Graves' disease and radioiodine therapy

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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Graves' disease and radioiodine therapy

Nuklearmedizin ◽

10.3413/nukmed-0087 ◽

2008 ◽

Vol 47 (01) ◽

pp. 13-17 ◽

Cited By ~ 27

Author(s):

W. Eschner ◽

F. Sudbrock ◽

I. Weber ◽

K. Marx ◽

M. Dietlein ◽

...

Keyword(s):

Standard Deviation ◽

Radioiodine Therapy ◽

Thyroid Volume ◽

Antithyroid Drugs ◽

Graves Disease ◽

Inclusion Criteria ◽

Thyroid Dose ◽

Point Measure ◽

The Mean ◽

Age And Sex

SummaryAim: This study was performed to determine the results of ablative radioiodine therapy (RIT) when the achieved dose in the thyroid was above 200 Gy and to characterize predictive factors for treatment outcome. Patients, methods: A total of 571 consecutive patients were observed for 12 months between July 2001 and June 2004. Inclusion criteria were a confirmed diagnosis Graves' disease, compensation of hyperthyroidism and withdrawal of antithyroid drugs two days before preliminary radioiodine-testing and RIT. The intended dose was 250 Gy and the therapeutically achieved dose was calculated from serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The relation between success rate and the achieved dose, thyroid volume, age and sex of patients, TSH- and TRAb-values and presence of ophthalmopathy was analysed. Results: Relief from hyperthyroidism was achieved in 96% of patients who received more than 200 Gy, even for thyroid volumes >40 ml. The success of ablative RIT was not influenced by age or sex of patients, or by TSH- or TRAb values or concomitant ophthalmopathy. The mean achieved dose in the thyroid was 298 Gy with a standard deviation of 74.6 Gy. Conclusion: To achieve a dose of over 200 Gy with the above standard deviation, we recommend calculating an intended dose of 250 Gy and using a dosimetric approach with early and late uptake values in the radioiodine test, to allow early therapeutic intervention should the posttherapeutic thyroid dose fall unexpectedly below 200 Gy.

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RAI Therapy for Graves’ Hyperthyroidism

10.5772/intechopen.96083 ◽

2021 ◽

Author(s):

Ioannis Iakovou ◽

Evanthia Giannoula ◽

Paraskevi Exadaktylou ◽

Nikitas Papadopoulos

Keyword(s):

Therapeutic Effect ◽

Therapeutic Dose ◽

Initial Treatment ◽

Radioiodine Therapy ◽

Treatment Options ◽

Symptomatic Improvement ◽

Therapeutic Management ◽

Antithyroid Drugs ◽

Graves Disease ◽

Common Cause

Graves’ Disease is the most common cause of hyperthyroidism. It has multiple manifestations and it requires appropriate diagnostic and therapeutic management. Once it has been established that the patient is hyperthyroid and the cause is GD, the patient and physician must choose between three effective and relatively safe initial treatment options: antithyroid drugs (ATDs), radioiodine (RAI) therapy, or thyroidectomy. RAI has been used to treat hyperthyroidism for more than seven decades. It is well tolerated and complications are rare, except for those related to orbitopathy. Most patients are effectively treated with one therapeutic dose of I-131. The patient usually notes symptomatic improvement within 3 weeks of therapy. However, the full therapeutic effect takes 3 to 6 months because stored hormone must first be released. Radioiodine therapy may not initially be effective in up to 10% of patients. They require repeat treatment, usually with a higher administered dose.

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Cigarette Smoking Has no Impact on the Effect of Radioiodine Therapy in Patients with Graves Disease / Pušenje cigareta nema uticaj na ishod radiojodne terapije kod bolesnika sa Grejvsovom bolešću

Acta Facultatis Medicae Naissensis ◽

10.1515/afmnai-2015-0007 ◽

2015 ◽

Vol 32 (1) ◽

pp. 67-75

Author(s):

Vladan Sekulić ◽

Milena P. Rajić ◽

Marina Vlajković ◽

Slobodan Ilić ◽

Miloš Stević ◽

...

Keyword(s):

Cigarette Smoking ◽

Radioiodine Therapy ◽

Response To Therapy ◽

Stressful Events ◽

Antithyroid Drugs ◽

Graves Disease ◽

Significant Difference ◽

Iodine 131 ◽

The Impact

Summary Presently, there is very little data on the impact of nicotine and other components of tobacco smoking on the outcome of radioiodine therapy (RIT) in Graves’ disease (GD). Thus, this study was aimed to analyze a possible impact of cigarette smoking on the effect of radioiodine therapy in the patients with Graves’ disease. The study included 31 patients (16 smokers and 15 non-smokers) with GD, aged from 22 to 73 years, who were treated with a single dose of iodine-131 sodium iodide (131I-NaI) and subjected to a 12-month follow-up, thereafter. Patients were treated with antithyroid drugs (ATDs) before RIT and described very intense stressful events occurring prior to diagnosing Graves’ hyperthyroidism. A successful response to RIT was defined as euthyroidism and subclinical or clinical hypothyroidism, while an unsuccessful response was defined as persistent hyperthyroidism. Comparison of age (47.4±9.41 vs. 49.5±13.8 years, p=0.628) at the time of RIT, applied activity of 131I-NaI (372±78.4 vs. 363±43.7 MBq, p=0.675), and duration of ATDs therapy (3.47±3.33 vs. 4.94±5.62 years, p=0.387) between smokers and non-smokers showed no significant difference. The cumulative incidence of successful response to therapy in smokers and non-smokers was 31.2 vs. 46.7% (p<0.05), 50.0 vs. 60.0% (p>0.05), 56.2 vs. 60.0% (p>0.05), and 56.2 vs. 66.7% (p>0.05) after 3, 6, 9 and 12 months, respectively. The results showed that cigarette smoking has no impact on the effect of radioiodine therapy after twelve-month period in patients who had experienced stressful events before the occurrence of Graves’ disease. However, patients with smoking habits achieved successful response later than non-smokers.

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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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Effects of high and low doses of methimazole in patients with Graves' thyrotoxicosis

Acta Endocrinologica ◽

10.1530/acta.0.114s312 ◽

1987 ◽

Vol 116 (1_Suppl) ◽

pp. S312-S317 ◽

Cited By ~ 6

Author(s):

G. Benker ◽

D. Reinwein ◽

H. Creutzig ◽

H. Hirche ◽

W. D. Alexander ◽

...

Keyword(s):

Antithyroid Drug ◽

Drug Dosage ◽

Antithyroid Drugs ◽

Graves Disease ◽

Duration Of Treatment ◽

Disease Heterogeneity ◽

Remission Rates ◽

Set Up ◽

The Many ◽

The Impact

Abstract. In spite of the long-established use of antithyroid drugs, there are many unsettled questions connected with this treatment of Graves' disease. There is a lack of controlled prospective trials studying the results of antithyroid drug therapy while considering the many variables such as disease heterogeneity, regional differences, drug dosage and duration of treatment. Therefore, a multicenter study has been set up in order to compare the effects of two fixed doses of methimazole (10 vs 40 mg) with thyroid hormone supplementation on the clinical, biochemical and immunological course of Graves' disease and on remission rates. Experience accumulated so far suggests that treatment is safe using either 10 or 40 mg of methimazole. While there is a tendency for an advantage of the higher dose within the first weeks (higher effectiveness in controlling hyperthyroidism), this difference is not significant. The impact of dosage on remission rates remains to be shown.

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Remission Rate of Graves' Disease and the Trend of Changes in Serum TSH Receptor Antibodies in Prolonged Antithyroid Drug Treatment

International Journal of Endocrinology and Metabolism ◽

10.5812/ijem.101473 ◽

2020 ◽

Vol 18 (Suppl) ◽

Cited By ~ 1

Author(s):

Danilo Villagelin ◽

Roberto Bernardo Santos ◽

João Hamilton Romaldini

Keyword(s):

Drug Treatment ◽

Remission Rate ◽

Antithyroid Drug ◽

Antithyroid Drugs ◽

Graves Disease ◽

Remission Rates ◽

Thyrotropin Receptor Antibodies ◽

Antithyroid Drug Treatment ◽

The Impact ◽

Receptor Antibodies

Context: Graves’ disease is an autoimmune disease caused by thyrotropin receptor antibodies (TRAb). These antibodies can be measured and used for the diagnosis, prediction of remission, and risk of Graves’ orbitopathy development. There are three treatments for Graves’ disease that have remained unchanged for the last 75 years: Antithyroid drugs, radioiodine, and surgery. Antithyroid drugs are the first treatment option worldwide and are usually used for 12 - 18 months. Recent reports suggest the use of antithyroid drugs for more than 18 months with better outcomes. This review focuses on two aspects of treatment with antithyroid drugs: The impact of using antithyroid drugs for more than 12 - 18 months on remission rates and the trend of TRAb during prolonged antithyroid drug treatment. Evidence Acquisition: A review was performed in Medline on the published work regarding the duration of ATD treatment and remission of Graves' disease and also ATD treatment and TRAb status during the 1990 - 2019 period. Results: Remission rates are variable (30% - 80%), and many clinical and genetic factors serve as predictors. The long-term use of antithyroid drugs appears to increase remission rates. TRAb values usually decline during ATD treatment, but the trend could occur in two ways: Becoming negative or showing a fluctuating pattern. However, approximately 10% of the patients will remain TRAb-positive after five years of treatment with antithyroid drugs. Conclusions: Antithyroid drugs can be used for long periods with an increase in remission rates, and a gradual decrease in TRAb levels, with the disappearance of TRAb in 90% of the patients after 60 months.

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Aeromedical Decision Making for Military Aircrew with Graves’ Disease

Aerospace Medicine and Human Performance ◽

10.3357/amhp.5885.2021 ◽

2021 ◽

Vol 92 (12) ◽

pp. 980-986

Author(s):

Edwin Hong-Teck Loh ◽

Feng Wei Soh ◽

Brian See ◽

Benjamin Boon Chuan Tan

Keyword(s):

Decision Making ◽

Air Force ◽

Case Series ◽

Definitive Treatment ◽

Antithyroid Drugs ◽

Graves Disease ◽

First Line Therapy ◽

The Mean ◽

Stable Maintenance ◽

The Impact

BACKGROUND: Graves’ Disease (GD) is a common cause of hyperthyroidism. Although definitive treatment with radioactive iodine (RAI) is preferred for military aircrew, there are cultural and individual differences in receptivity toward RAI, and clinical guidelines that recommend antithyroid drugs (ATD) as the first line therapy. We examined a case series of Republic of Singapore Air Force (RSAF) aviators with GD treated with ATD and the impact of their condition on aeromedical disposition.CASE SERIES: All RSAF aircrew diagnosed with GD and treated with ATD over a 15-yr period were retrospectively identified and analyzed to determine the impact on their fitness for flying duties. The mean age of the 13 aircrew was 33 ± 7.1 yr (range, 25–47 yr), with 11 (84.6%) being males. There were 10 (76.9%) who had ATD as the only treatment while 3 (23.1%) were initially treated with ATD but subsequently underwent RAI or surgery. Of the 10 treated with only ATD, 3 (30.0%) were returned to restricted flying, 6 (60.0%) were returned to unrestricted flying, and 1 (10.0%) is still undergoing ATD titration. There were 10 (76.9%) aircrew who were returned to some form of flying duties while on low doses of ATD.DISCUSSION: This case series suggests that ATD is a viable treatment modality in the aeromedical management of military aviators with GD and it is possible to return military aircrew on a stable maintenance dose of ATD to flying duties. A framework is proposed to support the aeromedical decision-making process for military aircrew in the treatment of GD.Loh EH-T, Soh FW, See B, Tan BBC. Aeromedical decision making for military aircrew with Graves’ disease. Aerosp Med Hum Perform. 2021; 92(12):980–986.

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

Nuklearmedizin ◽

10.1055/s-0038-1625295 ◽

2002 ◽

Vol 41 (06) ◽

pp. 240-244 ◽

Cited By ~ 3

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.

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