<b>The development of transient hypothyroidism after iodine‐131 treatment in hyperthyroid patients with Graves' disease: prevalence, mechanism and prognosis</b>

Aizawa, Yoshihiko; Yoshida, Katsumi; Kaise, Nobuko; Fukazawa, Hiroshi; Kiso, Yoshinori; Sayama, Noriyo; Hori, Hatsuhiro; Abe, Keishi

doi:10.1046/j.1365-2265.1997.d01-1737.x

Cited by 56 publications

(39 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Early hypothyroidism seems related to the organ dose, whereas late hypothyroidism is probably related to an autoimmune process of GD (12,13). Similarly the numbers of patients with positive rTSHAb were not different among the three groups in our study, although some previous results suggest that rTSHAb activity may cause a recovery of cell function following irradiation and is associated with a relative resistance to radioiodine therapy (14). A plausible explanation may be that we did not have the opportunity to determine the amount of cAMP produced by rTSHAb on cultured cells and therefore to determine if these antibodies were stimulating or blocking.…”

Section: Discussioncontrasting

confidence: 43%

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

Catargi¹,

Leprat²,

Guyot

et al. 1999

Eur J Endocrinol

View full text Add to dashboard Cite

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 50 Gy 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-, hyperor 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, 24 h 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.

show abstract

Section: Discussioncontrasting

confidence: 43%

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

Catargi¹,

Leprat²,

Guyot

et al. 1999

Eur J Endocrinol

View full text Add to dashboard Cite

show abstract

“…O tratamento com 131 I apresenta como principal efeito colateral uma alta incidência de hipotireoidismo permanente, cuja freqüência no primeiro ano de tratamento varia de acordo com a dose de 131 I administrada (64), enquanto que a incidência posterior (3% ao ano) depende de fatores imunológicos (65), da associação ou não com drogas antitireoidianas (66), tamanho do bócio (67), radiosensibilidade individual, homogeneidade da distribuição de iodo na glândula tireóide e duração do seguimento dos pacientes tratados (68). Hipotireoidismo transitório pode ocorrer no período de 2 a 5 meses após o uso do radioisótopo (9-58% dos casos) (69).…”

Section: Iodo Radioativo Iodo Radioativounclassified

Tratamento do hipertireoidismo da Doença de Graves

Andrade

Gross

Maia

2001

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

A Doença de Graves constitui a forma mais comum de hipertireoidismo e três abordagens terapêuticas são atualmente utilizadas: drogas antitireoidianas (DAT), cirurgia e iodo radioativo (131I). As DAT continuam como tratamento de primeira escolha em pacientes com doença leve, bócios pequenos, crianças e adolescentes, e em situações especiais como na gravidez. Por outro lado, o 131I tem sido cada vez mais utilizado, porque é considerado um tratamento seguro, definitivo e de fácil aplicação. O risco de exacerbação do hipertireoidismo após administração do 131I, os fatores prognós-ticos de falência e o cálculo da dose administrada têm sido alguns dos aspectos discutidos na literatura recentemente, e são particulamente comentados nesta revisão. O tratamento cirúrgico constitui quase um tratamento de exceção, com indicação para os casos em que as terapias anteriores não possam ser utilizadas. ABSTRACT ABSTRACTGraves' disease is the most frequent cause of hyperthyroidism and current treatments consist of antithyroid drugs (ATD), radioiodine (131I) and surgery. ATD are the first choice of treatment in patients with mild disease, small goiters, children, adolescents and in special situations as pregnancy. On the other hand, 131I is increasingly being used as definitive therapy, because it long has proven to be a safe, cheap and effective treatment. The risk of exacerbation of hyperthyroidism after 131I administration, factors that may predict the response to radioiodine and the dose to be administrated have been discussed in the literature and we comment the controversies in this review. Surgery is rarely employed, and it is indicated only in cases where ATD have not been effective, radioiodine is contraindicated or not acceptable to the patients. A DOENÇA DE GRAVES CONSTITUI A FORMA mais comum de hipertireoidismo (60%-80%), afetando principalmente as mulheres (5-10:1) entre 40-60 anos (1). Na Inglaterra apresenta uma prevalência de 2% em mulheres e 0,2% em homens, enquanto nos EUA estima-se que acometa 0,4% da população (2). A maioria dos estudos relata taxas de incidência de 0,5/1000 indivíduos/ano e o risco calculado de mulheres e homens desenvolverem hipertireoidismo em alguma fase de suas vidas é de 5% e 1% respectivamente (3).O hipertireoidismo da Doença de Graves é caracterizado imunologicamente por infiltração linfocitária da glândula tireóide e por ativação

show abstract

“…Treatment with lithium prevented serum free T4 increase after methimazole withdrawal and RAI therapy. At last, studies have shown that RAI is safe and except of transient or permanent iatrogenic hypothyroidism no significants outcomes have been reported (5). In a follow up study for 20 years, Ron and cols.…”

Section: Discussionmentioning

confidence: 97%

Marrow hypoplasia: a rare complication of untreated Grave’s disease

Garcia

França

Ellinger

et al. 2014

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

SUMMARYAtypical presentation forms of hyperthyroidism are always a challenge to the clinician. We pre sent a female patient with the typical symptoms of thyrotoxicosis, without any thionamides treatment before, associated with pancytopenia, which recovered after euthyroidism state was achieved. Although the major cases of pancytopenia in Grave's disease are seen as a compli cation of antithyroid drugs (thioamides), in this case report the alteration in blood tests was associated with untreated hyperthyroidism. In the literature review, we found 19 case reports between 1981 to 2012, but it has been related to a hypercellular bone marrow with periferic destruction. Our case, however, is about a hypocellular bone marrow without fibrosis or fat tissue replacement, which proceeded with a periferic improvement following thyroid treatment. Although rare, pancytopenia, when present, may develop as an unusual and severe manifesta tion in untreated subjects. Arq Bras Endocrinol Metab. 2014;58(9):953-7 SUMÁRIOFormas atípicas de apresentação do hipertireoidismo são sempre um desafio para o clínico. Apresentamos uma paciente do sexo feminino, com sintomas típicos de tireotoxicose associa do a um quadro de pancitopenia sem nenhum tratamento prévio com tionamidas. A melhora da alteração hematológica ocorreu após recuperação do eutireoidismo. Embora a maioria dos casos de pancitopenia na doença de Graves seja uma complicação das drogas antitireoidianas (tionamidas), neste caso a alteração hematológica foi associada ao quadro de hipertireoidismo não tratado. Após uma revisão na literatura, encontramos 19 relatos de caso descritos no perío do de 1981 a 2012, nos quais o quadro de pancitopenia estava relacionado à hipercelularidade medular com destruição periférica das células sanguíneas. Nosso caso, entretanto, tratase de uma pancitopenia com medula óssea hipocelular, sem infiltração por tecido adiposo ou fibrose, que evoluiu com melhora dos elementos do sangue periférico após tratamento do hipertireoi dismo. Embora rara, a pancitopenia, quando presente, pode se manifestar como uma severa manifestação se não tratada a condição desencadeadora. Arq Bras Endocrinol Metab. 2014;58(9):953-7

show abstract

The development of transient hypothyroidism after iodine‐131 treatment in hyperthyroid patients with Graves' disease: prevalence, mechanism and prognosis

Cited by 56 publications

References 10 publications

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

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

Tratamento do hipertireoidismo da Doença de Graves

Marrow hypoplasia: a rare complication of untreated Grave’s disease

Contact Info

Product

Resources

About