Evidence for Higher Success Rates and Successful Treatment Earlier in Graves' Disease with Higher Radioactive Iodine Doses

Sztal‐Mazer, Shoshana; Nakatani, Viviane Yumi; Bortolini, Luis Gustavo Cambrussi; Boguszewski, César Luiz; Graf, Hans; Carvalho, Gisah Amaral de

doi:10.1089/thy.2011.0362

Cited by 24 publications

(33 citation statements)

References 19 publications

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“…Similar to these studies, we found that lower doses of RAI were associated with failure while higher doses were protective (16, 18, 24, 25). For example, Sztal-Mazer et al found that patients treated with ≤ 15 mCi experienced a 26% failure rate (18). After the period of this study, our institution standardized its practice and now only gives doses greater than 8 mCi.…”

Section: Discussionsupporting

confidence: 88%

“…The failure rate for RAI reported here is slightly higher than the range reported in the literature of 14–20% (16, 18, 20, 24–26). This is likely a reflection of the variability in treatment strategies used by the physicians at our institution and the lack of a formal dosing algorithm.…”

Section: Discussioncontrasting

confidence: 69%

“…Others have defined successful or failed treatment of hyperthyroidism based on thyroid function studies at defined time points (16–18). Here, we did not make any divisions between persistence and recurrence, and instead opted for a more all-encompassing examination of failure of RAI.…”

Section: Discussionmentioning

confidence: 99%

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Failure of Radioactive Iodine in the Treatment of Hyperthyroidism

et al. 2014

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Introduction Persistent or recurrent hyperthyroidism after treatment with radioactive iodine (RAI) is common, and many patients require either additional doses or surgery before they are cured. The purpose of this study was to identify patterns and predictors of failure of RAI in patients with hyperthyroidism. Methods We conducted a retrospective review of patients treated with RAI from 2007–2010. Failure of RAI was defined as receipt of additional dose(s) and/or total thyroidectomy. Using a Cox proportional hazards model, we conducted univariate analysis to identify factors associated with failure of RAI. A final multivariate model was then constructed with significant (p < 0.05) variables from the univariate analysis. Results Of the 325 patients analyzed, 74 patients (22.8%) failed initial RAI treatment. 53 (71.6%) received additional RAI, 13 (17.6%) received additional RAI followed by surgery, and the remaining 8 (10.8%) were cured after thyroidectomy. The percentage of patients who failed decreased in a step-wise fashion as RAI dose increased. Similarly, the incidence of failure increased as the presenting T3 level increased. Sensitivity analysis revealed that RAI doses < 12.5 mCi were associated with failure while initial T3 and free T4 levels of at least 4.5 pg/mL and 2.3 ng/dL, respectively, were associated with failure. In the final multivariate analysis, higher T4 (HR 1.13, 95% CI 1.02–1.26, p=0.02) and methimazole treatment (HR 2.55, 95% CI 1.22–5.33, p=0.01) were associated with failure. Conclusions Laboratory values at presentation can predict which patients with hyperthyroidism are at risk for failing RAI treatment. Higher doses of RAI or surgical referral may prevent the need for repeat RAI in selected patients.

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Section: Discussionsupporting

confidence: 88%

Section: Discussioncontrasting

confidence: 69%

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Failure of Radioactive Iodine in the Treatment of Hyperthyroidism

et al. 2014

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“…The remission rate for adults was comparable to a recent study by Schneider et al 2 and other studies. 21–23 Of those failing initial RAI who opted for operative treatment, all were successfully treated.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of radioactive iodine versus thyroidectomy for definitive treatment of Graves disease

Lorenzen

Beck

et al. 2017

Surgery

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Background Management of Graves disease includes antithyroid drugs, 131I therapy, or thyroidectomy. Our aim was to review our institutional experience with definitive treatments for Graves disease. Methods This was a retrospective review of patients undergoing 131I therapy (n = 295) or thyroidectomy (n = 103) for Graves disease (2003–2015). Demographic, clinical, pathology, and outcome data were collected from institutional databases. Results 131I therapy patients were older (39.1 years vs 33.4 years, P = .001). There was no difference in the presence of ophthalmopathy between groups. A larger proportion of children received thyroidectomy than 131I therapy (17.1% vs 9.2%, P = .026). The success rate of the first 131I therapy dose was 81.4%. Overall success rate, including additional doses, was 90.1%. Rapid turnover of iodine correlated with 131I therapy failure (58.3% rapid turnover failure vs 14.9% non–rapid turnover failure, P < .05). All surgical patients underwent total or near-total thyroidectomy. 131I therapy complications included worsening thyrotoxicosis (1%) and deteriorating orbitopathy (0.7%). Operative complications were higher than 131I therapy complications (P < .05) but were transient. There was no worsening orbitopathy or recurrent Graves disease among surgical patients. Conclusion A higher proportion of pediatric Graves disease patients underwent thyroidectomy than 131I therapy. Rapid turnover suggested more effective initial management with operation than 131I therapy. Although transient operative complications were high, 131I therapy complications included worsening of Graves orbitopathy among those with pre-existing orbitopathy.

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“…[1213] Recently, the American Thyroid Association and American Association of Clinical Endocrinologists Taskforce on Hyperthyroidism and Other Causes of Thyrotoxicosis proposed that radiation should be administered in a single dose, typically 370 to 555 MBq, to render the patient with Graves’ disease euthyroid. It also recommended that no patient should be treated with a dose less than 370 MBq.…”

mentioning

confidence: 99%

Thyrotoxicosis and radioiodine therapy: Does the dose matter?

Collier¹

2012

Indian J Endocr Metab

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Evidence for Higher Success Rates and Successful Treatment Earlier in Graves' Disease with Higher Radioactive Iodine Doses

Cited by 24 publications

References 19 publications

Failure of Radioactive Iodine in the Treatment of Hyperthyroidism

Failure of Radioactive Iodine in the Treatment of Hyperthyroidism

Comparative analysis of radioactive iodine versus thyroidectomy for definitive treatment of Graves disease

Thyrotoxicosis and radioiodine therapy: Does the dose matter?

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