Radioiodine Therapy of Graves' Disease and the Uptake Paradox

Overview

Journal Indian J Nucl Med

Specialty Nuclear Medicine

Date 2020 Jan 18

PMID 31949364

Citations 1

Authors

Sumeet Suresh Malapure

Anirban Mukherjee

Chandrasekar Bal

Affiliations

Soon will be listed here.

Abstract

Purpose Of The Study: Radioiodine (I) therapy is approved and well-accepted modality for the treatment of hyperthyroidism. The dosage of I for successful treatment is based on many factors; however, an objective tool to determine the dose was missing. In a retrospective study, we found that high I uptake values required more dose to achieve desirable results contrary to the belief.

Materials And Methods: Clinically and scintigraphically proven Graves' disease patients with high I uptake (>50%) were accrued for this study and block randomized into low-dose (Group I) and high-dose (Group II) groups. Low activity (5 mCi) was administered in Group I and higher activity (10 mCi) in Group II. The patients were followed up after 3 months with thyroid function tests to determine the outcome.

Results: A total of 344 patients were analyzed at the end of 3 months, with 174 in low-dose group and 170 in high-dose group. Euthyroidism/hypothyroidism was achieved in significantly higher number of patients as compared to the low-dose group.

Conclusion: The higher dose of I is required to achieve euthyroidism/hypothyroidism in patients with high I uptake.

Citing Articles

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

Wang Y, Hong L, Yang C, Lv G, Wang K, Huang X Endocr Connect. 2023; 13(2).

PMID: 38108761 PMC: 10831585. DOI: 10.1530/EC-23-0429.

References

Kalinyak J, McDougall I . How should the dose of iodine-131 be determined in the treatment of Graves' hyperthyroidism?. J Clin Endocrinol Metab. 2003; 88(3):975-7. DOI: 10.1210/jc.2002-021801. View

Kristoffersen U, Hesse B, Rasmussen A, Kjaer A . Radioiodine therapy in hyperthyroid disease: poorer outcome in patients with high 24 hours radioiodine uptake. Clin Physiol Funct Imaging. 2006; 26(3):167-70. DOI: 10.1111/j.1475-097X.2006.00666.x. View

Damle N, Bal C, Kumar P, Reddy R, Virkar D . The predictive role of 24h RAIU with respect to the outcome of low fixed dose radioiodine therapy in patients with diffuse toxic goiter. Hormones (Athens). 2013; 11(4):451-7. DOI: 10.14310/horm.2002.1377. View

Catargi B, Leprat F, Guyot M, Valli N, Ducassou D, Tabarin A . Optimized radioiodine therapy of Graves' disease: analysis of the delivered dose and of other possible factors affecting outcome. Eur J Endocrinol. 1999; 141(2):117-21. DOI: 10.1530/eje.0.1410117. View

Abraham R, Srinivasa Murugan V, Pukazhvanthen P, Sen S . Thyroid disorders in women of Puducherry. Indian J Clin Biochem. 2012; 24(1):52-9. PMC: 3453473. DOI: 10.1007/s12291-009-0009-y. View

Moka D, Dietlein M, Schicha H . Radioiodine therapy and thyrostatic drugs and iodine. Eur J Nucl Med Mol Imaging. 2002; 29 Suppl 2:S486-91. DOI: 10.1007/s00259-002-0868-4. View

Menon V, Sundaram K, Unnikrishnan A, Jayakumar R, Nair V, Kumar H . High prevalence of undetected thyroid disorders in an iodine sufficient adult south Indian population. J Indian Med Assoc. 2009; 107(2):72-7. View

Ross D, Burch H, Cooper D, Greenlee M, Laurberg P, Maia A . 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016; 26(10):1343-1421. DOI: 10.1089/thy.2016.0229. View

Korber C, Schneider P, Korber-Hafner N, Hanscheid H, Reiners C . Antithyroid drugs as a factor influencing the outcome of radioiodine therapy in Graves' disease and toxic nodular goitre?. Eur J Nucl Med. 2001; 28(9):1360-4. DOI: 10.1007/s002590100565. View

10.

Sabri O, Zimny M, Schreckenberger M, Reinartz P, OSTWALD E, Buell U . Radioiodine therapy in Graves' disease patients with large diffuse goiters treated with or without carbimazole at the time of radioiodine therapy. Thyroid. 2000; 9(12):1181-8. DOI: 10.1089/thy.1999.9.1181. View

11.

Walter M, Christ-Crain M, Eckard B, Schindler C, Nitzsche E, Muller-Brand J . Radioiodine therapy in hyperthyroidism: inverse correlation of pretherapeutic iodine uptake level and post-therapeutic outcome. Eur J Clin Invest. 2004; 34(5):365-70. DOI: 10.1111/j.1365-2362.2004.01349.x. View

12.

Haase A, Bahre M, Lauer I, Meller B, Richter E . Radioiodine therapy in Graves' hyperthyroidism: determination of individual optimum target dose. Exp Clin Endocrinol Diabetes. 2000; 108(2):133-7. DOI: 10.1055/s-2000-5807. View

13.

Orsini F, Traino A, Grosso M, Guidoccio F, Boni G, Volterrani D . Personalization of radioiodine treatment for Graves' disease: a prospective, randomized study with a novel method for calculating the optimal 131I-iodide activity based on target reduction of thyroid mass. Q J Nucl Med Mol Imaging. 2013; 56(6):496-502. View

14.

Andrade V, Gross J, Maia A . The effect of methimazole pretreatment on the efficacy of radioactive iodine therapy in Graves' hyperthyroidism: one-year follow-up of a prospective, randomized study. J Clin Endocrinol Metab. 2001; 86(8):3488-93. DOI: 10.1210/jcem.86.8.7707. View

15.

Golden S, Robinson K, Saldanha I, Anton B, Ladenson P . Clinical review: Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab. 2009; 94(6):1853-78. PMC: 5393375. DOI: 10.1210/jc.2008-2291. View

16.

Chiovato L, Fiore E, Vitti P, Rocchi R, Rago T, Dokic D . Outcome of thyroid function in Graves' patients treated with radioiodine: role of thyroid-stimulating and thyrotropin-blocking antibodies and of radioiodine-induced thyroid damage. J Clin Endocrinol Metab. 1998; 83(1):40-6. DOI: 10.1210/jcem.83.1.4492. View

17.

Tunbridge W, Evered D, Hall R, Appleton D, Brewis M, Clark F . The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf). 1977; 7(6):481-93. DOI: 10.1111/j.1365-2265.1977.tb01340.x. View

18.

Shapiro B . Optimization of radioiodine therapy of thyrotoxicosis: what have we learned after 50 years?. J Nucl Med. 1993; 34(10):1638-41. View

19.

Peters H, Fischer C, Bogner U, Reiners C, Schleusener H . Radioiodine therapy of Graves' hyperthyroidism: standard vs. calculated 131iodine activity. Results from a prospective, randomized, multicentre study. Eur J Clin Invest. 1995; 25(3):186-93. DOI: 10.1111/j.1365-2362.1995.tb01547.x. View

20.

Gomez-Arnaiz N, ANDIA E, Guma A, Abos R, Soler J, Gomez J . Ultrasonographic thyroid volume as a reliable prognostic index of radioiodine-131 treatment outcome in Graves' disease hyperthyroidism. Horm Metab Res. 2003; 35(8):492-7. DOI: 10.1055/s-2003-41807. View