Low failure rate of fixed administered activity of 400 MBq 131I with pre-treatment with carbimazole for thyrotoxicosis: the Gateshead Protocol

Razvi, Salman; Basu, Ansu; McIntyre, Emily; Wahid, Shahid; Bartholomew, P.; Weaver, Judith B.

doi:10.1097/01.mnm.0000130242.29692.b2

Cited by 18 publications

(11 citation statements)

References 40 publications

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“…Moreover, in contrast to previous reports, the negative effect of carbimazole on radioiodine therapy was con- firmed not only biochemically but also clinically, as quantified by the Crooks-Wayne score. Previous reports have indicated that the success of radioiodine treatment is not diminished if carbimazole is discontinued for 16 days [6], 5 days [7] or 5 to 3 days [8] before administration of radioiodine. However, even merely 5 days of withdrawal can lead to aggravation of hyperthyroidism [9], which is especially of concern in patients with severe concomitant diseases.…”

Section: Discussionmentioning

confidence: 99%

“…However, most studies have merged patients on diverse antithyroid drugs, namely thiamazoles and thiouracils, which have distinct detrimental effects on radioiodine treatment [20]. The influence of carbimazole alone on radioiodine treatment has been investigated in only a few reports [3][4][5][6][7][8], in which low success rates of radioiodine therapy with concomitant carbimazole treatment have exclusively been associated with significantly lower radioiodine uptake under carbimazole [3,5]. Generally, low radioiodine uptake is assumed to adversely affect the success of radioiodine therapy [12,13], although the opposite effect has also been reported [16].…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, patients receiving radioiodine under simultaneous carbimazole medication show significantly lower success rates than patients who do not receive carbimazole [3][4][5]. Withdrawal of carbimazole has the potential to overcome this detrimental effect [6][7][8], but discontinuation for 5 days or longer leads to exacerbation of hyperthyroidism [9]. Reports from prospective interventional studies on the outcome of radioiodine treatment after a brief period of carbimazole withdrawal, however, are limited [5,7,8].…”

Section: Introductionmentioning

confidence: 99%

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Outcome of radioiodine therapy without, on or 3 days off carbimazole: a prospective interventional three-group comparison

Walter

Christ‐Crain

Schindler

et al. 2006

Eur J Nucl Med Mol Imaging

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Abstract. Purpose: Carbimazole ameliorates hyperthyroidism but reduces radioiodine uptake and adversely affects the outcome of simultaneous radioiodine therapy. We explored whether withdrawal of carbimazole for 3 days can restore the outcome of radioiodine treatment without concurrent exacerbation of hyperthyroidism. By generating three groups with comparable radioiodine uptake, we also investigated whether the effect of carbimazole depends on the radioiodine uptake. Methods: Stratified by a radioiodine uptake >30%, 227 consecutive adult patients were prospectively assigned to radioiodine therapy (target dose 200 Gy) without, on or 3 days off carbimazole. Patients were clinically (CrooksWayne score) and biochemically (T 3 , fT 4 , TSH) followed up after 3, 6 and 12 months. Primary endpoint was outcome 12 months after radioiodine therapy. Results: A total of 207 patients completed follow-up (toxic nodular goitre, n=117; Graves' disease, n=90). The overall success rate was 71.5%. Patients without and 3 days off carbimazole had similar biochemical (81.4% and 83.3%, respectively; p=0.82) and clinical outcomes [median (range) Crooks-Wayne score 0 (0-16) and 1 (0-10), respectively; p=0.73], which were both higher than in patients on carbimazole [42.6%, p<0.001; Crooks-Wayne score 3 (0-30), p<0.03]. Time to achieve cure was delayed on carbimazole. No changes in thyroid hormone levels occurred after 3 days' discontinuation of carbimazole. Logistic regression revealed that all observed cure rates were independent of entity, sex, age, thyroid volume, radioiodine uptake, radioiodine half-life, fT 4 , T 3 and TSH. Conclusion: Patients under carbimazole treatment can be referred for radioiodine therapy after withdrawal of carbimazole for only 3 days. Three days of carbimazole withdrawal is long enough to restore the success of radioiodine therapy and short enough to avoid the risk of exacerbation of hyperthyroidism.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of radioiodine therapy without, on or 3 days off carbimazole: a prospective interventional three-group comparison

Walter

Christ‐Crain

Schindler

et al. 2006

Eur J Nucl Med Mol Imaging

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“…(40) evidenciaram maior chance de remissão nos pacientes com menor RAIU nas 24 h (40). Além disso, em um outro estudo recente, não se observou diferença na resposta terapêutica ao 131 I em pacientes com RAIU nas 24 h entre 11 e 30% ou maior que 30% (41).…”

Section: Radioiodoterapia Em Doenças De Gravesunclassified

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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“…A total dose of 20 mCi achieves thyroid ablation in almost all patients and results in permanent hypothyroidisms in 75-90% of patients. 51 The incidence of post radioiodine hypothyroidism in first year is 25% and steadily increases thereafter at a rate of 5% per year. When required, the second dose of radioiodine should be given at least 6 months after the first dose.…”

Section: Radioiodinementioning

confidence: 99%

Thyroid Hormone Excess: Graves’ Disease

Agrawal¹,

Prakash²,

Sharma³

2012

Thyroid Hormone

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Low failure rate of fixed administered activity of 400 MBq 131I with pre-treatment with carbimazole for thyrotoxicosis: the Gateshead Protocol

Cited by 18 publications

References 40 publications

Outcome of radioiodine therapy without, on or 3 days off carbimazole: a prospective interventional three-group comparison

Outcome of radioiodine therapy without, on or 3 days off carbimazole: a prospective interventional three-group comparison

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

Thyroid Hormone Excess: Graves’ Disease

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