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 Radioiodine Treatment of Hyperthyroidism—Prognostic Factors for Outcome

2001 ◽  
Vol 86 (8) ◽  
pp. 3611-3617 ◽  
Author(s):  
Amit Allahabadia ◽  
Jacquie Daykin ◽  
Michael C. Sheppard ◽  
Stephen C. L. Gough ◽  
Jayne A. Franklyn
Keyword(s):  
Single Dose ◽  
Prognostic Factors ◽  
Nodular Goiter ◽  
Fixed Dose ◽  
Graves Disease ◽  
Cure Rate ◽  
Toxic Nodular Goiter ◽  
Large Size ◽  
Lower Cure Rate ◽  
Lower Cure

There is little consensus regarding the most appropriate dose regimen for radioiodine (131I) in the treatment of hyperthyroidism. We audited 813 consecutive hyperthyroid patients treated with radioiodine to compare the efficacy of 2 fixed-dose regimens used within our center (185 megabequerels, 370 megabequerels) and to explore factors that may predict outcome. Patients were categorized into 3 diagnostic groups: Graves’ disease, toxic nodular goiter, and hyperthyroidism of indeterminate etiology. Cure after a single dose of 131I was investigated and defined as euthyroid off all treatment for 6 months or T4 replacement for biochemical hypothyroidism in all groups. As expected, patients given a single dose of 370 megabequerels had a higher cure rate than those given 185 megabequerels, (84.6% vs. 66.6%, P < 0.0001) but an increase in hypothyroidism incidence at 1 yr (60.8% vs. 41.3%, P < 0.0001). There was no difference in cure rate between the groups with Graves’ disease and those with toxic nodular goiter (69.5% vs. 71.4%; P, not significant), but Graves’ patients had a higher incidence of hypothyroidism (54.5% vs. 31.7%, P< 0.0001). Males had a lower cure rate than females (67.6% vs. 76.7%, P = 0.02), whereas younger patients (<40 yr) had a lower cure rate than patients over 40 yr old (68.9% vs. 79.3%, P < 0.001). Patients with more severe hyperthyroidism (P < 0.0001) and with goiters of medium or large size (P < 0.0001) were less likely to be cured after a single dose of 131I. The use of antithyroid drugs, during a period 2 wk before or after 131I, resulted in a significant reduction in cure rate in patients given 185 megabequerels 131I (P < 0.01) but not 370 megabequerels. Logistic regression analysis showed dose, gender, goiters of medium or large size, and severity of hyperthyroidism to be significant independent prognostic factors for cure after a single dose of 131I. We have demonstrated that a single fixed dose of 370 megabequerels 131I is highly effective in curing toxic nodular hyperthyroidism as well as Graves’ hyperthyroidism. Because male patients and those with more severe hyperthyroidism and medium or large-sized goiters are less likely to respond to a single dose of radioiodine, we suggest that the value of higher fixed initial doses of radioiodine should be evaluated in these patient categories with lower cure rates.

Clinical Efficacy of A Single Dose Radioiodine Therapy for Hyperthyroidism

2015 ◽  
Vol 1 (1) ◽  
pp. 13
Author(s):  
Zabah Muhammed Jawa ◽  
Rufai Isa Ahmed ◽  
Aisha Ismail
Keyword(s):  
Single Dose ◽  
Clinical Efficacy ◽  
Radioactive Iodine ◽  
Radioiodine Therapy ◽  
Antithyroid Drug ◽  
Radioactive Iodine Therapy ◽  
Toxic Adenoma ◽  
Plummer's Disease ◽  
Plummer’S Disease ◽  
Post Therapy

<p><strong>Objective</strong>: Radioiodine is a safe, cheap, and recognized permanent treatment option for patients with hyperthyroidism. Despite, the extensive use of radioiodine therapy in hyperthyroidism there is no consensus regarding the optimal dose of radioiodine. To evaluate the clinical efficacy and our clinical experience with the use of a single dose radioiodine therapy for hyperthyroidism in our institution.</p><p><strong>Methods:</strong> A total of 274 patients who received a single dose of radioactive iodine therapy for hyperthyroidism at our institution between 2007-2015 were retrospectively reviewed. Of these, 186 patients had Graves’ disease (GD), 73 patients had Plummer’s disease (PD), and 15 patients had a single toxic adenoma (STA). All patients received between 10-30mCi of oral radioiodine capsule. The efficacy of therapy was determined 3 months post-therapy using serum thyroid function test, weight and heart rate measurements. Therapy success refers to patients whose outcome was euthyroidism and hypothyroidism post-therapy and treatment failure where patients still manifested with persistent hyperthyroidism.</p><p><strong>Results:</strong>  The efficacy of a single dose of radioiodine 3months post-therapy varies with the type of hyperthyroidism, 96% for Graves’s disease, 92% for Plummer’s disease and 100% in single toxic adenoma.</p><p><strong>Conclusion:</strong> Our study showed that a single dose of radioactive iodine therapy 3 months post-therapy is 96% efficient in all types of hyperthyroidism. However, we observed that patients at risk of therapy failure 3month post-therapy included, large thyroid gland prolong antithyroid drug usage and male gender.</p><p> </p>

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 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.

scholarly journals Biochemical Outcome of Repeated Radioactive Iodine Therapy in Patients with Primary Hyperthyroidism– Follow Up of a Decade

2021 ◽  
Vol 22 (2) ◽  
pp. 119-124
Author(s):  
Sharmin Reza ◽  
Azmal Kabir Sarker ◽  
Farhana Haque ◽  
Mohammed Mehedi Al Zahid Bhuiyan ◽  
Simoon Salekin ◽  
...  
Keyword(s):  
Radioactive Iodine ◽  
Nodular Goiter ◽  
Descriptive Statistics ◽  
Fixed Dose ◽  
Radioactive Iodine Therapy ◽  
Clinical Reality ◽  
Demographic Traits ◽  
Primary Hyperthyroidism ◽  
Incremental Dose

Background: Whileradioactive iodine therapy (RAIT) in patients with primary hyperthyroidism results in euthyreosis or hypothyreosis, requirement of repeated therapy in a proportion of patients is a clinical reality. This study describesbiochemical outcomeof patients requiring repeated RAIT and the dose profiles across the demographic traits. Patients and Methods: The study retrospectively included the patients who underwent RAIT for Primary hyperthyroidism from January to December of 2006, using a modified fixed dose protocol following an institutional guideline which was adopted as the national guideline in 2007. Persistence of biochemical features of hyperthyroidism six months after RAIT was an indication for repeated therapy. Follow up data of eligible patients till December of 2016 was included in the descriptive statistics. Results: One, Two, three and four instances of RAIT were given to 83%, 14%, 2% and ≤ 1% of patients resulting in hypothyroidism to 58%, 67%, 67% and 100% of patients after each instance of therapy with incremental dose. Apparently more females than males ended up as biochemically hypothyroid, though not significant (OR 1.15, p=0.56).Younger females became significantly hypothyroid (p = 0.03).Patients with euthyroid outcome received higher dose-1of RAIT (P=0.007) which was found significant in females (p=0.005), in patients with Graves’ disease (GD) (p=0.018) and in patients receiving two instances of RAIT (p=0.03). Among the patients with GD, Single Toxic Nodule (STN) and Multi-Nodular Goiter (MNG), the proportion of hypothyroid outcome were 61%, 67% and 35%, at ten years following first dose. GD and STN required RAIT for up to four instances.MNG received an apparently higher mean of dose -1 and apparently less steep increment of doses, in comparison to GD and STN. Conclusion: Thisobservationof patient outcome over a decade was a scope to compare the mentioned guideline’s performance with the targets set by influential guidelines and recent reports around the globe. Bangladesh J. Nuclear Med. 22(2): 119-124, Jul 2019

scholarly journals The effect of prior antithyroid drug use on delaying remission in high uptake Graves' disease following radioiodine ablation

2016 ◽  
Vol 5 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Muthiah Subramanian ◽  
Manu Kurian Baby ◽  
Krishna G Seshadri
Keyword(s):  
Standard Dose ◽  
Antithyroid Drug ◽  
Fixed Dose ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Cure Rate ◽  
Monthly Basis ◽  
Radioiodine Ablation ◽  
The Impact

Antithyroid drugs (ATDs) have been shown to attenuate the effectiveness of radioiodine (radioiodine ablation, RIA) therapy in Graves' disease. We undertook a study to look at the impact of iodine uptakes on the outcome of 131I therapy. To determine the effect of prior ATD use on the duration of time to achieve cure in patients with high vs intermediate uptake Graves' disease who received a fixed dose (15 mCi) of 131I radioiodine. In a retrospective study of patients with Graves' disease, 475 patients who underwent RIA were followed-up on a two-monthly basis with thyroid function tests. Of the 123 patients with a documented preablation RAIU and consistent follow-up it was observed that 40 patients had an intermediate RAIU (10–30%) and 83 subjects had a distinctly increased uptake (>30%). Successful cure was defined as the elimination of thyrotoxicosis in the form of low free thyroxin and rising TSH levels. When a standard dose of 15 mCi 131I was administered, a cure rate of 93% was achieved. The median duration of time to cure (TC) was 129 days. Surprisingly, a direct proportional linear relationship (R2=0.92) was established between time to cure and radioiodine uptake (TC>30%=172days, TC10–30%=105 days, P<0.001). Patients who used ATD medications took a proportionately longer duration to achieve remission (TCNO ATD=102days, TCATD=253days, P<0.001). The effect of prior ATD therapy in delaying remission was amplified in the subset of patients with higher uptakes (TC>30%+ATD=310days, TC>30%+NO ATD=102days, P<0.001) compared to those with the intermediate uptakes (TC10–30%+ATD=126 days, TC10–30%+NO ATD=99 days, P<0.001). RIA, using a dose of 15 mCi achieved a high cure rate. Higher uptakes predicted longer time to achieve remission, with prior ATD use amplifying this effect.

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