Effectiveness of radioiodine (131-I) as definitive therapy in patients with autoimmune and non-autoimmune hyperthyroidism

PurposeTreatment options in Graves’ disease are clearly defined, but management practices and the perceptions of success are varied. The outcomes of treatment in large consecutive cohorts of Graves’ disease have not been well characterised. The study describes the epidemiology, management strategies and medium term outcomes following anti-thyroid drug treatment, radio-iodine ablation and surgery in Graves’ disease.MethodsAll patients (n = 659) who received treatment for a new diagnosis of Graves’ disease in secondary care over a 5 year period were included with a median (interquartile range) follow-up of 42.9 (29–57.5) months.ResultsThe age adjusted incidence of adult onset Graves’ disease in Sheffield, UK was 24.8 per 100,000 per year. Excluding 35 patients lost to follow-up, 93.1% (n = 581) were controlled on anti-thyroid drug treatment. Of these, 73.6% went into remission following withdrawal of anti-thyroid drugs; 5.2% were still undergoing initial therapy; 13.3% lost control whilst on anti-thyroid drugs; and 7.9% went on to have either surgery or radio-iodine ablation whilst controlled on anti-thyroid drugs. Of the 428 patients who achieved remission, 36.7% relapsed.Of 144 patients who had radio-iodine ablation treatment, 5.6% relapsed and needed further treatment. Of 119 patients having surgery, 5.2% had long-term hypoparathyroidism and none had documented long-term recurrent laryngeal nerve palsy.ConclusionsIn the follow-up, 39.9% of patients underwent surgery or radio-iodine ablation with little morbidity. Up to two-thirds of patients who achieved remission did not relapse. Data on effectiveness and risks of treatments for Graves’ disease presented in this study will help clinicians and patients in decision making.

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“…This is in keeping with previous studies which have reported success of RIA therapy to be over 85% [41, 42]. …”

Section: Discussionsupporting

confidence: 92%

Epidemiology, management and outcomes of Graves’ disease—real life data

et al. 2017

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“…Altogether, these results, both in terms of effectiveness with a single administration (main endpoint) and in terms of minimizing the risk of hypothyroidism (secondary endpoint), are fair, when compared with those reported in literature [3][4][5] In one long-term follow-up study on patients treated with radioiodine, a prevalence of hypothyroidism of 3 % at 1 year and 64 % at 24 years was shown [19]. It is likely that the administration of lower activities with respect to other dosimetric methods can also offer advantages in terms of reduction of the long-term hypothyroidism incidence.…”

Section: Discussionsupporting

confidence: 60%

“…Radioiodine therapy with 131 I-iodide is one of the treatments of choice of MTG, together with surgery [3][4][5]. In fact, antithyroid drugs, as a rule, are unable to achieve hyperthyroidism cure.…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of radioiodine therapy in multinodular toxic goiter, applying an implemented dose calculation algorithm

et al. 2014

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Radioiodine is a common therapeutic option for Multinodular Toxic Goiter (MTG). We evaluated an algorithm for personalized radioiodine activity calculation. Ninety-three (28 male, 65 female; 43-84 years) patients with MTG eligible for radioiodine treatment (131I-iodide) were studied. The quantity of 131I-iodide to be administered was estimated by Thyroid Volume Reduction (TVR) algorithm, developed for Graves' disease. It takes into account 131I uptake, its effective half-life (T1/2eff), thyroid volume, and its expected reduction during treatment. A comparison with the activity calculated by other dosimetric protocols and the "fixed" activity method was performed. 131I uptake was measured by external counting, thyroid volume by ultrasonography (US), thyroid stimulating hormone (TSH), and thyroid hormones by standard immunometric methods. In a follow-up of 6-120 months, remission of hyperthyroidism after a single 131I-iodide treatment was observed in 76 patients (64 euthyroid, 12 hypothyroid). The thyroid volume reduction observed by US after the treatment fairly correlated with what predicted by our model; T1/2eff was highly variable and critically affected dose calculation. The administered activities (median 526 MBq, range 156-625 MBq) were slightly lower than the "fixed" activities (600 MBq) and with respect to the other protocols' prescriptions (-15/38%); the median 131I activity administered to relapsed patients (605 MBq) was significantly greater (P=0.01) with respect to the dose administered to cured patients (471 MBq). Our study shows that an effective cure of MTG can be obtained with relatively low 131I activities and probably with a relatively low incidence of hypothyroidism, using TVR method.

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“…Tarantini [27] found that with a median activity of 555 MBq, 75% of patients with toxic adenoma were euthyroid and 18.7% were hypothyroid, 3 years after iodine therapy. As expected, on decreasing the dose, the rate of hypothyroidism seems to be decreasing as well.…”

Section: Discussionmentioning

confidence: 99%