Comparison of Different Thyroid Committed Doses in Radioiodine Therapy for Graves' Hyperthyroidism

Grosso, M; Traino, Antonio Claudio; Boni, Giuseppe; Banti, Elena; Porta, Mauro; Manca, Gianpiero; Volterrani, Duccio; Chiacchio, Serena; AlSharif, Abedallatif; Borsò, Elisa; Raschillà, R; Martino, Fabio; Mariani, Giuliano

doi:10.1089/cbr.2005.20.218

Cited by 38 publications

(22 citation statements)

References 18 publications

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“…The failure rate for RAI reported here is slightly higher than the range reported in the literature of 14–20% (16, 18, 20, 24–26). This is likely a reflection of the variability in treatment strategies used by the physicians at our institution and the lack of a formal dosing algorithm.…”

Section: Discussioncontrasting

confidence: 68%

Failure of Radioactive Iodine in the Treatment of Hyperthyroidism

et al. 2014

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Introduction Persistent or recurrent hyperthyroidism after treatment with radioactive iodine (RAI) is common, and many patients require either additional doses or surgery before they are cured. The purpose of this study was to identify patterns and predictors of failure of RAI in patients with hyperthyroidism. Methods We conducted a retrospective review of patients treated with RAI from 2007–2010. Failure of RAI was defined as receipt of additional dose(s) and/or total thyroidectomy. Using a Cox proportional hazards model, we conducted univariate analysis to identify factors associated with failure of RAI. A final multivariate model was then constructed with significant (p < 0.05) variables from the univariate analysis. Results Of the 325 patients analyzed, 74 patients (22.8%) failed initial RAI treatment. 53 (71.6%) received additional RAI, 13 (17.6%) received additional RAI followed by surgery, and the remaining 8 (10.8%) were cured after thyroidectomy. The percentage of patients who failed decreased in a step-wise fashion as RAI dose increased. Similarly, the incidence of failure increased as the presenting T3 level increased. Sensitivity analysis revealed that RAI doses < 12.5 mCi were associated with failure while initial T3 and free T4 levels of at least 4.5 pg/mL and 2.3 ng/dL, respectively, were associated with failure. In the final multivariate analysis, higher T4 (HR 1.13, 95% CI 1.02–1.26, p=0.02) and methimazole treatment (HR 2.55, 95% CI 1.22–5.33, p=0.01) were associated with failure. Conclusions Laboratory values at presentation can predict which patients with hyperthyroidism are at risk for failing RAI treatment. Higher doses of RAI or surgical referral may prevent the need for repeat RAI in selected patients.

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Section: Discussioncontrasting

confidence: 68%

Failure of Radioactive Iodine in the Treatment of Hyperthyroidism

et al. 2014

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“…Não há consenso sobre o melhor esquema para administração do radioiodo, sendo a dose ideal ainda controversa (16,18). As taxas de remissão do hipertireoidismo após administração do 131 I, em doses variando entre 7 a 20 mCi, são de 59 a 100% (16,20,(25)(26)(27)(28)(29).…”

Section: Discussionunclassified

“…O 131 I vem sendo consolidado como o tratamento definitivo mais efetivo, de menor custo e seguro, podendo ocasionar como efeito colateral mais significativo o hipotireoidismo, que poderá ser transitório ou definitivo (15)(16)(17)(18). As taxas de remissão do hipertireoidismo (pacientes que evoluem para eutireoidismo e hipotireoidismo após administração do 131 I) podem chegar a 100% (19)(20)(21).…”

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“…As doses usualmente empregadas variam de 7 a 20 mCi, conforme a região e experiência do Serviço de Saúde, não havendo consenso sobre o melhor esquema (20,21). Alguns autores advogam o uso de doses elevadas, ablativas, para provocar um hipotireoidismo intencional precoce, seguido de reposição permanente com levotiroxina (18,20). Essa conduta vem tendo aceitação crescente nos Estados Unidos, sendo pouco utilizada no Japão e na Europa (11).…”

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Avaliação da radioiodoterapia com doses fixas de 10 e 15 mCi em pacientes com doença de graves

Canadas

Vilar²,

Moura³

et al. 2007

Arq Bras Endocrinol Metab

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RESUMOAs opções terapêuticas para a hipertireoidismo da doença de Graves são as drogas antitireoidianas, a cirurgia e o radioiodo, porém nenhuma delas é considerada ideal pois não atuam diretamente na etiopatogênese da doença. O radioiodo vem sendo cada vez mais utilizado como primeira escolha, sendo um tratamento definitivo, seguro e de fácil administração. Há autores que preferem doses mais altas para induzir deliberadamente o hipotireoidismo, enquanto outros recomendam doses mais baixas que, a curto prazo, implicam menor incidência de hipotireoidismo e maior de eutireoidismo. Não há consenso sobre o melhor esquema de doses fixas a ser utilizado, sendo esse o principal enfoque deste estudo, no qual comparamos doses de 10 e 15 mCi. Dos 164 pacientes analisados, 61 (37,2%) foram submetidos a 10 mCi e 103 (62,8%), a 15 mCi de 131 I. Na análise longitudinal, observou-se que a remissão do hipertireoidismo foi estatisticamente diferente no sexto mês (p < 0,001), sendo maior no grupo em que foi empregada a dose de 15 mCi. Contudo, foi semelhante nos dois grupos após 12 e 24 meses. É possível concluir que doses fixas de 10 e 15 mCi promovem semelhante remissão do hipertireoidismo após 12 meses de tratamento. A remissão do hipertireoidismo não teve associação com idade, sexo ou uso prévio de drogas antitireoidianas. The treatment options for the hyperthyroidism of Graves' disease are antithyroid drugs, surgery and radioiodine, none of which is considered ideal, as they do not act directly on the etiopathogenesis of the disease. Radioiodine has been increasingly used as the treatment of choice because it is a safe and definitive therapy whose administration is very easy. Some authors prefer to administer higher doses in order to deliberately induce hypothyroidism, while others recommend lower doses that result in a lower incidence of hypothyroidism and a greater incidence of euthyroidism. There is no consensus for the optimal regimen of fixed doses to be used and this is the main focus of the present study, where doses of 10 and 15 mCi of 131 I were compared. Among the 164 patients analyzed, 61 (37.2%) were submitted to 10 mCi and 103 (62.8%) to 15 mCi. In the longitudinal analysis it was observed that remission of the hyperthyroidism was statistically different in the sixth month (p < 0.001), being higher in the group that used the dose of 15 mCi, but similar in both groups at 12 and 24 months. It may be concluded that the administration of fixed doses of 10 and 15 mCi of 131 I brought about a similar remission of the hyperthyroidism after 12 months of treatment. Moreover, the remission rate of the hyperthyroidism had no association with age, sex or previous therapy with antithyroid drugs.

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“…Based on a priori assumptions derived from literature data for the expected effective half-life (T eff ) of 131 I in the thyroid of the individual patient with GD and the measured U 4h and U 24h in the study, the T eff values used in this study were considered as follows (20): normal kinetics, T eff ϭ 121 hours (T max ϭ 24 h, U 24h /U 4h Ͼ 1.0); normal kinetics with quick uptake, T eff ϭ 121 hours (T max ϭ 4 h, 0.88 Յ U 24h /U 4h Յ 0.92); quick kinetics, T eff ϭ 107 hours (T max ϭ 4 h, U 24h /U 4h Ͻ 0.88); slow kinetics, T eff ϭ 169 hours (T max ϭ 4 h, U 24h /U 4h Ͼ 0.92), where T max is the time to maximum activity.…”

Section: Thyroid 131 I Biokineticsmentioning

confidence: 99%