Auftreten einer immunogene Hyperthyreose nach Radioiod-Therapie fokaler Schilddrüsenautonomien

Weiss, Mayo; Görges, R.; Hirsch, Christine; Bader, J. B.; Tatsch, Klaus; Hahn, Klaus

doi:10.1007/bf03045047

Cited by 9 publications

(1 citation statement)

References 10 publications

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“…Beie twa1 %d er Patienteni nS tudienm it großenF allzahlen ( 34,35,104,118), in kleinerenS erienz ur Ve rkleinerung dere uthyreoten Knotenstruma beib is zu 5% der Patienten ( 12,47,54,57,79,82,84), triggert die Radioiodtherapie denÜbergangin eine immunogene postradiogene Hyperthyreose, die aber nur seltenmit einerendokri-nenOrbitopathie assoziiert ist (11). Risikofaktor ist eine prätherapeutische Erhöhung derAnti-TPO-Antikörper (82,104).…”

Section: Immunogene Hyperthyreoseunclassified

Therapy for non-toxic multinodular goiter

Dietlein¹,

Dederichs²,

Kobe³

et al. 2006

Nuklearmedizin

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SummaryThe need for therapy for nodular goiter results from the growth of thyroid nodules over decades and from the possibility of tracheal compression and worsening of respiratory function. Given the high prevalence of non-toxic goiter, the epidemiologically low incidence of clinically apparent thyroid cancer justifies non-surgical strategies. Randomised studies have shown that levothyroxine offers limited therapeutic effects and is inferior to radioiodine therapy regarding goiter shrinkage. When indication for a definitive therapy is given, the choice between resection and radioiodine therapy should consider volume of goiter, severity of clinical symptoms, thyroid uptake, patient’s age, co-morbidity, previous resection of goiter, patient’s profession and patient’s wish. Even in large goiters between 100 and 300 ml radioiodine therapy showed consistent results with goiter size reduction from 35-40% one year and 40-60% two years after radioiodine therapy. Thyroid hormones to prevent recurrence of goiter are not necessary. Recurrent goiters were seldom observed after radioiodine therapy and resulted from initially very large goiters or uptake in dominante nodules or from low 131I activities. Recombinant human TSH (rhTSH) offers the opportunity to enhance the effect of radioiodine therapy. Observational studies have shown that rhTSH increases low 131I uptake in case of high alimentary iodine-supply by the factor 4, causes a more homogenous 131I distribution within the goiter and improves goiter reduction. A phase I study for dose finding is running in the USA. Conclusion: Radioiodine therapy for shrinkage of large non-toxic goiter should not be restricted to elderly patients, or to patients with co-morbidity or high operative risk, but is an attractive alternative to surgery in patients with special professions (singer, teacher, speaker) or with the wish for a non-invasive treatment modality.

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Section: Immunogene Hyperthyreoseunclassified

Therapy for non-toxic multinodular goiter

Dietlein¹,

Dederichs²,

Kobe³

et al. 2006

Nuklearmedizin

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Relapses of hyperthyroidism in patients treated with radioiodine for nodular toxic goiter: Relation to thyroid autoimmunity

Custro

Ganci

Scafidi

2003

J Endocrinol Invest

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Relapses of hyperthyroidism after treatment with radioiodine for uni- or multi-nodular goiter may be accompanied by the appearance of TSAb. However, this phenomenon has only emerged from one retrospective study on Northern European patients, in which it was not possible to determine whether TSAb also appeared in treated patients who did not relapse. The present study aimed to assess the appearance, immunogenic nature and clinical characteristics of hyperthyroidism relapse after treatment with 131I for nodular toxic goiter in patients from the Mediterranean area. A retrospective study was performed on 76 consecutive patients, born and resident in Sicily and aged 56-80 yr at diagnosis, who were treated with radioiodine. Serum aliquots obtained from the patients before 131I treatment and during a follow-up of 36-144 months were assayed for TSAb and TPOAb. The clinical charts of the patients were also re-examined. Twenty-six out of 76 patients (36.8%) had a hyperthyroidism relapse after a first treatment with 131I. Eight of the 26 (30.7%) also relapsed after the second treatment. Three out of 26 (11.5%) relapsed after a third treatment. The 50 patients who required only one treatment and the 18 who relapsed only once were all TSAb-negative at baseline, while 3/8 (37.5%) who relapsed also after the second treatment were already TSAb-positive at baseline. TSAb became positive in 3/18 patients (16.7%) who relapsed once, and in 4/8 (50.0%) of those who relapsed after a second treatment. One of these 7 TSAb-positive relapsers was also already TPOAb-positive at baseline and another became TPOAb-positive after treatment. The presence of circulating TSAb in 3/76 (3.9%) patients before treatment for toxic goiter more probably points to a diagnosis of Marine-Lenhart's syndrome. In contrast, the de novo appearance of TSAb in the presence of hyperthyroidism relapse in 4/76 (5.3%) patients suggests the development of a Graves'-like disease after radioiodine treatment. This occurrence does not seem to have precise ethnic grounds, since the incidence we observed in Mediterranean patients was similar to that previously reported in Northern European patients.

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The Marine-Lenhart syndrome revisited

Biersack

Biermann

2011

Wien Klin Wochenschr

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The coexistence of thyroid autonomy (Plummer's disease) and Graves' disease has been termed "Marine-Lenhart syndrome". During the last years, several papers have been published on the development of Graves' disease shortly after radioiodine therapy of Plummer's disease (autonomy). Especially in patients with elevated thyroid antibodies, the incidence of this event is significantly higher after radioiodine therapy of autonomy. A review of the literature dating back to 1911 is discussed in this paper. The original paper published by Marine and Lenhart comes to the conclusion that the two diseases are different expressions of one disease. Looking at the literature, we have to state now that the Marine-Lenhart syndrome has never existed: With Plummer we know now that Plummer's and Graves' disease are different diseases. They may develop in the same patient but independent from each other.

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Auftreten einer immunogene Hyperthyreose nach Radioiod-Therapie fokaler Schilddrüsenautonomien

Cited by 9 publications

References 10 publications

Therapy for non-toxic multinodular goiter

Therapy for non-toxic multinodular goiter

Relapses of hyperthyroidism in patients treated with radioiodine for nodular toxic goiter: Relation to thyroid autoimmunity

The Marine-Lenhart syndrome revisited

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