Research Article
The Effect of Empirical Fixed-Dose Radioactive Iodine Administration on Treatment Success in Patients with Hyperthyroidism and its Comparison with Sensitive Dosimetric Methods in the Literature
Abstract
Our study aimed to evaluate the effect of empirical fixed-dose iodine administration on treatment success in patients admitted to our clinic with hyperthyroidism and compare it with sensitive dosimetric methods in the literature. The files of 206 patients who received radioactive iodine therapy (RIT) in our clinic between 2014-2020 were retrospectively analyzed. Patients’ demographic characteristics such as gender, age, pre-treatment thyroid scintigraphy, pre-, and post-treatment thyroid function tests (TSH and fT4) were evaluated. The patients were followed up for six months after radioactive iodine treatment. After RIT, euthyroidism or hypothyroidism was observed in 177 patients (85.9%) in the first six months and was accepted as a complete cure. In 38 patients (14.1%), euthyroid or hypothyroidism was not observed in the first six months, and RIT treatment was considered unsuccessful. There was no statistically significant relationship between treatment response with gender and age. The success rate in the group with toxic multinodular goiter was statistically significantly lower than the other two groups with the diffuse hyperactive thyroid gland and a single hyperactive nodule. The treatment success rate was statistically higher in the patients with high pre-treatment TSH values. We concluded that empirical fixed-dose radioactive iodine therapy is a very successful method in the patients with hyperthyroidism and has a similar success rate with RIT doses calculated by the precise dosimetric method in the literature. For this reason, the fixed-dose application can be used as a convenient and successful method to provide more patient comfort, time savings and reduce medical costs.
References
- 1. Bartalena L. Diagnosis and management of Graves disease: a global overview. Nat Rev Endocrinol. 2013;9(12):724.
- 2. Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011;99(1):39-51.
- 3. Vija Racaru L, Fontan C, Bauriaud-Mallet M, et al. Clinical outcomes 1 year after empiric 131I therapy for hyperthyroid disorders: real life experience and predictive factors of functional response. Nucl med commun. 2017;38(9):756-63.
- 4. Holm L-E, Hall P, Wiklund K, et al. Cancer risk after iodine-131 therapy for hyperthyroidism. JNCI: J Natl Cancer Inst. 1991;83(15):1072-7.
- 5. Metso S, Auvinen A, Huhtala H, et al. Increased cancer incidence after radioiodine treatment for hyperthyroidism. Cancer. 2007;109(10):1972-9.
- 6. Ron E, Doody MM, Becker DV, et al. Cancer mortality following treatment for adult hyperthyroidism. Jama. 1998;280(4):347-55.
- 7. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-421.
- 8. Skugor M, Wilder JB. Thyroid Disorders: A Cleveland Clinic Guide: Cleveland Clinic Press; 2006.
- 9. Nordyke RA, Gilbert FI. Optimal iodine-131 dose for eliminating hyperthyroidism in Graves’ disease. J Nucl Med. 1991;32(3):411-6.
- 10. Allahabadia A, Daykin J, Sheppard MC, et al. Radioiodine treatment of hyperthyroidism prognostic factors for outcome. J Clin Endocrinol Metab 2001;86(8):3611-7.
- 11. Jarløv AE, Hegedüst L, Kristensen LØ, et al. Is calculation of the dose in radioiodine therapy of hyperthyroidism worth while? Clin Endocrinol. 1995;43(3):325-9.
- 12. Leslie WD, Ward L, Salamon EA, et al. A randomized comparison of radioiodine doses in Graves’ hyperthyroidism. J Clin Endocrinol Metab2003;88(3):978-83.
- 13. Catargi B, Leprat F, Guyot M, et al. Optimized radioiodine therapy of Graves’ disease: analysis of the delivered dose and of other possible factors affecting outcome. Eur J Endocrinol.1999;141(2):117-21.
- 14. Alexander EK, Larsen PR. High dose 131I therapy for the treatment of hyperthyroidism caused by Graves’ disease. J Clin Endocrinol Metab. 2002;87(3):1073-7.
- 15. Erdogan MF, Küçük NÖ, Anl C, et al. effect of radioiodine therapy on thyroid nodule size and function in patients with toxic adenomas. Nucl Med Commun. 2004;25:1083-7.
- 16. Tajiri J, Noguchi S. Antithyroid drug-induced agranulocytosis: special reference to normal white blood cell count agranulocytosis. Thyroid. 2004;14(6):459-62.
- 17. Sisson JC, Avram AM, Rubello D, et al. Radioiodine treatment of hyperthyroidism: fixed or calculated doses; intelligent design or science? Eur J Nucl Med Mol Imaging. 2007;34(7):1129-30.
- 18. Van Isselt JW, de Klerk JM, Lips CJ. Radioiodine treatment of hyperthyroidism: fixed or calculated doses; intelligent design or science? Eur J Nucl Med Mol Imaging. 2007;34(11):1883-4.
- 19. Hedley A, Lazarus J, McGhee S, et al. Treatment of hyperthyroidism by radioactive iodine: Summary of a UK national survey prepared for the Royal College of Physicians Committee on Endocrinology and Diabetes. J R Coll Physicians Lond. 1992;26(4):348.
- 20. Franklyn J, Daykin J, Holder R, et al. Radioiodine therapy compared in patients with toxic nodular or Graves’ hyperthyroidism. QJM: 1995;88(3):175-80.
- 21. Metso S, Jaatinen P, Huhtala H, et al. Long-term follow-up study of radioiodine treatment of hyperthyroidism. Clin Endocrinol. 2004;61(5):641-8.
- 22. Ahmad AM, Ahmad M, Young ET. Objective estimates of the probability of developing hypothyroidism following radioactive iodine treatment of thyrotoxicosis. Eur J Endocrinol 2002;146(6):767-75.
- 23. Yoshimoto M, Iino S, Yoshimura H, et al. A five-year follow-up of two different 131I treatment methods for Graves’ disease and the factors affecting the outcome. Nihon Naibunpi Gakkai Zasshi. 1994;70(9):995-1006.
- 24. Aktaş GE, Turoğlu HT, Erdil TY, et al. Long-term results of fixed high-dose I-131 treatment for toxic nodular goiter: higher euthyroidism rates in geriatric patients. Mol Imaging Radionucl Ther. 2015;24(3):94.
- 25. Allahabadia A, Daykin J, Holder RL, et al. Age and gender predict the outcome of treatment for Graves’ hyperthyroidism. J Clin Endocrinol Metab. 2000;85(3):1038-42.
Hipertiroidili Hastalarda Ampirik Sabit Doz Radyoaktif İyot Uygulamasının Tedavi Başarısı Üzerine Etkisi ve Literatürdeki Hassas Dozimetrik Yöntemlerle Kıyaslanması
Abstract
Çalışmamızda kliniğimizde hipertiroidi nedeniyle ampirik sabit doz ile uyguladığımız radyoaktif iyot tedavisinin (RIT) başarısının, diğer bir yöntem olan hassas dozimetrik doz hesaplama ile uygulanan RIT’ın literatürdeki başarısı ile karşılaştırmayı amaçladık. Hipertiroidi nedeniyle kliniğimizde RIT uygulanan 206 hastanın dosyasını incelendik. Cinsiyet, yaş gibi demografik özellikler ile tiroid sintigrafisi, tiroid fonksiyon testlerini (TSH ve sT4) değerlendirdik. RIT sonrası en az altı aylık takipleri yapıldı. RIT sonrası 177 hastada (%85.9) ilk altı ayda ötiroidi veya hipotiroidi izlendi ve tedavi başarılı kabul edildi. Otuz sekiz hastada ise (%14.1) ilk altı ayda ötiroidi veya hipotiroidi izlenmedi ve bu hastalarda RIT başarısız kabul edildi. Cinsiyet ve yaş ile tedavi başarısı arasında istatistiksel anlamlı ilişki bulunmadı. Toksik multinoduler guatr izlenen gruptaki başarı oranı diffüz hiperaktif tiroid bezi ve toksik adenomlu diğer iki gruptan daha düşüktü. Tedavi öncesindeki TSH değeri yüksek olanlarda tedavi başarısı daha yüksek idi. Hipertiroidili hastalarda ampirik sabit dozda uygulanan RIT başarılı bir yöntem olduğu ve literatürdeki hassas dozimetrik yöntemle hesaplanan doz ile uygulanan RIT ile benzer başarı oranına sahip olduğu sonucuna vardık. Bu nedenle sabit doz uygulaması daha fazla hasta rahatlığı, zaman tasarrufu sağlamak, aynı zamanda tıbbi maliyetleri düşürmek için uygun ve başarılı bir yöntem olarak kullanılabilir.
Keywords
Tiroid sintigrafisi Radyoaktif iyot tedavisi Hipertiroidizm Hyperthyroidism Radioactive Iodine Therapy Thyroid Scintigraphy
References
- 1. Bartalena L. Diagnosis and management of Graves disease: a global overview. Nat Rev Endocrinol. 2013;9(12):724.
- 2. Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011;99(1):39-51.
- 3. Vija Racaru L, Fontan C, Bauriaud-Mallet M, et al. Clinical outcomes 1 year after empiric 131I therapy for hyperthyroid disorders: real life experience and predictive factors of functional response. Nucl med commun. 2017;38(9):756-63.
- 4. Holm L-E, Hall P, Wiklund K, et al. Cancer risk after iodine-131 therapy for hyperthyroidism. JNCI: J Natl Cancer Inst. 1991;83(15):1072-7.
- 5. Metso S, Auvinen A, Huhtala H, et al. Increased cancer incidence after radioiodine treatment for hyperthyroidism. Cancer. 2007;109(10):1972-9.
- 6. Ron E, Doody MM, Becker DV, et al. Cancer mortality following treatment for adult hyperthyroidism. Jama. 1998;280(4):347-55.
- 7. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-421.
- 8. Skugor M, Wilder JB. Thyroid Disorders: A Cleveland Clinic Guide: Cleveland Clinic Press; 2006.
- 9. Nordyke RA, Gilbert FI. Optimal iodine-131 dose for eliminating hyperthyroidism in Graves’ disease. J Nucl Med. 1991;32(3):411-6.
- 10. Allahabadia A, Daykin J, Sheppard MC, et al. Radioiodine treatment of hyperthyroidism prognostic factors for outcome. J Clin Endocrinol Metab 2001;86(8):3611-7.
- 11. Jarløv AE, Hegedüst L, Kristensen LØ, et al. Is calculation of the dose in radioiodine therapy of hyperthyroidism worth while? Clin Endocrinol. 1995;43(3):325-9.
- 12. Leslie WD, Ward L, Salamon EA, et al. A randomized comparison of radioiodine doses in Graves’ hyperthyroidism. J Clin Endocrinol Metab2003;88(3):978-83.
- 13. Catargi B, Leprat F, Guyot M, et al. Optimized radioiodine therapy of Graves’ disease: analysis of the delivered dose and of other possible factors affecting outcome. Eur J Endocrinol.1999;141(2):117-21.
- 14. Alexander EK, Larsen PR. High dose 131I therapy for the treatment of hyperthyroidism caused by Graves’ disease. J Clin Endocrinol Metab. 2002;87(3):1073-7.
- 15. Erdogan MF, Küçük NÖ, Anl C, et al. effect of radioiodine therapy on thyroid nodule size and function in patients with toxic adenomas. Nucl Med Commun. 2004;25:1083-7.
- 16. Tajiri J, Noguchi S. Antithyroid drug-induced agranulocytosis: special reference to normal white blood cell count agranulocytosis. Thyroid. 2004;14(6):459-62.
- 17. Sisson JC, Avram AM, Rubello D, et al. Radioiodine treatment of hyperthyroidism: fixed or calculated doses; intelligent design or science? Eur J Nucl Med Mol Imaging. 2007;34(7):1129-30.
- 18. Van Isselt JW, de Klerk JM, Lips CJ. Radioiodine treatment of hyperthyroidism: fixed or calculated doses; intelligent design or science? Eur J Nucl Med Mol Imaging. 2007;34(11):1883-4.
- 19. Hedley A, Lazarus J, McGhee S, et al. Treatment of hyperthyroidism by radioactive iodine: Summary of a UK national survey prepared for the Royal College of Physicians Committee on Endocrinology and Diabetes. J R Coll Physicians Lond. 1992;26(4):348.
- 20. Franklyn J, Daykin J, Holder R, et al. Radioiodine therapy compared in patients with toxic nodular or Graves’ hyperthyroidism. QJM: 1995;88(3):175-80.
- 21. Metso S, Jaatinen P, Huhtala H, et al. Long-term follow-up study of radioiodine treatment of hyperthyroidism. Clin Endocrinol. 2004;61(5):641-8.
- 22. Ahmad AM, Ahmad M, Young ET. Objective estimates of the probability of developing hypothyroidism following radioactive iodine treatment of thyrotoxicosis. Eur J Endocrinol 2002;146(6):767-75.
- 23. Yoshimoto M, Iino S, Yoshimura H, et al. A five-year follow-up of two different 131I treatment methods for Graves’ disease and the factors affecting the outcome. Nihon Naibunpi Gakkai Zasshi. 1994;70(9):995-1006.
- 24. Aktaş GE, Turoğlu HT, Erdil TY, et al. Long-term results of fixed high-dose I-131 treatment for toxic nodular goiter: higher euthyroidism rates in geriatric patients. Mol Imaging Radionucl Ther. 2015;24(3):94.
- 25. Allahabadia A, Daykin J, Holder RL, et al. Age and gender predict the outcome of treatment for Graves’ hyperthyroidism. J Clin Endocrinol Metab. 2000;85(3):1038-42.
There are 25 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | Original Article |
| Authors | |
| Publication Date | December 30, 2022 |
| Submission Date | May 28, 2021 |
| Published in Issue | Year 2022 Volume: 9 Issue: 3 |
