare. We present a very rare condition of lateral apparent papillary thyroid carcinoma eight years after receiving radioactive iodine for thyrotoxicosis, which led to complete anatomical and functional involution of the thyroid gland.

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

Diagnosis and Treatment of Graves Disease

2003 ◽  
Vol 37 (7-8) ◽  
pp. 1100-1109 ◽  
Author(s):  
Darcie D Streetman ◽  
Ujjaini Khanderia
Keyword(s):  
Thyroid Gland ◽  
Radioactive Iodine ◽  
Radioiodine Therapy ◽  
Patient Adherence ◽  
Treatment Options ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Extensive Experience ◽  
Long Term Treatment ◽  
Β Blockers

OBJECTIVE: To review the etiology, diagnosis, and clinical presentation of Graves disease and provide an overview of the standard and adjunctive treatments. Specifically, antithyroid drugs, β-blockers, inorganic iodide, lithium, and radioactive iodine are discussed, focusing on current controversies. DATA SOURCES: Primary articles were identified through a MEDLINE search (1966–July 2000). Key word searches included β-blockers, Graves disease, inorganic iodide, lithium, methimazole, and propylthiouracil. Additional articles from these sources and endocrinology textbooks were also identified. We agreed to include articles that would highlight the most relevant points, as well as current areas of controversy. DATA SYNTHESIS: Graves disease is the most common cause of hyperthyroidism. The 3 main treatment options for patients with Graves hyperthyroidism include antithyroid drugs, radioactive iodine, and surgery. Although the antithyroid drugs propylthiouracil (PTU) and methimazole (MMI) have similar efficacy, there are situations when 1 agent is preferred. MMI has a longer half-life than PTU, allowing once-daily dosing that can improve patient adherence to treatment. PTU has historically been the drug of choice for treating pregnant and breast-feeding women because of its limited transfer into the placenta and breast milk. Adjuvant therapies for Graves disease include β-blockers, inorganic iodide, and lithium. β-Blockers are used to decrease the symptoms of hyperthyroidism. Inorganic iodide is primarily used to prepare patients for thyroid surgery because of its ability to decrease the vascularity of the thyroid gland. Lithium, which acts in a manner similar to iodine, is not routinely used due to its transient effect and the risk of potentially serious adverse effects. In the US, radioiodine therapy has become the preferred treatment for adults with Graves disease. It is easy to administer, safe, effective, and more affordable than long-term treatment with antithyroid drugs. Hypothyroidism is an inevitable consequence of radioiodine therapy. Radioiodine is contraindicated in pregnant women because it can damage the fetal thyroid gland, resulting in fetal hypothyroidism. Bilateral subtotal thyroidectomy, which was once the only treatment available, is now performed only in special circumstances. In addition to the normal risks associated with surgery, laryngeal nerve damage, hypoparathyroidism, and hypothyroidism can occur following that procedure. CONCLUSIONS: Despite extensive experience with medical management, controversy prevails regarding choosing among the various drugs for treatment of Graves disease. None of the treatment options, including antithyroid drugs, radioiodine, and surgery, is ideal. Each has risks and benefits, and selection should be tailored to the individual patient.

scholarly journals Type 1 and type 2 iodothyronine deiodinases in the thyroid gland of patients with 3,5,3′-triiodothyronine-predominant Graves' disease

2011 ◽  
Vol 164 (1) ◽  
pp. 95-100 ◽  
Author(s):  
Mitsuru Ito ◽  
Nagaoki Toyoda ◽  
Emiko Nomura ◽  
Yuuki Takamura ◽  
Nobuyuki Amino ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Mrna Level ◽  
Antithyroid Drug ◽  
High Serum ◽  
Graves Disease ◽  
Iodothyronine Deiodinase ◽  
Iodothyronine Deiodinases ◽  
Antithyroid Drug Therapy

Objective3,5,3′-triiodothyronine-predominant Graves' disease (T3-P-GD) is characterized by a persistently high serum T3 level and normal or even lower serum thyroxine (T4) level during antithyroid drug therapy. The source of this high serum T3 level has not been clarified. Our objective was to evaluate the contribution of type 1 and type 2 iodothyronine deiodinase (D1 (or DIO1) and D2 (or DIO2) respectively) in the thyroid gland to the high serum T3 level in T3-P-GD.MethodsWe measured the activity and mRNA level of both D1 and D2 in the thyroid tissues of patients with T3-P-GD (n=13) and common-type GD (CT-GD) (n=18) who had been treated with methimazole up until thyroidectomy.ResultsThyroidal D1 activity in patients with T3-P-GD (492.7±201.3 pmol/mg prot per h) was significantly higher (P<0.05) than that in patients with CT-GD (320.7±151.9 pmol/mg prot per h). On the other hand, thyroidal D2 activity in patients with T3-P-GD (823.9±596.4 fmol/mg prot per h) was markedly higher (P<0.005) than that in patients with CT-GD (194.8±131.6 fmol/mg prot per h). There was a significant correlation between the thyroidal D1 activity in patients with T3-P-GD and CT-GD and the serum FT3-to-FT4 ratio (r=0.370, P<0.05). Moreover, there was a strong correlation between the thyroidal D2 activity in those patients and the serum FT3-to-FT4 ratio (r=0.676, P<0.001).ConclusionsOur results suggest that the increment of thyroidal deiodinase activity, namely D1 and especially D2 activities, may be responsible for the higher serum FT3-to-FT4 ratio in T3-P-GD.

scholarly journals Iatrogenic Hyperthyroidism With Recurrent Functioning Thyroid Tissue 40 Years After Thyroidectomy for Graves’ Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A936-A937
Author(s):  
Sara Ashlyn Penquite ◽  
Juan Pablo Galvez
Keyword(s):  
Thyroid Gland ◽  
Laboratory Testing ◽  
Radioactive Iodine ◽  
Thyroid Tissue ◽  
Definitive Treatment ◽  
Endocrine Surgery ◽  
Graves Disease ◽  
Once Daily ◽  
Remnant Thyroid

Abstract Background: Graves’ disease is an immune-mediated cause of thyrotoxicosis treated with anti-thyroid drugs (ADTs), radioactive iodine (RAI) or thyroidectomy. Thyroidectomy has been documented to have the lowest rate of recurrence amongst treatment options1. Data regarding long-term recurrence rates is limited beyond 54 months. Clinical Case: An asymptomatic 59 year old female was found to have recurrent thyrotoxicosis on routine laboratory testing. The patient underwent thyroidectomy at age 19 years for Graves’ disease. Prior records unavailable to clarify initial surgical intervention. The patient had post-surgical hypothyroidism which was managed with levothyroxine 100mcg once daily for over 20 years. A biochemically euthyroid state was clearly documented on prior laboratory testing. Initial laboratory testing with TSH &lt;0.01mIU/L (0.45-4.50), FT3 2.8ng/dL (0.8-1.7). Levothyroxine was discontinued with persistent thyrotoxicosis after 8 weeks: TSH &lt;0.01, FT3 5.7, FT4 1.74. Radioactive Iodine Uptake and scan was obtained after administration of 6uCi of iodine-131 which demonstrated 50.8% uptake of radioactive iodine at 24 hours (Normal 10-30%). The left thyroid gland was noted to be in normal position and enlarged with diffuse increase intensity of radiotracer uptake. The right thyroid gland was surgically absent. The patient subsequently underwent completion thyroidectomy with endocrine surgery with resolution of hyperthyroid state. Surgical pathology was benign and consistent with Graves’ disease and multinodular goiter. The patient did become hypothyroid post-operatively and required levothyroxine replacement. She is clinically and biochemically euthyroid on levothyroxine 100mcg once daily 14 months post-operatively. Conclusion: This is a case of recurrent hyperthyroidism approximately 40 years after definitive treatment with thyroidectomy. Although it is unclear whether patient underwent total thyroidectomy or subtotal thyroidectomy for initial intervention, the recurrence of thyrotoxicosis after such a long period of time has not previously been reported in the literature to the knowledge of this writer. This has important implications regarding the underlying pathophysiology of Graves’ disease and the ability of remnant thyroid tissue to regenerate over time. This also has important implications for long-term monitoring in patients with history of thyroidectomy for Graves’ disease. Reference: 1. Sundaresh, V., Brito, J. P., Wang, Z., Prokop, L. J., Stan, M. N., Murad, M. H., & Bahn, R. S. (2013). Comparative effectiveness of therapies for Graves’ hyperthyroidism: a systematic review and network meta-analysis. The Journal of clinical endocrinology and metabolism, 98(9), 3671–3677.

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