131I treatment of diffuse and nodular toxic goitre with or without antithyroid agents

Abstract

Abstract. The results of 131I treatment in combination with pre- and post-treatment with carbimazole (n = 122) were compared to the results of 131I used as the only antithyroid treatment (n = 203). The two groups of patients were fully comparable in regard to age, size of goitre and time of observation, and the same diagnostic criteria and dosage regimen of 131I were used. The incidence of early myxoedema in patients with diffuse goitre was significantly reduced after combination therapy, 5 per cent, compared to 16 per cent after 131I as the only antithyroid therapy (P < 0.05). The incidence of late myxoedema was 6 per cent in both groups 3 years after the last treatment, and fully compensated myxoedema was found in 13 and 22 per cent (n.s.). No severe acute side effects were observed after 131I therapy in any of the two groups. It is concluded that - in diffuse toxic goitre - a lower early incidence of myxoedema was obtained on the combined regimen because of either a possibly lower absorbed radiation dose or a more fractionate therapy. A major advantage of the combination therapy is also, that the patients are rendered euthyroid shortly after the diagnosis and remain so during the prolonged period of treatment. 131I treatment in combination with carbimazole is advocated in all patients with diffuse and nodular toxic goitre if the patient is above fertile age and thyroidectomy is not indicated.

Changes in the Thyroid Technetium-99m Scintigram after Antithyroid and Subsequent Radioiodine Treatment for Solitary Autonomous Nodules

“…The frequency of hypothyroidism varies from 0% to 36% in different surveys (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The main factors that have been associated with occurrence of hypothyroidism after 131I therapy in patients with solitary autonomous thy-roid nodules are: nonsuppressed serum TSH, 131I uptake in the paranodular tissue, thyroid autoantibodies, and the size of 131I dose.…”

“…In previous investigations of the effect of 131I treatment on autonomous solitary thyroid nodules, only a minority received antithyroid medication prior to 131I therapy (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The aim of this study was to investigate changes in the thyroid 99mTc-pertechnetate scintigram related to normalization of serum TSH with antithyroid drugs before and after subsequent 131I therapy.…”

Serum TSH and the response to radioiodine treatment of toxic multinodular goitre

“…Serum hormone concentrations were estimated by commercial assays: serum TSH (LUMI-test, Brahms Diagnostica GMBH, Berlin, Germany); serum T 4 (Amerlex-M T 4 RIA, Johnson & Johnson Clinical Diagnostics Ltd, Rochester, NY, USA); serum T 3 and T 3 uptake (Coat-ACount, Diagnostic Products Corporation, Los Angeles, CA, USA). Free T 4 and free T 3 indices were calculated as the product of the T 3 uptake and serum T 4 or serum T 3 respectively.…”

“…Much effort has been devoted to the improvement of 131 I dosage by the development of compensatory models that take into account goitre volume and thyroid iodine uptake (2,3). However, many centres still report treatment failure rates of 5-70% for nodular goitres and development of hypothyroidism in 5-47% of patients, depending on the 131 I dosage schedule and treatment policy (4)(5)(6)(7)(8)(9)(10). Even with more accurate determination of goitre volume (11) or of measure of thyroid iodine metabolism (12,13), it seems difficult to achieve better results.…”

Long-term results of two schedules of radioiodine treatment for toxic multinodular goitre

“…In earlier reports on the results of this treatment, different Later studies on radioiodine therapy of Graves' disease showed that regardless of the dosage schedule used, patients with Graves' disease are at high risk of becoming hypothyroid [1,2]. In studies on the results of radioiodine treatment of patients with toxic uni-and multinodular goitres, incidences of hypothyroidism are extremely varied, ranging from 1% to 64% [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. However, interpretation of literature data is difficult for several reasons.…”