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Watanabe S, Okamoto S, Akikawa K, Miyamoto N, Okamura-Kawasaki M, Uchiyama Y, Takenaka J, Toyonaga T, Hirata K, Kudo K. Identification of patients with Graves' disease who benefit from high-dose radioactive iodine therapy. Ann Nucl Med 2022; 36:923-930. [PMID: 35972673 DOI: 10.1007/s12149-022-01781-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Radioactive iodine (RAI) therapy is a useful treatment for Graves' disease (GD). Most RAI sessions administer ≤ 500 MBq of iodine (I)-131. Sometimes patients require repeated RAI, often for longer periods of remission. We investigated the characteristics of patients for whom high dose (mostly 1110 MBq of I-131) RAI was effective as RAI therapy for GD. METHODS We retrospectively analyzed the cases of 79 patients who underwent RAI for GD in a multicenter setting. We divided the patients into two groups based on the I-131 dose administered: the low dose (LD) group who received ≤ 500 MBq (n = 44) and the high dose (HD) group who received > 500 MBq (n = 35). The therapeutic effect was defined as achieving remission and reaching the point of participating in thyroid hormone replacement therapy within 1 year after RAI. We compared the LD and HD groups' remission rates and conducted a multivariate logistic regression analysis of predictive factors for remission. In a simulation, using the formula for predicting the probability of remission obtained from the analysis results, we estimated how much the remission rate would change if the I-131 dose is increased from 500 to 1110 MBq. RESULTS The mean ± standard deviation I-131 dose administered in the LD group was 480 ± 6 MBq, and that of the HD group was 1054 ± 265 MBq. Thirty-five patients (80%) in the LD group and 26 patients (74%) in the HD group achieved remission; this difference in the remission rate was not significant. The multivariate analysis results demonstrated that the absorbed dose and thyroid-stimulating antibody (TSAb) were independent predictors of remission. Seven patients (8.9%) showed an increased probability of remission from < 50% to > 50% when the higher RAI dose was applied (1110 MBq instead of 500 MBq). The thyroid volume and TSAb values in these patients were relatively large at 54.7 ± 34.2 mL and 1378.4 ± 586.3%, respectively. CONCLUSION Although the overall remission rate was not significantly different between the patients who received high- or low-dose I-131, treatment with high-dose RAI may improve the probability of remission in patients with a massive thyroid volume and/or high-TSAb Graves' disease.
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Affiliation(s)
- Shiro Watanabe
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
- Department of Nuclear Medicine, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
| | - Shozo Okamoto
- Department of Radiology, Obihiro Kosei Hospital, Minami 10-1, Nishi 14, Obihiro City, Hokkaido, 080-0024, Japan
| | - Kazumasa Akikawa
- Department of Internal Medicine, Hokkaido Medical Center of Rheumatic Diseases, 1-1-45, Kotoni 1-jo 3-chome, Nishi-ku, Sapporo, Hokkaido, 063-0811, Japan
| | - Noriyuki Miyamoto
- Department of Radiology, Obihiro Kosei Hospital, Minami 10-1, Nishi 14, Obihiro City, Hokkaido, 080-0024, Japan
| | - Miyuki Okamura-Kawasaki
- Department of Radiology, Tomakomai City Hospital, 1-5-20 Shimizu-cho, Tomakomai, 053-8567, Japan
| | - Yuko Uchiyama
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Junki Takenaka
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Takuya Toyonaga
- Positron Emission Tomography (PET) Center, Radiology and Biomedical Imaging, Yale School of Medicine, 801 Howard Ave., P.O. Box 208048, New Haven, CT, 06520, USA
| | - Kenji Hirata
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Kita-14, Nishi-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
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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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