Thiamazole Pretreatment Lowers the131I Activity Needed to Cure Hyperthyroidism in Patients With Nodular Goiter

Kyrilli, Aglaia; Tang, Bich-Ngoc-Thanh; Huyge, Valérie; Blocklet, Didier; Goldman, Serge; Corvilain, Bernard; Moreno‐Reyes, Rodrigo

doi:10.1210/jc.2015-1026

Cited by 17 publications

(7 citation statements)

References 32 publications

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“…If symptoms of hyperthyroidism recur during the interval of drug withdrawal, b-blocking drugs can usually control symptoms. In hyperthyroid patients for whom radioiodine therapy is selected as the first-line option, a brief course of antithyroid drug treatment is suggested to deplete the intrathyroidal hormone stores by blocking iodination of tyrosine while the gland continues to respond to TRAb with release of previously formed thyroid hormone, especially in elderly patients and patients with preexisting heart disease or severe systemic illness (40,47).…”

Section: Preparationmentioning

confidence: 99%

The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders, Part 1: Hyperthyroidism

et al. 2020

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Learning Objectives: On successful completion of this activity, participants should be able to (1) acquire knowledge on the clinical manifestations and underlying pathophysiology of the different forms of hyperthyroidism; (2) understand how to interpret ultrasound imaging and radionuclide evaluation in patients with hyperthyroidism; and (3) become familiar with the different methodological approaches to radioiodine therapy in patients with hyperthyroidism.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through March 2023.Benign thyroid disorders, especially hyper-and hypothyroidism, are the most prevalent endocrine disorders. The most common etiologies of hyperthyroidism are autoimmune hyperthyroidism (Graves disease, GD), toxic multinodular goiter (TMNG), and toxic thyroid adenoma (TA). Less common etiologies include destructive thyroiditis (e.g., amiodarone-induced thyroid dysfunction) and factitious hyperthyroidism. GD is caused by autoantibodies against the thyroid-stimulating hormone (TSH) receptor. TMNG and TA are caused by a somatic activating gain-of-function mutation. Typical laboratory findings in patients with hyperthyroidism are low TSH, elevated free-thyroxine and free-triiodothyronine levels, and TSH-receptor autoantibodies in patients with GD. Ultrasound imaging is used to determine the size and vascularity of the thyroid gland and the location, size, number, and characteristics of thyroid nodules. Combined with lab tests, these features constitute the first-line diagnostic approach to distinguishing different forms of hyperthyroidism. Thyroid scintigraphy with either radioiodine or 99m Tc-pertechnetate is useful to characterize different forms of hyperthyroidism and provides information for planning radioiodine therapy. There are specific scintigraphic patterns for GD, TMNG, TA, and destructive thyroiditis. Scintigraphy with 99m Tcsestamibi allows differentiation of type 1 from type 2 amiodarone-induced hyperthyroidism. The radioiodine uptake test provides information for planning radioiodine therapy of hyperthyroidism. Hyperthyroidism can be treated with oral antithyroid drugs, surgical thyroidectomy, or 131 Iiodide. Radioiodine therapy is generally considered after failure of treatment with antithyroid drugs, or when surgery is contraindicated or refused by the patient. In patients with TA or TMNG, the goal of radioiodine therapy is to achieve euthyroid status. In GD, the goal of radioiodine ...

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Section: Preparationmentioning

confidence: 99%

The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders, Part 1: Hyperthyroidism

et al. 2020

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“…Two other studies, conducted under the supervision of A. Flores-Rebollar and A. Kyrilli, add, moreover, that the application of MMI prior to a 131 I therapy can be a safe, easy and acceptable method to increase TSH concentrations, representing a valid alternative to the widely used rhTSH. This is because both the methods of stimulating RAIU cause an approximately twofold increase in its value [8,9]. Our research shows that the applied adjuvant therapy with MMI caused an over twofold rise not only in RAIU 24 h but also in RAIU 48 h : 2.24 and 2.11, respectively.…”

Section: Discussionmentioning

confidence: 61%

Enhancing the efficacy of 131I therapy in non-toxic multinodular goitre with appropriate use of methimazole: an analysis of randomized controlled study

et al. 2019

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Purpose It is possible to raise the rate of the uptake of 131 I in the thyroid gland (RAIU) by increasing the endogenous TSH level through appropriate use of methimazole (MMI) prior to 131 I therapy. The purpose of this paper is to assess the impact of pre treatment with MMI on the efficacy of 131 I therapy in non-toxic multinodular goitre (NMG). Methods Thirty-one patients with NMG received 131 I treatment in order to reduce the volume of the thyroid (TVR). Those in group 1 (n = 16) were administered 10 mg of methimazole for 6 weeks. Four days after its discontinuation, they received 131 I. Patients in group 2 (n = 15) were given a placebo instead of MMI. The therapeutic activity of 131 I was constant (800 MBq) and was repeated every 6 months. Treatment was discontinued when TVR reached <40 ml. Results In group 1, RAIU increased approximately twofold. Ten patients from group 2 and four patients from group 1 received further doses of 131 I. The median of time until TVR decreased below 40 ml was 9 months [6-12 months] and 18 months [14-22 months] in group 2. At 2 years after the 131 I therapy, the occurrence of hypothyroidism did not differ significantly (36% in group 1 and 33% in group2, p = 0.074). Conclusions Radioiodine treatment of NMG preceded with appropriate application of MMI is efficient thanks to increased RAIU, shorter period of treatment, and lower frequency of 131 I administration, without an increase in the incidence of posttreatment hypothyroidism.

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“…All patients received, on an ambulatory basis, a single activity of 131 I which was calculated according to the following formula, considering the 24-radioidodine uptake and thyroid size, as previously described [21]: µCi activity = R activity µCi × thyroid size (g) 24 h uptake (%). R activity (required activity) varied between 80 and 220 µCi (2.96–8.14 MBq)/g according to thyroid size.…”

Section: Methodsmentioning

confidence: 99%

Metabolic Changes after Radioiodine Correction of Grade 1 and Grade 2 Subclinical Hyperthyroidism

et al. 2021

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Objective: Endogenous subclinical hyperthyroidism (eSCH) is defined by subnormal serum thyroid-stimulating hormone (TSH) level. There is limited evidence of metabolic changes induced by eSCH. The aim of our work was to evaluate changes in BMI and lipid parameters after radioiodine treatment in patients with grade 1 (TSH: 0.1–0.39 mlU/L) and 2 (TSH <0.1 mlU/L) eSCH. Design: A retrospective study was performed on 74 patients with eSCH caused by benign autonomous nodular goiter which was treated with radioiodine. Methods: We assessed BMI, lipids parameters, and TSH after radioiodine therapy. The 12-month follow-up time point was used to compare the primary outcome variables. TSH was measured by the electrochemiluminescence method. Results: After radioiodine therapy, the absolute and relative increases in BMI at 12 months were significantly higher in the grade 2 group than in the grade 1 group (1.07 ± 0.27 kg/m2 vs. 0.26 ± 0.15 kg/m2, respectively; p = 0.023 and 4.01 ± 0.98% vs. 1.01 ± 0.56%, respectively; p = 0.026). Compared to baseline, significant increases in the levels of total cholesterol and LDL were observed after treatment in the grade 2 eSCH group (16.7 ± 4.5 mg/dL p < 0.01 and 14.3 ± 4.1 mg/dL p < 0.01, respectively) but not in the grade 1 group. In a multivariate model, a negative correlation was observed between pretreatment TSH levels and absolute BMI gain (p < 0.01). Conclusions: After correction of eSCH, increases in BMI and LDL levels were observed only in patients with grade 2 eSCH. Pretreatment serum TSH was the main independent factor associated with BMI changes after radioiodine treatment.

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Thiamazole Pretreatment Lowers the¹³¹I Activity Needed to Cure Hyperthyroidism in Patients With Nodular Goiter

Cited by 17 publications

References 32 publications

The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders, Part 1: Hyperthyroidism

The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders, Part 1: Hyperthyroidism

Enhancing the efficacy of 131I therapy in non-toxic multinodular goitre with appropriate use of methimazole: an analysis of randomized controlled study

Metabolic Changes after Radioiodine Correction of Grade 1 and Grade 2 Subclinical Hyperthyroidism

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