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Campennì A, Avram AM, Verburg FA, Iakovou I, Hänscheid H, de Keizer B, Petranović Ovčariček P, Giovanella L. The EANM guideline on radioiodine therapy of benign thyroid disease. Eur J Nucl Med Mol Imaging 2023; 50:3324-3348. [PMID: 37395802 PMCID: PMC10542302 DOI: 10.1007/s00259-023-06274-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023]
Abstract
This document provides the new EANM guideline on radioiodine therapy of benign thyroid disease. Its aim is to guide nuclear medicine physicians, endocrinologists, and practitioners in the selection of patients for radioiodine therapy. Its recommendations on patients' preparation, empiric and dosimetric therapeutic approaches, applied radioiodine activity, radiation protection requirements, and patients follow-up after administration of radioiodine therapy are extensively discussed.
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Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, Messina, Italy
| | - Anca M Avram
- Departments of Radiology and Medicine, MetroHealth Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Frederik A Verburg
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Ioannis Iakovou
- Academic Department of Nuclear Medicine, University Hospital AHEPA, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Academic Department of Nuclear Medicine, General Hospital Papageorgiou, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Heribert Hänscheid
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Luca Giovanella
- Clinic for Nuclear Medicine, Ente Ospedaliero Cantonale, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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Perros P, Basu A, Boelaert K, Dayan C, Vaidya B, Williams GR, Lazarus JH, Hickey J, Drake WM, Crown A, Orme SM, Johnson A, Ray DW, Leese GP, Jones TH, Abraham P, Grossman A, Rees A, Razvi S, Gibb FW, Moran C, Madathil A, Žarković MP, Plummer Z, Jarvis S, Falinska A, Velusamy A, Sanderson V, Pariani N, Atkin SL, Syed AA, Sathyapalan T, Nag S, Gilbert J, Gleeson H, Levy MJ, Johnston C, Sturrock N, Bennett S, Mishra B, Malik I, Karavitaki N. Postradioiodine Graves' management: The PRAGMA study. Clin Endocrinol (Oxf) 2022; 97:664-675. [PMID: 35274331 DOI: 10.1111/cen.14719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Thyroid status in the months following radioiodine (RI) treatment for Graves' disease can be unstable. Our objective was to quantify frequency of abnormal thyroid function post-RI and compare effectiveness of common management strategies. DESIGN Retrospective, multicentre and observational study. PATIENTS Adult patients with Graves' disease treated with RI with 12 months' follow-up. MEASUREMENTS Euthyroidism was defined as both serum thyrotropin (thyroid-stimulating hormone [TSH]) and free thyroxine (FT4) within their reference ranges or, when only one was available, it was within its reference range; hypothyroidism as TSH ≥ 10 mU/L, or subnormal FT4 regardless of TSH; hyperthyroidism as TSH below and FT4 above their reference ranges; dysthyroidism as the sum of hypo- and hyperthyroidism; subclinical hypothyroidism as normal FT4 and TSH between the upper limit of normal and <10 mU/L; and subclinical hyperthyroidism as low TSH and normal FT4. RESULTS Of 812 patients studied post-RI, hypothyroidism occurred in 80.7% and hyperthyroidism in 48.6% of patients. Three principal post-RI management strategies were employed: (a) antithyroid drugs alone, (b) levothyroxine alone, and (c) combination of the two. Differences among these were small. Adherence to national guidelines regarding monitoring thyroid function in the first 6 months was low (21.4%-28.7%). No negative outcomes (new-onset/exacerbation of Graves' orbitopathy, weight gain, and cardiovascular events) were associated with dysthyroidism. There were significant differences in demographics, clinical practice, and thyroid status postradioiodine between centres. CONCLUSIONS Dysthyroidism in the 12 months post-RI was common. Differences between post-RI strategies were small, suggesting these interventions alone are unlikely to address the high frequency of dysthyroidism.
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Affiliation(s)
- Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ansu Basu
- Department of Endocrinology and Diabetes, Sandwell and West Birmingham Hospitals, Birmingham, UK
| | - Kristien Boelaert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Colin Dayan
- Thyroid Research Group, Institute of Molecular Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Graham R Williams
- Molecular Endocrinology Laboratory, Imperial College London, London, UK
| | - John H Lazarus
- Thyroid Research Group, Institute of Molecular Medicine, Cardiff University School of Medicine, Cardiff, UK
| | | | - William M Drake
- Department of Endocrinology, St Bartholomews Hospital, London, UK
| | - Anna Crown
- Department of Endocrinology, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Stephen M Orme
- Department of Endocrinology, St. James's University Hospital, Leeds, UK
| | - Andrew Johnson
- Department of Endocrinology and Diabetes, North Bristol NHS Trust, Bristol, UK
| | - David W Ray
- Manchester Centre for Endocrinology and Diabetes, Institute of Human Development, The University of Manchester, Manchester, UK
| | - Graham P Leese
- Department of Endocrinology and Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Thomas Hugh Jones
- Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Prakash Abraham
- Department of Diabetes and Endocrinology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ashley Grossman
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Aled Rees
- School of Medicine, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Salman Razvi
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology and Diabetes, Edinburgh, UK
| | - Carla Moran
- Addenbrooke's Hospital, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge Metabolic Research Laboratories, Cambridge, UK
| | - Asgar Madathil
- Department of Endocrinology and Metabolic Medicine, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Miloš P Žarković
- Serbia Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Sheba Jarvis
- Molecular Endocrinology Laboratory, Imperial College London, London, UK
| | | | - Anand Velusamy
- Department of Endocrinology, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Violet Sanderson
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Nadia Pariani
- Addenbrooke's Hospital, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge Metabolic Research Laboratories, Cambridge, UK
| | - Stephen L Atkin
- Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK
| | - Akheel A Syed
- Department of Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Sath Nag
- Department of Endocrinology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Jackie Gilbert
- Department of Endocrinology, King's College Hospital, London, UK
| | - Helena Gleeson
- Department of Endocrinology, University Hospitals of Leicester, Leicester, UK
| | - Miles J Levy
- Department of Endocrinology, University Hospitals of Leicester, Leicester, UK
| | - Colin Johnston
- Department of Endocrinology and Diabetes, West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK
| | - Nigel Sturrock
- Department of Endocrinology and Metabolic Medicine, Nottingham City Hospitals NHS Trust, Nottingham, UK
| | - Stuart Bennett
- Department of Endocrinology and Metabolic Medicine, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Biswa Mishra
- Department of Endocrinology and Metabolic Medicine, Pennine Acute Hospitals NHS Trust, Royal Oldham Hospital, Oldham, UK
| | - Isha Malik
- Department of Endocrinology and Metabolic Medicine, Pennine Acute Hospitals NHS Trust, Royal Oldham Hospital, Oldham, UK
| | - Niki Karavitaki
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
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Fang Y, Du WH, Zhang CX, Zhao SX, Song HD, Gao GQ, Dong M. The effect of radioiodine treatment on the characteristics of TRAb in Graves' disease. BMC Endocr Disord 2021; 21:238. [PMID: 34847904 PMCID: PMC8630916 DOI: 10.1186/s12902-021-00905-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Graves' disease (GD) is one of the most common autoimmune thyroid diseases (AITDs) in humans, and thyrotropin receptor antibody (TRAb) is a characterized autoantibody in GD. The use of radioactive iodine therapy (RAI) for GD treatment is increasing. OBJECTIVES We studied the biological properties of TRAb and evaluated the effect of RAI therapy on TRAb in GD patients. METHODS In total, 225 patients (22 onset GD patients without 131I therapy, 203 GD patients treated with 131I therapy) and 20 healthy individuals as normal controls were included in this study. Clinical assessments were performed, and we examined in vitro the biological properties of TRAb in the 22 onset GD patients and 20 controls as well as 84 GD patients with 131I therapy. RESULTS Serum TRAb and thyroid peroxidase antibody (TPOAb) levels increased in the initial year of RAI treatment, and both antibodies decreased gradually after one year. After 5 years from radioiodine treatment, TRAb and TPOAb levels decreased in 88% and 65% of GD patients, respectively. The proportion of patients positive for thyroid-stimulatory antibody (TSAb) was significantly higher in the 7-12-month group, and thyroid-blocking antibody (TBAb) levels were elevated after one year in half of the patients who received 131I treatment. CONCLUSIONS Treatment of GD patients with radioiodine increased TPOAb and TRAb (their main biological properties were TSAbs) within the first year after therapy, and the main biological properties of elevated TRAb were TBAbs after 1 year.
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Affiliation(s)
- Ya Fang
- Department of Molecular Diagnostics & Endocrinology, The Core Laboratory in Medical Center of Clinical Research, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China
| | - Wen-Hua Du
- Department of Endocrinology, Linyi People's Hospital, Linyi, China
| | - Cao-Xu Zhang
- Department of Molecular Diagnostics & Endocrinology, The Core Laboratory in Medical Center of Clinical Research, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China
| | - Shuang-Xia Zhao
- Department of Molecular Diagnostics & Endocrinology, The Core Laboratory in Medical Center of Clinical Research, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China
| | - Huai-Dong Song
- Department of Molecular Diagnostics & Endocrinology, The Core Laboratory in Medical Center of Clinical Research, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China.
| | - Guan-Qi Gao
- Department of Endocrinology, Linyi People's Hospital, Linyi, China.
| | - Mei Dong
- Department of Molecular Diagnostics & Endocrinology, The Core Laboratory in Medical Center of Clinical Research, Shanghai Ninth People's Hospital, State Key Laboratory of Medical Genomics, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China.
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Azizi F, Abdi H, Cheraghi L, Amouzegar A. Treatment of Subclinical Hyperthyroidism in the Elderly: Comparison of Radioiodine and Long-Term Methimazole Treatment. Thyroid 2021; 31:545-551. [PMID: 32811342 DOI: 10.1089/thy.2020.0433] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: This study aimed to compare the effectiveness and safety of radioiodine (RAI) and long-term methimazole (MMI) in the treatment of subclinical hyperthyroidism (SH) in the elderly. Methods: From 306 patients, aged ≥65 years, with SH, 83 patients with thyrotropin <0.1 mU/L entered the study. In this randomized parallel-group trial, 41 and 42 patients were randomized to either RAI or long-term MMI treatment, respectively. Results: In the RAI and MMI groups, 3 and 4 patients were excluded due to side effects, choosing other modes of treatment, and not returning for follow-up; 35 and 36 patients completed 60 months of follow-up, respectively. In the RAI group, 23 (66%) became hypothyroid, and 12 (34%) remained euthyroid 60 months after a fixed dose of 15 mCi RAI. In the MMI group, the starting dose was 10 mg daily and decreased to 4.9 ± 1.0, 4.3 ± 1.0, 4.4 ± 1.4, 4.3 ± 1.8, and 3.7 ± 1.3 mg after 1, 2, 3, 4, and 5 years of continuous MMI treatment, employing titration method. By the end of study, 34 (94%) patients were euthyroid and 2 patients with diffuse goiter developed spontaneous hypothyroidism with MMI treatment. Minor adverse events occurred in both groups in the first four months of treatment. No death or serious side effects were observed during 60 months of follow-up. Conclusions: Both RAI and long-term low-dose MMI therapies are effective and safe for treatment of SH in the elderly.
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Affiliation(s)
- Fereidoun Azizi
- Endocrine Research Center; Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hengameh Abdi
- Endocrine Research Center; Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Cheraghi
- Department of Epidemiology and Biostatistics; Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center; Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Predictive factors for the outcomes of Graves' disease patients with radioactive iodine (131I) treatment. Biosci Rep 2020; 40:221501. [PMID: 31840740 PMCID: PMC6944668 DOI: 10.1042/bsr20191609] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 12/05/2022] Open
Abstract
Although radioactive iodine (131I) treatment (RIT) is recommended as the preferred option for patients with Graves’ disease (GD), the predictive factors for its clinical outcomes are still unclear. In the present study, we aim to investigate the factors influencing the success rate of RIT treatment on primary GD with a calculated dose approach. The thyroid function (hyperthyroidism, euthyroidism or hypothyroidism) was evaluated at least 1 year after RIT, and its relationship with presenting clinical characteristics and pre-RIT parameters was analyzed in 45 patients retrospectively. After RIT, the remission rate was 62.2%, including 13 euthyroidism cases (28.9%) and 15 hypothyroidism cases (33.3%). We found no significant association between the types of thyroid function and age, gender, the 3-h radioactive iodine uptake (RAIU) prior to RIT, or radioactive iodine (131I) dosage. However, a variable 24-h RAIU > 46.31% was found associated with the success rate of RIT. The present study implied that a calculated dose approach for GD is effective, but high failure rates are expected in patients presenting poor 24-h RAIU, particularly those with 24-h RAIU below 46.31%.
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Thou S, Vinjamuri S. The relationship between thyroid eye disease and radioiodine treatment. Nucl Med Commun 2019; 40:194-198. [DOI: 10.1097/mnm.0000000000000965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhou J, Cheng G, Pang H, Liu Q, Liu Y. The effect of 131I-induced hypothyroidism on the levels of nitric oxide (NO), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), total nitric oxide synthase (NOS) activity, and expression of NOS isoforms in rats. Bosn J Basic Med Sci 2018; 18:305-312. [PMID: 29579409 DOI: 10.17305/bjbms.2018.2350] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/26/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022] Open
Abstract
Accumulating evidence has shown that hypothyroidism affects the cardiovascular system, significantly increasing the incidence of cardiovascular diseases. In the present study we investigated the effect of radioactive iodine (I-131)-induced hypothyroidism on several parameters of vascular function, such as nitric oxide (NO), total nitric oxide synthase (NOS) activity and expression of NOS isoforms, as well as on interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) as indicators of inflammation, in rats. A dose of 150 µCi of 131-I was determined as optimal for establishing the model of hypothyroidism in rats. After administration of 131-I, at the end of month 1, 2, and 4 (n = 3 for each time point), NO, IL-6, and TNF-α in the serum and total NOS activity in the aorta were determined in 150 µCi group, compared to controls. The mRNA and protein expression of endothelial, neuronal, and inducible NOS (eNOS, nNOS, and iNOS) in the rat aorta was also estimated, using quantitative reverse transcription polymerase chain reaction and Western blot, respectively. The levels of IL-6 and TNF-α increased in 150 µCi group; the results were significant at the end of month 2 and 4 for IL-6, and at all time points for TNF-α. The levels of NO decreased significantly at the end of month 2 and 4 in 150 µCi group. The total NOS activity increased significantly in 150 µCi group, at all three time points. Significant changes in the mRNA and protein expression of all three NOS isoforms were observed in 150 µCi group compared to controls. NO, IL-6, TNF-α levels and NOS activity and expression are altered in hypothyroid state, and the underlying mechanism should be further investigated.
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Affiliation(s)
- Jing Zhou
- Department of Nuclear Medicine, The Fuling Central Hospital of Chongqing, Chongqing, China.
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Dong Q, Liu X, Wang F, Xu Y, Liang C, Du W, Gao G. DYNAMIC CHANGES OF TRAb AND TPOAb AFTER RADIOIODINE THERAPY IN GRAVES' DISEASE. ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:72-76. [PMID: 31149151 DOI: 10.4183/aeb.2017.72] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Context To analyze the dynamic changes of serum thyrotrophin receptor antibody (TRAb) and thyroid peroxidase antibody (TPOAb) in Graves' disease (GD) patients before and after radioactive iodine (RAI) treatment and to investigate if TRAb and TPOAb play a role in the occurrence of early hypothyroidism after 131I therapy for Graves' hyperthyroidism. Subjects and Methods A total of 240 patients newly diagnosed with GD were selected to study. A clinical and laboratory assessment was performed before and at 3, 6, and 12 months after 131I therapy. Chemiluminescent immunoassays were used to detect serum free triiodothyronine (FT3), free thyroxine (FT4), sensitive thyroid-stimulating hormone (TSH) and TPOAb concentration. Radio-receptor assay was used to measure serum TRAb concentration. According to the early onset of hypothyroidism in a year after RAI therapy, patients were divided into early hypothyroidism group (group A) and non-early hypothyroidism group (group B). Results In both groups, serum TRAb and TPOAb increased at 3 months, reached the highest level at 6 months and returned to the baseline at 12 months after RAI therapy. TRAb showed a significant difference between the two groups at 6 months (P<0.01). Serum TPOAb in group A was higher than that in group B before and at 3, 6, 12 months after RAI therapy (P<0.05). Conclusions Serum TRAb and TPOAb are closely related to the occurrence of the early hypothyroidism, and play an important role in judging prognosis after 131I treatment in Graves' disease.
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Affiliation(s)
- Q Dong
- Department of Endocrinology, People's Hospital of Linyi City, Shandong, China
| | - X Liu
- Department of Endocrinology, People's Hospital of Linyi City, Shandong, China
| | - F Wang
- Department of Endocrinology, People's Hospital of Linyi City, Shandong, China
| | - Y Xu
- Department of Endocrinology, People's Hospital of Linyi City, Shandong, China
| | - C Liang
- Department of Endocrinology, People's Hospital of Linyi City, Shandong, China
| | - W Du
- Department of Endocrinology, People's Hospital of Linyi City, Shandong, China
| | - G Gao
- Department of Endocrinology, People's Hospital of Linyi City, Shandong, China
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Sheehan MT, Doi SAR. Transient Hypothyroidism after Radioiodine for Graves' Disease: Challenges in Interpreting Thyroid Function Tests. Clin Med Res 2016; 14:40-5. [PMID: 26864507 PMCID: PMC4851449 DOI: 10.3121/cmr.2015.1297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/28/2015] [Indexed: 01/20/2023]
Abstract
Graves' disease is the most common cause of hyperthyroidism and is often managed with radioactive iodine (RAI) therapy. With current dosing schemes, the vast majority of patients develop permanent post-RAI hypothyroidism and are placed on life-long levothyroxine therapy. This hypothyroidism typically occurs within the first 3 to 6 months after RAI therapy is administered. Indeed, patients are typically told to expect life-long thyroid hormone replacement therapy to be required within this timeframe and many providers expect this post-RAI hypothyroidism to be complete and permanent. There is, however, a small subset of patients in whom a transient post-RAI hypothyroidism develops which, initially, presents exactly as the typical permanent hypothyroidism. In some cases the transient hypothyroidism leads to a period of euthyroidism of variable duration eventually progressing to permanent hypothyroidism. In others, persistent hyperthyroidism requires a second dose of RAI. Failure to appreciate and recognize the possibility of transient post-RAI hypothyroidism can delay optimal and appropriate treatment of the patient. We herein describe five cases of transient post-RAI hypothyroidism which highlight this unusual sequence of events. Increased awareness of this possible outcome after RAI for Graves' disease will help in the timely management of patients.
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Affiliation(s)
| | - Suhail A R Doi
- Research School of Population Health, Australian National University, Acton, Canberra, Australia
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Garcia J, França LD, Ellinger V, Wolff M. Marrow hypoplasia: a rare complication of untreated Grave's disease. ACTA ACUST UNITED AC 2015; 58:953-7. [PMID: 25627052 DOI: 10.1590/0004-2730000003216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/07/2014] [Indexed: 11/22/2022]
Abstract
Atypical presentation forms of hyperthyroidism are always a challenge to the clinician. We present a female patient with the typical symptoms of thyrotoxicosis, without any thionamides treatment before, associated with pancytopenia, which recovered after euthyroidism state was achieved. Although the major cases of pancytopenia in Grave's disease are seen as a complication of antithyroid drugs (thioamides), in this case report the alteration in blood tests was associated with untreated hyperthyroidism. In the literature review, we found 19 case reports between 1981 to 2012, but it has been related to a hypercellular bone marrow with periferic destruction. Our case, however, is about a hypocellular bone marrow without fibrosis or fat tissue replacement, which proceeded with a periferic improvement following thyroid treatment. Although rare, pancytopenia, when present, may develop as an unusual and severe manifestation in untreated subjects.
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Affiliation(s)
- Juliana Garcia
- Institute of Diabetes and Endocrinology Luiz Capriglione, Rio de Janeiro, RJ, Brazil
| | - Larissa de França
- Institute of Diabetes and Endocrinology Luiz Capriglione, Rio de Janeiro, RJ, Brazil
| | - Vivian Ellinger
- Institute of Diabetes and Endocrinology Luiz Capriglione, Rio de Janeiro, RJ, Brazil
| | - Mônica Wolff
- Institute of Diabetes and Endocrinology Luiz Capriglione, Rio de Janeiro, RJ, Brazil
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Jacob JJ, Stephen C, Paul TV, Thomas N, Oommen R, Seshadri MS. No impact of dietary iodine restriction in short term development of hypothyroidism following fixed dose radioactive iodine therapy for Graves' disease. Indian J Endocrinol Metab 2015; 19:60-65. [PMID: 25593828 PMCID: PMC4287782 DOI: 10.4103/2230-8210.131769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The increased incidence of autoimmune thyroid disease with increasing dietary iodine intake has been demonstrated both epidemiologically and experimentally. The hypothyroidism that occurs in the first year following radioactive iodine therapy is probably related to the destructive effects of the radiation and underlying ongoing autoimmunity. OBJECTIVE To study the outcomes at the end of six months after fixed dose I, (131)therapy for Graves' disease followed by an iodine restricted diet for a period of six months. MATERIALS AND METHODS Consecutive adult patients with Graves' disease planned for I(131) therapy were randomized either to receive instructions regarding dietary iodine restriction or no advice prior to fixed dose (5mCi) I(131) administration. Thyroid functions and urinary iodine indices were evaluated at 3(rd) and 6(th) month subsequently. RESULTS Forty seven patients (13M and 34F) were assessed, 2 were excluded, 45 were randomized (Cases 24 and Controls 21) and 39 patients completed the study. Baseline data was comparable. Median urinary iodine concentration was 115 and 273 μg/gm creat (p = 0.00) among cases and controls respectively. Outcomes at the 3(rd) month were as follows (cases and controls); Euthyroid (10 and 6: P = 0.24), Hypothyroid (3 and 5: P = 0.38) and Hyperthyroid (7 and 8: P = 0.64). Outcomes at the end of six months were as follows (cases and controls); Euthyroid (10 and 5: P = 0.12), Hypothyroid (3 and 5: P = 0.38) and Hyperthyroid (7 and 9: P = 0.43). Of the hypothyroid patients 5 (cases 1 and controls 4: P = 0.13) required thyroxine replacement. CONCLUSIONS There was no statistical significant difference in the outcome of patients with dietary iodine restriction following I(131) therapy for Graves' disease.
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Affiliation(s)
- Jubbin Jagan Jacob
- Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Charles Stephen
- Department of Biochemistry, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Thomas V. Paul
- Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Regi Oommen
- Department of Nuclear Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Mandalam S. Seshadri
- Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Lee JH, Na HJ, Park JW, Lee CH, Han HJ, Kim TH, Kim SH. Delayed presentation of aggravation of thyrotoxicosis after radioactive iodine therapy at Graves disease. Yeungnam Univ J Med 2014. [DOI: 10.12701/yujm.2014.31.2.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ji-Hyun Lee
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Hyun-Jin Na
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Jin-Woo Park
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Cheol-Ho Lee
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Hyun-Jeong Han
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Tae-Ho Kim
- Department of Internal Medicine, Catholic Kwandong University College of Medicine, Gangneung, Korea
| | - Se-Hwa Kim
- Department of Internal Medicine, Catholic Kwandong University College of Medicine, Gangneung, Korea
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Gibb FW, Zammitt NN, Beckett GJ, Strachan MWJ. Predictors of treatment failure, incipient hypothyroidism, and weight gain following radioiodine therapy for Graves' thyrotoxicosis. J Endocrinol Invest 2013; 36:764-9. [PMID: 23633646 DOI: 10.3275/8949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Following radioiodine ((131)I) therapy, both late recognition of hypothyroidism and treatment failure may result in adverse outcomes. AIM We sought to assess indicators of both incipient hypothyroidism and treatment failure following (131)I and determine factors predictive of weight gain. SUBJECTS AND METHODS Retrospective study of 288 patients receiving (131)I for treatment of Graves' thyrotoxicosis. Primary outcome measures were thyroid status and weight change at 1 yr following (131)I. RESULTS The treatment failure rate at 1 yr was 13.5%. Hypothyroidism developed in 80.9%, with 58.5% of patients having levels of free T4 (fT4) <6 pmol/l at diagnosis. Patients receiving thionamides before and after (131)I had significantly higher levels of treatment failure (23.3%) than those with no thionamide exposure (6.3%, p=0.003), but also had more active Graves' disease. Following (131)I, development of a detectable TSH or low-normal fT4 levels was not associated with recurrent thyrotoxicosis. Median weight gain was 5.3 kg, although patients with nadir fT4 levels <6 pmol/l gained an average 2 kg more than those with levels >6 pmol/l (p=0.05). The main predictor of weight gain was fT4 level immediately prior to treatment; those in the lowest tertile gained a median 3.1 kg whilst those in the highest tertile gained 7.4 kg (median difference 4.3 kg; 95% confidence interval: 2.5-6.2). CONCLUSIONS Marked hypothyroidism following (131)I is common and often occurs early. Simple biochemical parameters may help identify incipient hypothyroidism and potentially limit excess weight gain. Treatment failure is common in patients with severe thyrotoxicosis and in such cases larger doses of (131)I may be warranted.
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Affiliation(s)
- F W Gibb
- Edinburgh Centre for Endocrinology, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK.
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Bonnema SJ, Hegedüs L. Radioiodine therapy in benign thyroid diseases: effects, side effects, and factors affecting therapeutic outcome. Endocr Rev 2012; 33:920-80. [PMID: 22961916 DOI: 10.1210/er.2012-1030] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Radioiodine ((131)I) therapy of benign thyroid diseases was introduced 70 yr ago, and the patients treated since then are probably numbered in the millions. Fifty to 90% of hyperthyroid patients are cured within 1 yr after (131)I therapy. With longer follow-up, permanent hypothyroidism seems inevitable in Graves' disease, whereas this risk is much lower when treating toxic nodular goiter. The side effect causing most concern is the potential induction of ophthalmopathy in predisposed individuals. The response to (131)I therapy is to some extent related to the radiation dose. However, calculation of an exact thyroid dose is error-prone due to imprecise measurement of the (131)I biokinetics, and the importance of internal dosimetric factors, such as the thyroid follicle size, is probably underestimated. Besides these obstacles, several potential confounders interfere with the efficacy of (131)I therapy, and they may even interact mutually and counteract each other. Numerous studies have evaluated the effect of (131)I therapy, but results have been conflicting due to differences in design, sample size, patient selection, and dose calculation. It seems clear that no single factor reliably predicts the outcome from (131)I therapy. The individual radiosensitivity, still poorly defined and impossible to quantify, may be a major determinant of the outcome from (131)I therapy. Above all, the impact of (131)I therapy relies on the iodine-concentrating ability of the thyroid gland. The thyroid (131)I uptake (or retention) can be stimulated in several ways, including dietary iodine restriction and use of lithium. In particular, recombinant human thyrotropin has gained interest because this compound significantly amplifies the effect of (131)I therapy in patients with nontoxic nodular goiter.
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Affiliation(s)
- Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, DK-5000 Odense C, Denmark.
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Peacey SR, Kumar S, Wright D, King R. The follow-up of radioiodine-treated hyperthyroid patients: should thyroid function be monitored more frequently? J Endocrinol Invest 2012; 35:82-6. [PMID: 21720207 DOI: 10.3275/7807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a lack of data regarding the timing and particularly the severity of hypothyroidism post radioiodine (RI). AIM To investigate the timing and severity of hypothyroidism in RI-treated hyperthyroid patients. METHODS Retrospective examination of the records of 183 RI-treated hyperthyroid patients (79 autoimmune hyperthyroidism, 46 toxic multinodular goiter, and 58 hyperthyroidism of indeterminate etiology). RESULTS One hundred and fifty-nine patients requiring a single dose of RI (435 MBq), 107 (67%) developed hypothyroidism. Hypothyroidism detected in: 16% of patients at <8 weeks, 46% at 8 to <16 weeks, 24% at 16 to <24 weeks, 9% at 24 to <36 weeks, 3% at 36 to <52 weeks, and 2% at >52 weeks. One hundred and eighty-three patients had follow-up after one or more doses of RI and 124 (68%) patients developed hypothyroidism; of these, 44 (36%) had TSH>50 mU/l and 34 (27%) had free T4<5 pmol/l when hypothyroidism was first detected. Of those patients with a delayed outpatient visit (no.=77) and those with an outpatient visit within the recommended target interval (no.=47), median TSH was 23 (0.05-152) mU/l and 32 (0.05-150) mU/l, respectively (p=0.75) and median free T4 was 7.1 (1.3-16.7) pmol/l and 6.6 (1.3-15.4) pmol/l, respectively (p=0.21) at first detection of hypothyroidism. CONCLUSIONS The severity of hypothyroidism when first detected during follow-up is of concern and suggests that closer monitoring of thyroid function is required, particularly during the first 6 months post- RI therapy.
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Affiliation(s)
- S R Peacey
- Department of Diabetes and Endocrinology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
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Gupta SK, McGrath S, Rogers K, Attia J, Lewis G, Viswanathan S, Saul M, Allen L. Fixed dose (555 MBq; 15 mCi) radioiodine for the treatment of hyperthyroidism: outcome and its predictors. Intern Med J 2010; 40:854-7. [DOI: 10.1111/j.1445-5994.2010.02348.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Proust-Lemoine E, d'Herbomez M, Marchandise X, Wémeau JL. Precocious hypothyroidism mechanisms after radioiodine treatment in Graves' disease. Presse Med 2010; 40:e1-8. [PMID: 21036005 DOI: 10.1016/j.lpm.2010.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 05/06/2010] [Accepted: 06/14/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Hypothyroidism can occur after radioiodine treatment for Graves' disease. It may happen precociously and transiently in the first year after treatment. The purpose of this study was to understand the mechanisms responsible for precocious hypothyroidism. METHODS 36 patients treated for Graves disease by radiodiodine were prospectively studied; The following variables were included in the analysis: age, gender, attendance for Graves' orbitopathy (GO), delay before radioiodine treatment, number of recurrences, previous treatments, corticosteroid therapy, thyroid mass, and (131)I dose. The titres of free T4 (FT4), thyroid-stimulating hormone (TSH), anti-TSH receptor antibodies (TRAb), anti-thyroid peroxydase antibodies (TPOAb) and anti-thyroglobulin antibodies (TGAb) were monitored. Thyroid stimulating (TSAb) and blocking (TBAb) antibodies were determined and (123)I uptake was measured when hypothyroidism occurred. RESULTS 23 patients became precociously hypothyroid (group A) while 13 patients did not (group B). The initial TGAb titre was higher in group A (p=0.0024), and corticosteroid therapy was used more frequently to avoid aggravating GO in group B (p=0.0276). TPOAb and TGAb titres increased significantly only in group A (p=0.0112 and p=0.0202, respectively). When hypothyroidism occurred, TBAb was present in 13 patients. Transient hypothyroidism due to TBAb was observed in 1 patient. No iodide organification impairment was disclosed by the perchlorate test. CONCLUSION Radioinduced thyroiditis appears to be the main mechanism involved in the pathogenesis of precocious hypothyroidism. A higher TGAb titre before treatment is associated with precocious hypothyroidism, suggesting the prognostic value of TGAb. Transient hypothyroidism directly due to TBAb remains rare.
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Isolan-Cury RW, Monte O, Cury AN, Andrada e Silva MAD, Duprat A, Marone M, Almeida RD, Iglesias A. Efeitos agudos laringológicos e vocais da radioiodoterapia em pacientes com hipertireoidismo por doença de Basedow Graves. ACTA ACUST UNITED AC 2008. [DOI: 10.1590/s0034-72992008000200011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A Doença de Graves constitui a forma mais comum de hipertireoidismo e três abordagens terapêuticas são atualmente utilizadas: uso de medicamentos antitireoideanos, cirurgia e iodo radioativo (I 131). Os efeitos do o I 131 e a indução precoce de hipotireoidismo são conseqüências da destruição induzida do I131 sobre o parênquima tireoideano. São poucos relatos encontrados na literatura acerca dos efeitos da radioioterapia sobre a laringe e conseqüentemente na produção vocal. OBJETIVO: Avaliar os efeitos agudos sobre a voz da radioiodoterapia em pacientes com hipertireoidismo por Doença de Basedow Graves. MATERIAL E MÉTODO: Estudo de corte contemporâneo longitudinal, prospectivo. Procedimentos: Investigação vocal, mensuração do tempo máximo fonatório de /a/ e relação s/z, análise freqüência fundamental (Software Praat), laringoscopia e análise perceptivo-auditiva em três momentos: pré-dose, 4 dias e 20 dias pós dose. Momentos baseados no perfil inflamatório do tecido tireoideano. RESULTADOS: Não houve mudanças estatisticamente significantes nos aspectos vocais e laringológicos nos três momentos avaliados. CONCLUSÃO: A radioiodoterapia não afeta a qualidade vocal.
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Isolan-Cury RW, Monte O, Cury AN, Andrada E Silva MAD, Duprat A, Marone M, Almeida RD, Iglesias A. Acute effects of radioiodine therapy on the voice and larynx of basedow-graves patients. Braz J Otorhinolaryngol 2008; 74:224-9. [PMID: 18568200 PMCID: PMC9442091 DOI: 10.1016/s1808-8694(15)31092-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2006] [Accepted: 12/12/2007] [Indexed: 12/02/2022] Open
Abstract
Graves's disease is the most common cause of hyperthyroidism. There are three current therapeutic options: anti-thyroid medication, surgery, and radioactive iodine (I 131). There are few data in the literature regarding the effects of radioiodine therapy on the larynx and voice. The aim and the Aim os this study was: to assess the effect of radioiodine therapy on the voice of Basedow-Graves patients. Material and Method A prospective study was done. Following the diagnosis of Grave's disease, patients underwent investigation of their voice, measurement of maximum phonatory time (/a/) and the s/z ratio, fundamental frequency analysis (Praat software), laringoscopy and (perceptive-auditory) analysis in three different conditions: pre-treatment, 4 days, and 20 days post-radioiodine therapy. Conditions are based on the inflammatory pattern of thyroid tissue (Jones et al. 1999). Results No statistically significant differences were found in voice characteristics in these three conditions. Conclusion Radioiodine therapy does not affect voice quality.
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Abstract
Radioiodine has been in use for over 60 years as a treatment for hyperthyroidism. Major changes in clinical practice have occurred with the realization that accurate dosimetry is incapable of avoiding the risks of hypothyroidism, while more accurate assessment of the risks of other adverse effects of radioiodine such as ophthalmopathy and carcinogenesis have become available. More is also known of the potential for pretreatment with an antithyroid drug to affect the outcome of radioiodine treatment. However, we are still uncertain of the benefits of radioiodine treatment in subclinical hyperthyroidism. During the last two decades there has been wider acceptance of radioiodine as a safe and effective therapy for benign, nontoxic goitre, coupled with waning enthusiasm for the use of levothyroxine, as the risks and benefits of this option have become more apparent. The use of recombinant TSH offers the prospect that radioiodine treatment of nontoxic goitre can be simplified and improved, although more studies of this strategy are urgently required.
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Abós D, Ruiz P, Prats E, Razola P, García F, Tardín L, Banzo J. Tratamiento de la enfermedad de Graves-Basedow con 131I. Valoración de un protocolo de “actividades fijas moduladas”. ACTA ACUST UNITED AC 2007. [DOI: 10.1157/13097376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Guajardo-Salinas GE, Carvajal JA, Gaytan-Ramos ÁA, Arroyo L, López-Reyes AG, Islas JF, Cano BG, Arroyo-Currás N, Dávalos A, Madrid G, Moreno-Cuevas JE. Effects of bone marrow cell transplant on thyroid function in an I131-induced low T4 and elevated TSH rat model. J Negat Results Biomed 2007; 6:1. [PMID: 17233913 PMCID: PMC1784113 DOI: 10.1186/1477-5751-6-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Accepted: 01/18/2007] [Indexed: 11/10/2022] Open
Abstract
Background We developed a study using low dose radioactive iodine creating an animal model of transient elevation of thyroid stimulating hormone (TSH). Male derived bone marrow cells were transplanted to asses their effect on thyroid function and their capability to repair the thyroid parenchyma. Results At 40 an 80 days after I131 treatment, the study groups TSH and T4 serum values both increased and decreased significantly respectively compared to the negative control group. Eight weeks after cell transplantation, neither TSH nor T4 showed a significant difference in any group. The mean number of SRY gene copies found in group I (Left Intracardiac Transplant) was 523.3 and those in group II (Intrathyroid Transplant) were only 73. Group III (No Transplant) and IV had no copies. Group I presented a partial restore of the histological pattern of rat thyroid with approximately 20% – 30% of normal-sized follicles. Group II did not show any histological differences compared to group III (Positive control). Conclusion Both a significant increase of TSH and decrease of T4 can be induced as early as day 40 after a low dose of I131 in rats. Restore of normal thyroid function can be spontaneously achieved after using a low dose RAI in a rat model. The use of BM derived cells did not affect the re-establishment of thyroid function and might help restore the normal architecture after treatment with RAI.
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Affiliation(s)
- Gustavo E Guajardo-Salinas
- Cell Therapy Laboratory, ITESM School of Medicine, 3000 Ave. Morones Prieto, Monterrey, NL 64710, México
| | - Juan A Carvajal
- Cell Therapy Laboratory, ITESM School of Medicine, 3000 Ave. Morones Prieto, Monterrey, NL 64710, México
| | - Ángel A Gaytan-Ramos
- Cell Therapy Laboratory, ITESM School of Medicine, 3000 Ave. Morones Prieto, Monterrey, NL 64710, México
| | - Luis Arroyo
- Cell Therapy Laboratory, ITESM School of Medicine, 3000 Ave. Morones Prieto, Monterrey, NL 64710, México
| | - Alberto G López-Reyes
- Cell Therapy Laboratory, ITESM School of Medicine, 3000 Ave. Morones Prieto, Monterrey, NL 64710, México
| | - José F Islas
- Cell Therapy Laboratory, ITESM School of Medicine, 3000 Ave. Morones Prieto, Monterrey, NL 64710, México
| | - Beiman G Cano
- Cell Therapy Laboratory, ITESM School of Medicine, 3000 Ave. Morones Prieto, Monterrey, NL 64710, México
| | | | - Alfredo Dávalos
- Cell Therapy Laboratory, ITESM School of Medicine, 3000 Ave. Morones Prieto, Monterrey, NL 64710, México
| | - Gloria Madrid
- Cell Therapy Laboratory, ITESM School of Medicine, 3000 Ave. Morones Prieto, Monterrey, NL 64710, México
| | - Jorge E Moreno-Cuevas
- Cell Therapy Laboratory, ITESM School of Medicine, 3000 Ave. Morones Prieto, Monterrey, NL 64710, México
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Scharf JL, Ahmad SM, Gaughan JP, Soliman AMS. Thyroidectomy for Graves' Disease: A Case-Control Study. Ann Otol Rhinol Laryngol 2006; 115:902-7. [PMID: 17214264 DOI: 10.1177/000348940611501208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: The most common treatment for Graves' disease in the United States is radioactive iodine. Surgery is performed rarely. The surgery for Graves' disease is usually considered technically difficult. Our goal was to assess the differences in outcomes in patients with Graves' disease who underwent thyroidectomy and in patients without Graves' disease who underwent the same procedures. Methods: A retrospective chart review was performed of patients who underwent surgery for Graves' disease between 1997 and 2005. A control group of age-matched and thyroid size-matched patients who underwent thyroidectomy for a diagnosis other than Graves' disease was identified. The groups were statistically compared with respect to length of hospital stay, operative time, and estimated blood loss. Comparison with the published literature was also performed. Results: Eleven patients underwent thyroidectomy for a diagnosis of Graves' disease. The operative time, estimated blood loss, and length of hospitalization did not differ significantly from those of the control patients. Three of the 4 complications that occurred, however, were in the 3 patients with persistent hyperthyroidism despite medical therapy at the time of surgery. Conclusions: Thyroidectomy may be performed relatively safely for selected euthyroid patients with Graves' disease. In those with persistent hyperthyroidism at surgery, there were more complications.
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Affiliation(s)
- Joshua L Scharf
- Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA
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Abstract
Graves' disease is the most common form of hyperthyroidism in childhood. Current treatment options include antithyroid medications, surgery, and radioactive iodine. Medical therapy is generally associated with long-term remission rates of less than 25% and a small risk of serious adverse reactions that include hepatic failure and bone marrow suppression. Total thyroidectomy is associated with very high cure rates and a small risk of hypoparathyroidism and recurrent laryngeal nerve damage. When radioactive iodine is used at appropriate doses, there is a very high cure rate without increased risks of thyroid cancer or genetic damage. Clinicians caring for the child or adolescent with Graves' disease are thus faced with using medications with potential short-term and long-term toxicity, for a condition in which spontaneous remission occurs in the minority of pediatric patients. Definitive therapy in the form of surgery or radioactive iodine is necessary and unavoidable for the majority of pediatric patients with Graves' disease.
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Affiliation(s)
- Scott A Rivkees
- Yale Pediatric Thyroid Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520, USA.
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. MHB, . BL, . PRT, . ARKF, . RBJ. Treatment of 1035 Hyperthyroid Patients with 131Iodine. INT J PHARMACOL 2005. [DOI: 10.3923/ijp.2006.116.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Nakajo M, Tsuchimochi S, Tanabe H, Nakabeppu Y, Jinguji M. Three basic patterns of changes in serum thyroid hormone levels in Graves' disease during the one-year period after radioiodine therapy. Ann Nucl Med 2005; 19:297-308. [PMID: 16097639 DOI: 10.1007/bf02984622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED The purpose of this study was to clarify the characteristic patterns of the thyroid hormonal changes in Graves' disease during the one-year period after 131I therapy considering that few serial hormonal data during this period are available in the literature. METHODS The levels of serum T3, T4 and FT4 before and during one year were plotted as a function of time in 70 therapy courses of 58 patients without subsequent antithyroid or steroid therapy. RESULTS 35 euthyroid, 6 hypothyroid and 29 hyperthyroid states were obtained during one year after therapy. Although individual patients had individual hormonal changing patterns, 3 common basic patterns were observed from baseline to one month (early) and thereafter (late), respectively. The early patterns were a decrease in 54 (77%), a minimum change in 8 (11.5%) and an increase in 8 (11.5%). The late patterns were a stable state after an initial decrease with a bottom followed by an increase (valley pattern) in 47 (67%), a stable state after an initial increase with a peak followed by a decrease with a bottom and a subsequent re-increase (mountain pattern) in 12 (17%) and a late stable state after a gradual slow decrease without an obvious bottom near or till one year (downhill pattern) in 11 (16%). The bottom level and the degree of hormonal recovery from the bottom determined the stable euthyroid, hypothyroid or hyperthyroid state in 49 (86%) of 57 with the valley or mountain pattern. Most of the bottom levels (81%) and transient abnormal changes including transient hypothyroidism (93%, 13/14), peak or hyperthyroidism (85%, 11/13) and euthyroidism (67%, 10/15) appeared within 6 months. The post-therapeutic stable euthyroid, hypothyroid or hyperthyroid state could be judged from the hormonal patterns in 57% (39/68) from 2.5 to 6 months, in 18% (12/68) from 6 to 9 months and in 25% (17/68) thereafter. CONCLUSION Although the changes in thyroid hormones are not constant in Graves' disease during one year after 131I therapy, there are three basic patterns; valley, mountain and downhill patterns from one month after therapy. The post-therapeutic stable state can be judged by the hormonal level recovered from the bottom in most patients.
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Affiliation(s)
- Masayuki Nakajo
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
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Kita T, Yokoyama K, Kinuya S, Taki J, Michigishi T, Tonami N. Single dose planning for radioiodine-131 therapy of Graves’ disease. Ann Nucl Med 2004; 18:151-5. [PMID: 15195763 DOI: 10.1007/bf02985106] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with Graves' disease were studied one year after radioiodine-131 therapy to assess the relationship between the effectiveness of the therapy and the radioiodine doses used. METHODS Patients were classified into three groups according to thyroid function as hyperthyroidism, euthyroidism and hypothyroidism at one year after I-131 therapy. In these groups we compared the mean values of dose, dose per thyroid weight calculated with I-123 uptake before the therapy (pre D/W), dose per thyroid weight calculated with therapeutic I-131 uptake (post D/W), and absorbed dose. RESULTS No significant differences were found between the three groups in terms of dose or pre D/W. The mean values of post D/W and absorbed dose in the non-hyperthyroid (euthyroid and hypothyroid) group were significantly greater than those in the hyperthyroid group. Post D/W of 6.3 MBq/g was a threshold separating the non-hyperthyroid group from the hyperthyroid group. There was no correlation between pre D/W and post D/W; however, the mean post D/W was significantly greater than the mean pre D/W. All patients with pre D/W above 6.3 MBq/g showed non-hyperthyroidism at one year after the radioiodine treatment. CONCLUSIONS No indicators before the radioiodine therapy had significant relationships with the effectiveness of the therapy at one year after the treatment. However, the single therapy planned for setting the pre D/W above 6.3 MBq/g will certainly make the patients non-hyperthyroid. As this proposal of dose planning is based on a small number of patients, further study is needed.
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Affiliation(s)
- Tamotsu Kita
- Department of Biotracer Medicine, Kanazawa University Graduate School of Medical Sciences, Japan.
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Andrade VA, Gross JL, Maia AL. Iodo radioativo no manejo do hipertireoidismo da doença de Graves. ACTA ACUST UNITED AC 2004; 48:159-65. [PMID: 15611828 DOI: 10.1590/s0004-27302004000100017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
O hipertireoidismo da doença de Graves, a forma mais comum de hipertireoidismo, é diretamente causado por auto-anticorpos que ativam o receptor do TSH. A etiologia parece ser multifatorial, envolvendo fatores genéticos e não genéticos. As opções terapêuticas atualmente disponíveis são as drogas antitireoidianas (DAT), a cirurgia e o iodo radioativo (131I), sendo que nenhuma delas é considerada ideal, visto que não atuam diretamente na etiologia/patogênese da disfunção. O 131I tem sido cada vez mais utilizado como primeira escolha terapêutica por tratar-se de um tratamento definitivo, de fácil administração e seguro. A associação com DAT, fatores prognósticos de falência e o cálculo da dose administrada são alguns dos aspectos controversos na utilização do 131I, sendo este o principal foco desta revisão. As DAT ainda são utilizadas como primeira escolha nos casos de pacientes com bócios pequenos, crianças e adolescentes, e na gravidez. A tireoidectomia é, atualmente, quase um tratamento de exceção, com indicação restrita para casos em que as DAT ou o 131I sejam contra-indicados.
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Affiliation(s)
- Vânia A Andrade
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS
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Abós MD, Banzo J, Razola P, Prats E, García F, Ubieto MA. [Treatment of hyperthyroidism with 131 I]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2003; 22:262-76; quiz 277-81. [PMID: 12846955 DOI: 10.1016/s0212-6982(03)72199-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M D Abós
- Servicio de Medicina Nuclear Hospital Clínico Universitario Lozano Blesa. Zaragoza. Spain
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30
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Abstract
While diagnosing Graves disease in childhood and adolescence does not usually present specific problems, the treatment of hyperthyroidism is still controversial. In particular, with regard to the use of radioiodine therapy, strategies vary between many European and North American pediatric endocrinology centers. After the diagnosis is made, antithyroid drug treatment with methimazole (thiamazole), carbimazole, or propylthiouracil should be performed with caution, in particular, because of severe adverse effects, such as agranulocytosis or hepatitis, that are found in up to 1% of patients. Antithyroid drug treatment should not be continued long-term, particularly since definitive remission cannot be expected in more than 30-40% of patients. In contrast, the risk of severe adverse effects is still present, and the risk of thyroid carcinoma increases with time and appears to be considerably higher than after radioiodine treatment. To a great extent, the success of surgery depends on the skills of a trained surgeon. The question of whether to perform total or subtotal thyroidectomy is yet to be resolved. Surgery should be considered in patients with a large thyroid gland (>80g), severe ophthalmopathy, and a lack of remission on antithyroid drug treatment. Success rates have increased to up to 97%, while severe adverse effects (laryngeal nerve palsy, hypoparathyroidism) occur in approximately 4% of patients. Mortality is below 0.1%. Radioiodine treatment in children >5 years of age does not appear to be associated with an increased risk of thyroid carcinoma; however, long-term data are lacking. Compared with the surgical approach, success rates are lower, particularly if low doses of radioiodine are used. In general, adverse effects are less prevalent than in patients who have undergone surgery.
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Affiliation(s)
- Jorg Dötsch
- Department of Pediatrics, University of Erlangen-Nürnberg, Erlangen, Germany.
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31
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Abstract
A Doença de Graves constitui a forma mais comum de hipertireoidismo e três abordagens terapêuticas são atualmente utilizadas: drogas antitireoidianas (DAT), cirurgia e iodo radioativo (131I). As DAT continuam como tratamento de primeira escolha em pacientes com doença leve, bócios pequenos, crianças e adolescentes, e em situações especiais como na gravidez. Por outro lado, o 131I tem sido cada vez mais utilizado, porque é considerado um tratamento seguro, definitivo e de fácil aplicação. O risco de exacerbação do hipertireoidismo após administração do 131I, os fatores prognósticos de falência e o cálculo da dose administrada têm sido alguns dos aspectos discutidos na literatura recentemente, e são particulamente comentados nesta revisão. O tratamento cirúrgico constitui quase um tratamento de exceção, com indicação para os casos em que as terapias anteriores não possam ser utilizadas.
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32
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Affiliation(s)
- A P Weetman
- University of Sheffield Division of Clinical Sciences, Northern General Hospital, United Kingdom
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33
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Abstract
Anti-thyroid stimulating hormone receptor antibodies are pathophysiologic and clinical indicators in autoimmune thyroid diseases, not only in Graves' disease. The detection of these antibodies is useful for diagnostic and management purposes. The presence and titers of anti-TSH receptor antibodies, however, have to be interpreted in light of the clinical and other biological characteristics of each patient. Newer, more sensitive assays of anti-TSH receptor antibodies may increase their significance in the diagnosis and management of autoimmune thyroid diseases and Graves' disease.
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Affiliation(s)
- J Orgiazzi
- Department of Endocrinology, Centre Hospitalier Lyon Sud, France.
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34
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Nakazato N, Yoshida K, Mori K, Kiso Y, Sayama N, Tani JI, Nakagawa Y, Ito S. Antithyroid drugs inhibit radioiodine-induced increases in thyroid autoantibodies in hyperthyroid Graves' disease. Thyroid 1999; 9:775-9. [PMID: 10482369 DOI: 10.1089/thy.1999.9.775] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Methimazole (MMI) has been reported to affect prognosis in hyperthyroid Graves' disease patients treated with radioiodine (131I). In the present study, serum concentrations of thyroxine (T4), triiodothyronine (T3), thyroglobulin (Tg), thyrotropin-binding inhibitory immunoglobulin (TBII), thyroglobulin antibody (TgAb), and thyroid-peroxidase antibody (TPOAb) were measured serially for 1 year in patients with Graves' disease after 131I treatment either given alone (group 1, 41 patients) or followed by an antithyroid drug (group 2, 19 patients). The effect of antithyroid drugs on these parameters was analyzed retrospectively. Mean serum concentrations of T4 and T3 both decreased to normal within 3 months after 131I treatment in both groups. Serum Tg concentrations in group 1 showed significant transient increases (about four times the basal value) 1 month after 131I administration. Titers of TBII, TgAb, and TPOAb in group 1 also increased transiently after 131I treatment, with the maximum increase at 3 months. Antithyroid drugs significantly lessened 131I-induced increases in serum concentrations of Tg and all thyroid autoantibodies tested. One year after 131I treatment, 33 of 41 patients (80%) were euthyroid or hypothyroid in group 1; this was true for only 4 of 19 group II patients (22%). The results indicate that administering antithyroid drugs after 131I treatment reduced 131I-induced damage to the thyroid and reduced therapeutic efficacy of 131I in hyperthyroidism. Drug treatment also inhibited release of Tg and blunted 131I-induced increases in titers of thyroid autoantibodies.
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Affiliation(s)
- N Nakazato
- Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan
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35
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Bringmann IM, van Leeuwen BL, Hennemann G, Beckett GJ, Toft AD. Outcome of treatment of hyperthyroidism. J Endocrinol Invest 1999; 22:250-6. [PMID: 10342357 DOI: 10.1007/bf03343552] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This is a retrospective study designed to evaluate the initial response to carbimazole in patients with Graves' disease (GD), possible determinants of that response, the frequency of occurrence of adverse effects during treatment with carbimazole and the frequency of transient and permanent hypothyroidism after treatment with 131I in patients with GD and multinodular goiter (MNG). Data were collected from patients who first presented with GD or MNG at the Department of Endocrinology of the Royal Infirmary of Edinburgh between 1 January 1993 and 31 August 1996. Patients were divided into three groups: patients with GD treated with a daily dose of 40 mg carbimazole, patients with GD treated with a single dose of 400 MBq 1311, and patients with MNG treated with the same dose of 131I. Of the patients younger than 30 years, 50% remained biochemically hyperthyroid after 4-6 weeks of treatment with carbimazole, compared to 14% of patients over 30. Other determinants of the response to carbimazole expressed as the fall in thyroid hormone levels after 4-6 weeks were: pretreatment levels of FT4, T3, TRAb and the 4 h 131I uptake, patients with the higher levels responding significantly better to carbimazole. Adverse effects were reported in 11.5% of patients. Of the patients with GD treated with 1311, 62.6% became hypothyroid, transient hypothyroidism occurred in only 2.4% of these cases. The main predictors of development of hypothyroidism were positive titres of antithyroid peroxidase antibodies (AbTPO) and antithyroglobulin antibodies (AbTg), with positive predictive values of 79.5 and 91.6 respectively. None of the patients with MNG became hypothyroid after treatment with 131I, a response significantly different from patients with GD. In conclusion, GD younger patients might benefit from higher initial doses of carbimazole. In patients with positive titres of AbTPO and AbTg, lower doses of 1311 might prevent hypothyroidism. Transient hypothyroidism was underestimated in this study. No permanent thyroxin replacement therapy should be started within the first six months after 131I treatment.
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Affiliation(s)
- I M Bringmann
- Department of Internal Medicine University Hospital Rotterdam, The Netherlands
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36
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Gómez N, Gómez JM, Villabona C, Soler J. Transient hypothyroidism after iodine-131 therapy for Graves' disease. Clin Endocrinol (Oxf) 1998; 48:526-7. [PMID: 9640423 DOI: 10.1046/j.1365-2265.1998.00472.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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37
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Kaplan MM, Meier DA, Dworkin HJ. Treatment of hyperthyroidism with radioactive iodine. Endocrinol Metab Clin North Am 1998; 27:205-23. [PMID: 9534037 DOI: 10.1016/s0889-8529(05)70307-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Treatment of hyperthyroidism with RAI has been performed for more than a half century with efficacy and safety. For its optimal use, the physician must employ appropriate patient selection criteria and clinical judgment concerning pretreatment patient preparation. The dose of the 131I needed remains an area of uncertainty and debate; thus far, it has not been possible to resolve the trade-off between efficient definitive cure of hyperthyroidism and the high incidence of post-therapy hypothyroidism. Early side effects are uncommon and readily manageable. Other than the need for long-term monitoring and, in most cases, lifelong L-T4 treatment, late adverse consequences of this treatment remain only conjectural. The available follow-up studies support the current majority opinion of North American thyroid specialists that RAI treatment is an excellent choice for most hyperthyroid patients.
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Affiliation(s)
- M M Kaplan
- Department of Nuclear Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
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38
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Yoshida K, Aizawa Y, Kaise N, Fukazawa H, Kiso Y, Sayama N, Hori H, Nakazato N, Tani J, Abe K. Role of thyroid-stimulating blocking antibody in patients who developed hypothyroidism within one year after 131I treatment for Graves' disease. Clin Endocrinol (Oxf) 1998; 48:17-22. [PMID: 9509063 DOI: 10.1046/j.1365-2265.1998.00330.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We recently reported that thyroid-stimulating blocking antibody (TSBAb) may not contribute to the development of hypothyroidism more than six years after 131I treatment. In the present study, we attempted to determine whether hypothyroidism that develops within a shorter period of time following 131I therapy is associated with TSBAb. DESIGN Retrospective study. PATIENTS Sera were obtained from 8 patients who developed hypothyroidism within 6 months after 131I therapy (Group 1), 8 patients who became euthyroid one year after 131I therapy (Group 2), and 7 patients who developed transient hypothyroidism (Group 3). MEASUREMENTS Thyroid stimulating antibody (TSAb) activity was measured as the amount of cyclic adenosine monophosphate (cAMP) produced by cultured FRTL-5 cells, and TSBAb activity as the inhibition of cAMP produced in response to 100 mU/l bovine TSH. RESULTS At about 3 months after 131I treatment, TSAb activity increased significantly in Groups 2 and 3, but did not change in Group 1. In contrast, TSBAb activity in Group 1 increased significantly and was positive in 6 patients at that time. At 12-18 months after 131I treatment, TSBAb activity tended to decrease and remained positive in 3 patients but became negative in 3 patients. It did not change in the patients in Groups 2 and 3. The patients in Group 1 were treated with levothyroxine, 75-125 micrograms/day. Levothyroxine was discontinued in the 3 patients whose TSBAb activity disappeared. Two of them remained euthyroid, and 1 became hypothyroid. CONCLUSION Results indicate that the hypothyroidism that develops within a short time after 131I treatment may be caused by TSBAb activity. Thyroid function may be recovered when TSBAb activity disappears.
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Affiliation(s)
- K Yoshida
- Department of Clinical and Laboratory Medicine, Tohoku University School of Medicine, Sendai, Japan
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