Radiojodoterapia w chorobie Gravesa-Basedowa — czynniki wpływające na skuteczność leczenia w oparciu o analizę retrospektywną

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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“…The results suggested that, under similar conditions, men are more prone to developing NHRH compared to female patients, consistent with Allahabadia et al ( 21 ). DPUTV emerged as a protective factor against NHRH, indicating that a higher dose of 131 I relative to the thyroid weight correlates with a lower risk of NHRH, aligning with previous findings ( 22 , 23 ).…”

Section: Discussionsupporting

confidence: 90%

Ultrasound combined with Ki-67 to construct the prognostic model for radioactive iodine therapy outcomes in Graves’ disease patients

Wang,

Hong,

Yang

et al. 2023

Endocrine Connections

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To develop a prognostic model for radioactive iodine therapy outcome in patients with Graves' disease. Enrolled 127 patients. Information on radioactive iodine therapy, ultrasound indexes of thyroid, and other lifestyle factors was collected. The competing risk model was used to estimate the multivariable-adjusted hazard ratios and 95% confidence intervals for non-healing or recurrence of hyperthyroidism. The performance of the model was assessed by Receiver Operator Characteristic analysis and the Brier score, and internally validated by bootstrap resampling. Then, a nomogram was developed. Forty-one cases (32.2%) of non-healing or recurrence of hyperthyroidism were documented. Positive Ki-67 expression, a higher dose of per unit thyroid volume, and females showed lower risks of non-healing or recurrence of hyperthyroidism (all P < 0.05). The HR (95% CI) were 0.42 (0.23, 0.79), 0.01 (0.00, 0.02), and 0.47 (0.25, 0.89), respectively. The Bootstrap validation showed that the model had the highest accuracy and good calibration for predicting cumulative risk of non-healing or recurrence of hyperthyroidism at 180 days after radioactive iodine therapy (AUC = 0.772; 95% CI: 0.640-0.889, Brier score = 0.153). By decision curve analysis, the nomogram was shown to have a satisfactory net benefit between thresholds of 0.20 and 0.40. Ki-67, ultrasound volumetry, and scintigraphy techniques can play important roles in evaluating radioactive iodine therapy therapy outcome in Graves' disease patients. The prediction nomogram shows reasonable accuracy in predicting non-healing or recurrence of hyperthyroidism.

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“…Markovic and colleagues reported that the chances of recovery are much greater for the patients with thyroids smaller than 62 g (9.6% of unsuccessful attempts) as opposed to patients with thyroids larger than 62 g (44% of cases of persistent hyperthyroidism) 13 . Szumowski et al 14 have proven that the volume of the thyroid gland has a significant ( P <0.002) effect on the success of treatment, and the larger the thyroid volume, the worse the treatment efficiency. Similar to the results of other studies, our study showed that the lower weight of the thyroid led to greater success of treatment ( P =0.002).…”

Section: Discussionmentioning

confidence: 99%

“…Several factors that affect the success of 131 I treatment in GD patients have been put forward, such as the dose of 131 I administration, thyroid volume, age, thyroid uptake of 131 I, and the use of antithyroid drugs 12 . Some researchers have proven that thyroid volume has a significant influence on the success of treatment and the inefficiency of 131 I therapy is closely related to thyroid volume 13 , 14 . The effect of age on the outcome of 131 I treatment is still a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factor analysis in 325 patients with Graves’ disease treated with radioiodine therapy

Yang

Xue

et al. 2018

Nuclear Medicine Communications

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Introduction131I therapy is a choice for Graves’ hyperthyroidism. Several factors that affect the success of 131I treatment in Graves’ disease (GD) patients have been put forward. The aim of this retrospective study was to evaluate the factors influencing the success of 131I therapy and the occurrence of hypothyroidism after 131I therapy.Patients and methodsWe reviewed 325 GD patients, who were well documented out of 779 cases, treated with 131I in the First Affiliated Hospital of Xi’an Jiaotong University between 2010 and 2016. We collected the potential influencing factors, including demographic data (age, sex, family history), iodine intake state, antithyroid drugs (ATD) taking, thyroid texture, complications of hyperthyroidism, physical and laboratory examinations [thyroid weight, effective 131I half-life time (Teff), 24-h iodine uptake rate, tri-iodothyronine, thyroxine, free tri-iodothyronine (FT3), free thyroxine, thyroid-stimulating hormone, thyroglobulin antibody, thyroid microsome antibody, thyrotropin receptor antibody], and final administered dosages according to Quimby formula. The correlations between the prognosis of GD patients and these factors were analyzed by logistic regression analysis.ResultsOut of 325 patients, 247 (76.00%) were treated successfully with radioiodine. GD patients who were cured by 131I therapy were more likely to have smaller thyroid [odds ratio (OR)=0.988, 95% confidence interval (CI)=0.980–0.996, P=0.002], lower FT4 levels (OR=0.993, 95% CI=0.988–0.997, P=0.002), and shorter time of ATD withdrawal before 131I treatment (OR=0.985, 95% CI=0.975–0.996, P=0.002). Hypothyroidism occurred in 132 (41.00%) out of 325 patients. There was an increased risk of early hypothyroidism in patients with lower 24-h iodine uptake (OR=0.964, 95% CI=0.941–0.988, P=0.004), and treated with a lower total dose of iodine (OR=0.892, 95% CI=0.824–0.965, P=0.005) and a higher iodine dose per garm of thyroid tissue (OR=5.414E+14, 95% CI=45.495–6.444E+27, P=0.027).ConclusionOur results showed that 131I treatment was more successful in patients with lower weight of the thyroid, lower free thyroxine level, and shorter ATD taking period. Furthermore, early hypothyroidism after radioiodine treatment was more likely to occur in patients with lower 24-h iodine uptake, lower total dose of iodine, and higher iodine dose per garm of thyroid tissue.

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Radiojodoterapia w chorobie Gravesa-Basedowa — czynniki wpływające na skuteczność leczenia w oparciu o analizę retrospektywną

Cited by 16 publications

References 28 publications

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

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

Ultrasound combined with Ki-67 to construct the prognostic model for radioactive iodine therapy outcomes in Graves’ disease patients

Prognostic factor analysis in 325 patients with Graves’ disease treated with radioiodine therapy

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