Predicting outcomes and complications following radioiodine therapy in Graves’ thyrotoxicosis

Aung, Ei Thuzar; Zammitt, Nicola N.; Dover, Anna R.; Strachan, Mark W. J.; Gibb, Fraser

doi:10.1111/cen.13873

Cited by 48 publications

(33 citation statements)

References 26 publications

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“…ATD and/or KI administration before RIT, severity of hyperthyroidism, the thyroidal uptake of 99m Tcpertechnetate or radioiodine, and serum TRAb level are associated with the outcome of RIT [22][23][24]. We were unable to identify any clinical or laboratory differences between patients who showed marked efficacy and those who were refractory among the present patients.…”

Section: Discussionmentioning

confidence: 56%

Utility of outpatient fractionated radioiodine therapy for Graves disease involving a large goiter measuring more than 100 mL in volume

et al. 2021

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Contrary to large multinodular goiters, reports on 131 I radioiodine therapy (RIT) for Graves disease (GD) involving a large goiter are scarce. We retrospectively reviewed a total of 71 consecutive patients (25 males, 46 females) with GD involving a large goiter (>100 mL) who had received RIT in our clinic. Patients with a history of thyroid surgery or with large thyroid nodules and those who had dropped out less than one year after the initial RIT session were excluded. A fixed 131 I activity of 481 MBq was administered in most cases. RIT was repeated at intervals of 1-47 months, typically 3-6 months. The follow-up duration after the initial RIT session was 13-233 (median: 81) months. The thyroid volume was estimated using ultrasound. The number of 131 I doses were 1 dose in 13 patients, 2 doses in 29, 3 doses in 17, 4 doses in 5, 5 doses in 5, 6 doses in 1, and 8 doses in 1. Sixty-six patients had remission from overt hyperthyroidism after RIT: overt hypothyroidism in 45 patients, subclinical hypothyroidism or euthyroidism in 13, and subclinical hyperthyroidism in 8. Their thyroid volume decreased from 101-481 (median: 126) mL to 1.4-37 (8.2) mL. Three patients still had overt hyperthyroidism under treatment with methimazole after one to three doses, and two dropped out less than six months after the third or sixth dose. Even in GD patients with a large goiter (>100 mL), repeated RIT with an activity of 481 MBq could sufficiently shrink goiters and remit overt hyperthyroidism.

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Section: Discussionmentioning

confidence: 56%

Utility of outpatient fractionated radioiodine therapy for Graves disease involving a large goiter measuring more than 100 mL in volume

et al. 2021

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“…A recent study evaluating the use of an ablative RAI dose in 576 Graves' patients reports that 1 year after the first fixed 131 I dose of 400 MBq, 17% was still hyperthyroid, 77% hypothyroid, and 6% euthyroid [13]. At 80-month follow-up, 81 patients had received a second dose and eight patients a third dose; 3.2% was still hyperthyroid (but controlled by ATD or T x ), 86.4% hypothyroid, 3.3% euthyroid, and 6.4% had died; no data in 0.7%.…”

Section: Radioactive Iodinementioning

confidence: 99%

Graves' Disease: Can It Be Cured?

Wiersinga

2019

Endocrinol Metab

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Whether or not Graves' hyperthyroidism can be really cured, depends on the definition of “cure.” If eradication of thyroid hormone excess suffices for the label “cure,” then all patients can be cured because total thyroidectomy or high doses of 131I will abolish hyperthyroidism albeit at the expense of creating another disease (hypothyroidism) requiring lifelong medication with levothyroxine. I would not call this a “cure,” which I would like to define as a state with stable thyroid stimulating hormone (TSH), free thyroxine, and triiodothyronine serum concentrations in the normal range in the absence of any thyroid medication. Surgery and radioiodine are unlikely to result in so-defined cures, as their preferable aim as stated in guidelines is to cause permanent hypothyroidism. Discontinuation of antithyroid drugs is followed by 50% recurrences within 4 years; before starting therapy the risk of recurrences can be estimated with the Graves' Recurrent Events After Therapy (GREAT) score. At 20-year follow-up about 62% had developed recurrent hyperthyroidism, 8% had subclinical hypothyroidism, and 3% overt hypothyroidism related to TSH receptor blocking antibodies and thyroid peroxidase antibodies. Only 27% was in remission, and might be considered cured. If the definition of “cure” would also include the disappearance of thyroid antibodies in serum, the proportion of cured patients would become even lower.

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“…Commonly, after 12-18 months' drug treatment, the risk of recurrence is around 50% [7,8]. Compared to ATD, RAI is a definitive treatment of hyperthyroidism and can improve hyperthyroidism quickly [9,10]. Due to its low cost and high efficiency, lots of patients are tend to use RAI therapy to cure GD all over the world [11,12].…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for early hypothyroidism following the radioactive iodine therapy in Graves’ disease patients

2020

BMC Endocr Disord

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Background: Radioactive iodine (RAI) therapy is an important treatment option for Graves' disease (GD), the main side effect of RAI treatment is hypothyroidism, and the factors resulting in hypothyroidism are still controversial. The purpose of this retrospective study was to clarify the possible risk factors of early hypothyroidism after RAI therapy in Graves' disease. Methods: We reviewed 312 GD patients treated with RAI between January 2017 to December 2018, collected the potential risk factors, and analyzed the relationship between these variables and early hypothyroidism. Results: After 6 months' follow-up, 218 (69.87%) patients were evaluated as early hypothyroid. Male gender, shorter duration of disease, smaller thyroid weight, lower 2-h radioactive iodine uptake (RAIU), 6-h RAIU, 24-h RAIU and 6/ 24-h uptake ratio, lower administered dosages were significantly associated with early hypothyroidism. Logistics regression analysis showed that male gender, smaller thyroid weight and lower 6-h RAIU were associated with early hypothyroidism. Multi-factors combined ROC curve analysis suggested that the predictive power of male gender, smaller thyroid weight and lower 6-h RAIU for early hypothyroidism was 0.711. Conclusions: Our results show that RAI is an effective therapy for GD and most of the cured patients became to hypothyroid within 6 months. Male gender, smaller thyroid weight and lower 6-h RAIU are the main risk factors for early hypothyroidism.

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Predicting outcomes and complications following radioiodine therapy in Graves’ thyrotoxicosis

Cited by 48 publications

References 26 publications

Utility of outpatient fractionated radioiodine therapy for Graves disease involving a large goiter measuring more than 100 mL in volume

Utility of outpatient fractionated radioiodine therapy for Graves disease involving a large goiter measuring more than 100 mL in volume

Graves' Disease: Can It Be Cured?

Predictive factors for early hypothyroidism following the radioactive iodine therapy in Graves’ disease patients

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