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Leitha T, Schartel M, Hurtl I, Bednar R, König F, Mayrhofer K, Pietschmann F. Dosimetry-guided radioiodine therapy of hyperthyroidism: long-term experience and implications for guidelines. Nucl Med Commun 2021; 42:150-159. [PMID: 33165252 DOI: 10.1097/mnm.0000000000001315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term follow-up after radioactive iodine therapy (RIT) for Graves' disease and toxic thyroid autonomy is incompletely addressed by current guidelines. We retrospectively analyzed the clinical course of 1233 out of 1728 consecutive Graves' disease (n = 536) and thyroid autonomy (n = 1192) patients after dosimetry-guided RIT to optimize follow-up. METHODS Patients were referred between 1990 and 2018; follow-up was monitored according to available electronic registers with medical reports, including autopsies from 9 hospitals and 10 residential care homes. RESULTS In total, 495/1728 cases were censored because of incomplete 6-month follow-up data. The conversion rates to hypothyroidism in Graves' disease and different forms of thyroid autonomy can be deconvoluted into two follow-up periods: first year after RIT and afterward. The conversion rate in Graves' disease was significantly higher than that in all thyroid autonomy subgroups during the first year but almost identical afterwards. Thyroxine substitution started between 10 and 7900 days after RIT at thyroid stimulating hormone between 0.11 and 177 µU/ml. CONCLUSIONS We advise earlier (2-3 weeks) first follow-up checks after RIT in all Graves' disease patients and thyroid autonomy under antithyroid drugs (ATD) and re-checks every 2-4 weeks until conversion to hypothyroidism during the first year. The first check in thyroid autonomy without ATD should be after 3-4 weeks with re-checks every 4-6 weeks. After 1 year, both groups can be re-checked every 4-6 months over the next 5 years. The success rate of RIT in thyroid autonomyincreases with age but the history of RIT is rapidly lost during follow-up.
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Affiliation(s)
- Thomas Leitha
- Department of Nuclear Medicine, Danube Hospital, Vienna, Austria
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Yu D, Zhou H, Yang Y, Jiang Y, Wang T, Lv L, Zhou Q, Yang Y, Dong X, He J, Huang X, Chen J, Wu K, Xu L, Mao R. The bidirectional effects of hypothyroidism and hyperthyroidism on anxiety- and depression-like behaviors in rats. Horm Behav 2015; 69:106-15. [PMID: 25623236 DOI: 10.1016/j.yhbeh.2015.01.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/24/2014] [Accepted: 01/16/2015] [Indexed: 12/11/2022]
Abstract
Thyroid hormone disorders have long been linked to depression, but the causal relationship between them remains controversial. To address this question, we established rat models of hypothyroidism using (131)iodine ((131)I) and hyperthyroidism using levothyroxine (LT4). Serum free thyroxine (FT4) and triiodothyronine (FT3) significantly decreased in the hypothyroid of rats with single injections of (131)I (5mCi/kg). These rats exhibited decreased depression-like behaviors in forced swimming test and sucrose preference tests, as well as decreased anxiety-like behaviors in an elevated plus maze. Diminished levels of brain serotonin (5-HT) and increased levels of hippocampal brain-derived neurotrophic factor (BDNF) were found in the hypothyroid rats compared to the control saline-vehicle administered rats. LT4 treatment reversed the decrease in thyroid hormones and depression-like behaviors. In contrast, hyperthyroidism induced by weekly injections of LT4 (15μg/kg) caused a greater than 10-fold increase in serum FT4 and FT3 levels. The hyperthyroid rats exhibited higher anxiety- and depression-like behaviors, higher brain 5-HT level, and lower hippocampal BDNF levels than the controls. Treatment with the antidepressant imipramine (15mg/kg) diminished serum FT4 levels as well as anxiety- and depression-like behaviors in the hyperthyroid rats but led to a further increase in brain 5-HT levels, compared with the controls or the hypothyroid rats. Together, our results suggest that hypothyroidism and hyperthyroidism have bidirectional effects on anxiety- and depression-like behaviors in rats, possibly by modulating hippocampal BDNF levels.
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Affiliation(s)
- Dafu Yu
- School of Life Sciences, Yunnan University, Kunming 650091, China; Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China; Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Heng Zhou
- School of Life Sciences, University of Science and Technology of China, Hefei, 230026, China; Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China
| | - Yuan Yang
- School of Life Sciences, Yunnan University, Kunming 650091, China; Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China; Physiological Department, Kunming Medical University, Kunming 650500, China
| | - Yong Jiang
- Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Tianchao Wang
- Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Liang Lv
- Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Qixin Zhou
- Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China
| | - Yuexiong Yang
- Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China
| | - Xuexian Dong
- Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Jianfeng He
- Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Xiaoyan Huang
- State Key Laboratory of Phytochemistry and Plant Resources in Southwest China, and Kunming Institute of Botany, Chinese Academy of Science, Kunming 650201, China
| | - Jijun Chen
- State Key Laboratory of Phytochemistry and Plant Resources in Southwest China, and Kunming Institute of Botany, Chinese Academy of Science, Kunming 650201, China
| | - Kunhua Wu
- Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Lin Xu
- School of Life Sciences, Yunnan University, Kunming 650091, China; School of Life Sciences, University of Science and Technology of China, Hefei, 230026, China; Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China.
| | - Rongrong Mao
- Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China.
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