EANM procedure guidelines for therapy of benign thyroid disease

Abstract

The purpose of the present guidelines on the (131)I therapy of benign thyroid disorders formulated by the European Association of Nuclear Medicine (EANM) Therapy Committee is to provide advice to nuclear medicine clinicians on how to treat benign thyroid conditions employing optimal (131)I activities. The recommendations were formulated based on recent literature and expert opinion regarding rationale, indications and contraindications for the use of (131)I procedures, as well as the adequate (131)I activities in different thyroid disorders, and the administration and patient preparation techniques to be used. Recommendations are also provided on history and examinations before (131)I therapy, patient counselling and precautions associated with (131)I therapy. Furthermore, potential side effects and alternative treatment modalities are reviewed. Special attention is paid to these aspects in the treatment of children undergoing this procedure.

Radioiodine – the success story of Nuclear Medicine

“…The European Association of Nuclear Medicine (EANM) guidelines are more ambivalent. According to the EANM guidelines, in patients with hyperthyroidism, the aim of treatment with 131 I is to achieve a non-hyperthyroid status, which can be euthyroid or hypothyroid, recompensated by T4 medication [20]. Permanent hypothyroidism can be achieved relatively easily by administering a high activity to deliver an ablative dose.…”

“…A 15 mCi (555 MBq) administration results in an 81 % success rate [19]. The EANM guidelines indicate that complete ablation requires an absorbed dose of 200-300 Gy [20].…”

Matched pairs for radionuclide-based imaging and therapy

“…However, at least for radioiodine therapy of benign thyroid diseases, it is nowadays widely accepted that there is a dose-response relationship and pretherapeutic dosimetry is feasible and should be performed [2][3][4]. Dosimetry in the treatment of benign thyroid diseases is relatively easy, as the organ is close to the surface and there is little and calculable absorption or scatter, the target volume may be reliably measured by ultrasonography, and the activity distribution is quite homogeneous.…”

Single, very low dose (0.03 mg) of recombinant human thyrotropin (rhTSH) effectively increases radioiodine uptake in the I-131 treatment of large nontoxic multinodular goiter

“…Taking into consideration the immunosuppressive effects of ATD, the administration lasting at least 1.5 years is associated with an approx. 50% probability of achieving long-term remission [1,4].…”

“…The efficacy of RIT in these cases depends on the patient's condition as well as on appropriate preparation for treatment [1][2][3].…”