Guideline for radioiodine therapy for benign thyroid diseases (version 4)

Abstract

SummaryVersion 4 of the guideline for radioiodine therapy for benign thyroid diseases includes an interdisciplinary consensus on decision making for antithyroid drugs, surgical treatment and radioiodine therapy. The quantitative description of a specific goiter volume for radioiodine therapy or operation was cancelled. For patients with nodular goiter with or without autonomy, manifold circumstances are in favor of surgery (suspicion on malignancy, large cystic nodules, mediastinal goiter, severe compression of the trachea) or in favor of radioiodine therapy (treatment of autonomy, age of patient, co-morbidity, history of prior subtotal thyroidectomy, profession like teacher, speaker or singer). For patients with Graves' disease, radioiodine therapy or surgery are recommended in the constellation of high risk of relapse (first-line therapy), persistence of hyperthyroidism or relapse of hyperthyroidism. After counseling, the patient gives informed consent to the preferred therapy. The period after radioiodine therapy of benign disorders until conception of at least four months was adapted to the European recommendation.

Qualitative and Quantitative Impact of Protective Glucocorticoid Therapy on the Effective 131I Half-Life in Radioiodine Therapy for Graves Disease

“…The pred1 group was further subdivided into low-prednisolone (pred low , 0.5 mg/kg; 72 patients) and highprednisolone (pred high , $1 mg/kg; 53 patients) groups. At RIT, 113 patients were diagnosed with euthyroidism because of antithyroid medication, 106 with subclinical hyperthyroidism (thyroid-simulating hormone [TSH] suppressed, free triiodothyronine [fT 3 ] and free levothyroxine [fT 4 ] levels within reference range), and 52 with thyrotoxicosis (TSH suppressed, fT 3 or fT 4 levels elevated). Because of the effects of antithyroidal drugs, 20 patients presented with subclinical (TSH elevated, fT 3 and fT 4 levels within reference range) and 24 with overt (TSH elevated, fT 3 or fT 4 levels reduced) hypothyroidism.…”

“…The numbers of the prednisolone subdivisions within the metabolic groups are given in Table 1. For subsequent statistical calculations, the categoric variable metabolic state was transferred to a semiquantitative ordinal sum score accounting for the TSH level (0, elevated TSH; 1, TSH within reference range; and 2, suppressed TSH) and fT 3 and fT 4 levels (0, fT 3 /fT 4 levels reduced; 1, fT 3 /fT 4 levels within reference range; and 2, fT 3 /fT 4 levels elevated).…”

“…European and national statements on RIT in patients with Graves disease (GD) and EO recommend short courses of oral glucocorticoids during and after RIT (2,3). The German guidelines for treatment of GD with radioiodine propose low-dose glucocorticoid pulse therapy with 0.5 mg of prednisolone per kilogram in patients at risk of developing EO (3).…”

New Approach for Analysing the Discrepancy of Pretherapeutic Tc-99m and Intra-therapeutic I-131 uptake in Scintigraphies of Thyroid Autonomies using a Parametric 3D Analysis Programs

“…The primary goal of radioiodine therapy in cases of benign thyroid autonomies is to switch off the autonomous thyroid tisse [2]. The I-131 activity administered as part of the therapy is calculated according to the target dose using the Marinelli formula [3], in which the target volume, the maximum thyroidal iodine uptake and the effective half-life are taken into account.…”

Matched pairs for radionuclide-based imaging and therapy

“…However, at least for radioiodine therapy of benign thyroid diseases, it is nowadays widely accepted that there is a dose-response relationship and pretherapeutic dosimetry is feasible and should be performed [2][3][4]. Dosimetry in the treatment of benign thyroid diseases is relatively easy, as the organ is close to the surface and there is little and calculable absorption or scatter, the target volume may be reliably measured by ultrasonography, and the activity distribution is quite homogeneous.…”