Radioiodine therapy of Graves' disease

Piccardo, Arnoldo; Ugolini, Martina; Altrinetti, Vania; Righi, Sergio; Fiz, Francesco; Foppiani, Luca; Giovanella, Luca

doi:10.23736/s1824-4785.21.03337-9

Cited by 7 publications

(7 citation statements)

References 37 publications

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“…Although the treatment, levothyroxine monotherapy in solid formulation, aims to normalise TSH concentrations and resolve physical and mental complaints 7 . There are still prevalent symptoms of hypothyroidism exist, including fatigue, lethargy, cold intolerance, weight gain, constipation, changes in voice, and dry skin, while the clinical presentation can vary significantly based on age, sex, and the interval between onset and diagnosis 8–10 . Hence, when patients are partly responsible for selecting their treatment from multiple options, they may feel burdened and anxious about this type of medical decision‐making, leading to decision conflicts and dissatisfaction with medical decisions 11 .…”

Section: Introductionmentioning

confidence: 99%

“…7 There are still prevalent symptoms of hypothyroidism exist, including fatigue, lethargy, cold intolerance, weight gain, constipation, changes in voice, and dry skin, while the clinical presentation can vary significantly based on age, sex, and the interval between onset and diagnosis. [8][9][10] Hence, when patients are partly responsible for selecting their treatment from multiple options, they may feel burdened and anxious about this type of medical decisionmaking, leading to decision conflicts and dissatisfaction with medical decisions. 11 Moreover, in practical clinical work, not all patients achieved their treatment outcomes and quality of life, which may also contribute to decision regret.…”

Section: Introductionmentioning

confidence: 99%

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Quality of life and decision regret in patients with late‐hypothyroidism after radioiodine treatment for Graves' disease

Li,

Yang,

et al. 2023

Clinical Endocrinology

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ObjectivePatients with Graves' disease often engage in shared decision‐making to select an individualised treatment regimen from multiple options. Radioactive iodine (RAI) is one of the treatment choices for their condition, aims to improve quality of life and well‐being. Likewise, dissatisfaction with treatment outcomes can result in decision regret. We employed validated questionnaires to assess the prospective quality of life, decision regret and relative factors involved in decision‐making of patients with late hypothyroidism after RAI therapy.MethodsA questionnaire survey was conducted among patients in hypothyroidism status for more than 1 year after RAI therapy. Disease‐specific and generic QoL were assessed using the short form of thyroid‐related patient‐reported outcome (ThyPRO‐39) questionnaire. Patient satisfaction regarding their decision to undergo RAI was assessed using the Decision Regret Scale (DRS) and patients were asked about the importance of relative factors in decision‐making.ResultsOf 254 patients who responded to the survey, the mean age of patients was 45.3 years (range: 18–78 years) and the median time from RAI therapy to survey was 4 years (range: 1–30 years). Patients' median and mean DRS score were 34.4 and 38.8 (range: 0–100), respectively. A total of 100 (39.4%) patients express absent‐to‐mild regret (score: 0–25), 154 (60.6%) patients express moderate‐to‐severe regret (score: >25). The mean score of the absent‐to‐mild regret group were significantly higher than those of the moderate‐to‐severe regret group on most ThyPRO‐39 scales. A statistically significant positive correlation was observed between DRS score and most ThyPRO‐39 scale score. There was a significant positive association between higher DRS score and longer time intervals after RAI treatment, a brief duration of hyperthyroidism, and the significance of long‐time outpatient follow‐up. More decision regret was negatively associated Iodine‐free diet, ineffectiveness of ATD, fear of surgery.ConclusionImpairment of quality of life was positively correlated with decision regret in patients with late‐hypothyroidism after radioiodine therapy. Patients with insufficient information support before decision‐making are more likely to have higher decision regret after treatment. Our findings suggest that health providers should fully communicate with patients and provide information support in multiple dimensions during the shared‐decision‐making process.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quality of life and decision regret in patients with late‐hypothyroidism after radioiodine treatment for Graves' disease

Li,

Yang,

et al. 2023

Clinical Endocrinology

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“…The prevalence of benign thyroid diseases is constantly high 1 – 3 . Radioiodine-131 treatment (RIT) is a well-established non-invasive therapeutic option for patients suffering from hyperthyroidism 1 , 2 , 4 , 5 . For patients with Graves’ disease, RIT is applied to ablate target tissue related to autoimmunity and to reduce thyroid volume 2 , 4 , 6 , 7 .…”

Section: Introductionmentioning

confidence: 99%

“…Radioiodine-131 treatment (RIT) is a well-established non-invasive therapeutic option for patients suffering from hyperthyroidism 1 , 2 , 4 , 5 . For patients with Graves’ disease, RIT is applied to ablate target tissue related to autoimmunity and to reduce thyroid volume 2 , 4 , 6 , 7 . Graves’ disease is known as an autoimmune disorder of the thyroid in which thyrotropin receptor stimulating antibodies (TRAb) permanently stimulate thyroid cells.…”

Section: Introductionmentioning

confidence: 99%

“…Orally administered radioiodine-131 is selectively concentrated in thyroid cells and decays by emission of beta radiation with a physical half-life of 8 days and a mean β − energy of 190 keV 22 , 23 . The emitted electrons lead to ionisation resulting in DNA damage 4 , 21 , 24 , 25 . The aim of RIT is a euthyroid state with or without the necessity of substitutional hormone medication 26 .…”

Section: Introductionmentioning

confidence: 99%

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The influence of thionamides on intra-thyroidal uptake of 131I during radioiodine-131 treatment of Graves’ disease

Happel,

Bockisch,

Leonhäuser

et al. 2023

Sci Rep

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Graves’ disease is one of the most common causes of hyperthyroidism. Guideline recommendations advocate the intake of thionamides for at least 1 year. If hyperthyroidism persists, subsequent radioiodine-131 treatment (RIT) is a therapeutic option. Thionamides are known to influence intra-thyroidal bio-kinetics of iodine and should therefore be discontinued at least 3 days prior to RIT if possible. However, the required therapeutic activity has to be calculated individually by pre-therapeutic measurement of the uptake prior to RIT [radioiodine-131 uptake test (RIUT)] in Germany according to national guidelines. Therefore, the aim of this study was to quantify the influence of thionamides on intra-therapeutic uptake. A cohort of 829 patients with Graves’ disease undergoing RIUT and RIT was analysed. Patients were subdivided into three groups. Group A: patients with carbimazole medication (n = 312), group B: patients with methimazole medication (n = 252) and group C: patients without thionamides (n = 265). Group A and B were further subdivided depending on the reduction of dosage of thionamides. In order to analyse the influence of thionamides, the variance of the determined individual extrapolated maximum intra-thyroidal uptake (EMU) between RIUT and RIT within the single groups and within the subgroups was statistically evaluated. When administering an equal dose of thionamides or no thionamides in RIUT and RIT (groups A1, B1 and C) no significant differences were detected when comparing EMU in RIT to EMU in RIUT (p > 0.05). In the subgroups A2–A4 (reduced dosage of carbimazole prior to RIT) EMU was significantly increased in RIT compared to RIUT [21% for a reduction of 0 to < 10 mg/d (A2), 39% for a reduction of 10–15 mg/d (A3) and 80% for a reduction of > 15 mg/d (A4)]. In the subgroups B2–B4 (reduced dosage of methimazole prior to RIT) EMU was as well significantly increased in RIT compared to RIUT [26% for a reduction of 0 to < 10 mg/d (B2), 36% for a reduction of 10–15 mg/d (B3) and 59% for a reduction of > 15 mg/d (B4)]. A significant dose-dependent increase of EMU in RIT compared to EMU in RIUT in patients discontinuing or reducing thionamides was detected. Therefore, thionamides should be discontinued at least 2 days prior to RIUT in order to achieve the designated target dose more precisely and to minimize radiation exposure of organs at risk.

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