Factors Predicting Treatment Failure in Patients Treated with Iodine-131 for Graves′ disease

Kuruva, Manohar; Mittal, Bhagwant Rai; Bhoil, Amit; Bhattacharya, Anish; Dutta, Pinaki; Bhansali, Anil

doi:10.4103/1450-1147.136693

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…Studies evaluating remission factors in patients with Grave's disease in India have been very few[ 10 11 ] and none from South India. Even in western literature, large studies evaluating factors associated with remission in Grave's disease are few.…”

Section: Discussionmentioning

confidence: 99%

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Technetium uptake predicts remission and relapse in Grave's disease patients on antithyroid drugs for at least 1 year in South Indian subjects

Singhal

Pavithran

Bhavani

et al. 2016

Indian J Endocr Metab

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Context:Most of the information on remission related factors in Grave's disease are derived from Western literature. It is likely that there may be additional prognostic factors and differences in the postdrug treatment course of Grave's disease in India.Aim:To study factors which predict remission/relapse in Grave's disease patients from South India. Also to establish if technetium (Tc) uptake has a role in predicting remission.Subjects and Methods:Records of 174 patients with clinical, biochemical, and scintigraphic criteria consistent with Grave's disease, seen in our Institution between January 2006 and 2014 were analyzed. Patient factors, drug-related factors, Tc-99m uptake and other clinical factors were compared between the remission and nonremission groups.Statistical Analysis Used:Mann–Whitney U-test and Chi-square tests were used when appropriate to compare the groups.Results:Fifty-seven (32.7%) patients attained remission after at least 1 year of thionamide therapy. Of these, 11 (19.2%) patients relapsed within 1 year. Age, gender, goiter, and presence of extrathyroidal manifestations were not associated with remission. Higher values of Tc uptake were positively associated with remission (P- 0.02). Time to achievement of normal thyroid function and composite dose: Time scores were significantly associated with remission (P - 0.05 and P - 0.01, respectively). Patients with lower FT4 at presentation had a higher chance of remission (P - 0.01). The relapse rates were lower than previously reported in the literature. A higher Tc uptake was found to be significantly associated with relapse also (P - 0.009).Conclusion:The prognostic factors associated with remission in Graves's disease in this South Indian study are not the same as that reported in Western literature. Tc scintigraphy may have an additional role in identifying people who are likely to undergo remission and thus predict the outcome of Grave's disease.

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Section: Discussionmentioning

confidence: 99%

“…[ 16 ] Studies have also been conducted to study the association of Tc uptake with treatment success with a single dose of Iodine 131. [ 11 ] They found that patients with high pretreatment 99mT cO 4 − uptake are more likely to require repeated doses of 131I to achieve complete remission.…”

Section: Discussionmentioning

confidence: 99%

Technetium uptake predicts remission and relapse in Grave's disease patients on antithyroid drugs for at least 1 year in South Indian subjects

Singhal

Pavithran

Bhavani

et al. 2016

Indian J Endocr Metab

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“…The only criterion for the in-efficiency of RIT in this study was the index of radiopharmaceutical capture during scintigraphy of the thyroid gland with 99m Tc-Pertechnetate. So, in patients with radiopharmaceutical absorption at the 20 minute of the study more than 17.75%, the risk of development of thyrotoxicosis recurrence was 3 times higher (OR 3.14; p = 0.014) [7]. A high level of thyroid uptake can reflect on the rapid turnover of iodide in thyrocytes, which reduces the time spent in them by therapeutic I 131 , which in turn leads to treatment failure.…”

Section: Discussionmentioning

confidence: 96%

“…The results of different studies indicate that, despite the high effectiveness of RIT, in 17-20 % of cases after treatment, develops thyrotoxicosis recurrence [6,7]. There are no specific recommendations for the GD recurrence after RIT prevention; also, there are no unified criteria for prescribing therapeutic activity of radioactive iodine.…”

Section: Introductionmentioning

confidence: 99%

Прогностическое Значение Факторов Риска Развития Рецидива Тиреотоксикоза При радиойодотерапии

Ubaydullaeva¹,

Allayarova²,

Almuradov³

2021

Mìžnarodnij endokrinologìčnij žurnal

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Актуальность. Болезнь Грейвса — системное аутоиммунное заболевание, развивающееся в результате выработки антител к рецептору тиреотропного гормона, что клинически проявляется диффузными структурными изменениями щитовидной железы с развитием синдрома тиреотоксикоза, а также сочетается с экстратиреоидными проявлениями. Целью исследования было выявление факторов риска рецидива болезни Грейвса у женщин, получавших терапию радиоактивным йодом. Материалы и методы. Под наблюдением находились 93 женщины репродуктивного возраста, получавшие радиойодотерапию (РЙТ). Мы проанализировали результаты анкетирования, оценили факторы риска рецидива тиреотоксикоза и провели ретроспективный и проспективный анализ клинических показателей и данных анамнеза. Средний возраст пациентов составил 36,9 ± 7,1 года. Контрольную группу составили 35 здоровых женщин в возрасте 33,5 ± 7,6 года. Уровни тиреотропного гормона, свободного трийодотиронина, свободного тироксина и антител к тиреоидной пероксидазе определяли иммунохемилюминесцентным методом. Результаты. Чтобы оценить качество прогностической модели рецидива тиреотоксикоза, мы рассчитали все параметры факторов риска AUC. Наиболее значимыми факторами риска развития рецидива тиреотоксикоза после РЙТ с высоким относительным риском были возраст старше 30 лет (ОР = 7,59; EF = 8,82 %), объем щитовидной железы ≥ 30 см3 (ОР = 6,84; EF = 85,38 %), продолжительность лечения ≥ 2 лет (ОР = 6,37; EF = 84,30 %), комплайентность пациента (ОР = 6,19; EF = 83,84 %), количество процедур РЙТ (ОР = 5,74; EF = 82,58 %) и доза РЙТ 300 МБк (ОР = 5,41; EF = 81,52 %). Выводы. Установлено, что возраст старше 30 лет (AUC — 0,88), объем щитовидной железы ≥ 30 см3 (AUC — 0,86), продолжительность лечения ≥ 2 лет (AUC — 0,86), комплайентность пациента (AUC — 0,85), число процедур РЙТ (AUC — 0,85) и доза I131 (AUC — 0,82) имеют первостепенное значение.

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“…[ 14 15 17 ] However, there are some published studies elucidating male gender as a risk factor for ablation failure. [ 12 13 18 ]…”

Section: Discussionmentioning

confidence: 99%

Predictive value of pyramidal lobe, percentage thyroid uptake and age for ablation outcome after 15 mCi fixed dose of radioiodine-131 in Graves' disease

et al. 2015

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Purpose:The purpose was to find out the efficacy of fixed 15 mCi radioactive iodine-131 (RAI) dose and predictive values of various factors for inducing hypothyroidism in Graves’ disease (GD).Materials and Methods:Retrospective study conducted from January 2012 till August 2014. Patients with GD who had a technetium-99m thyroid scan, thyroid antibodies, received fixed 15 mCi RAI and did follow endocrine clinics for at least 6 months were selected. RAI was considered successful if within 6 months of RAI therapy patients developed hypothyroidism.Results:Of the 370 patients with GD who had RAI during study period, 210 (57%) qualified study criteria. Mean age of patients was 48 ± 15 years with female: male ratio of 69:31, positive thyroid antibodies in 61%, means thyroid uptake of 15.09 ± 11.23%, and presence of pyramidal lobe in 40% of total population. Hypothyroidism was achieved in 161 (77%) patients while 49 (23%) patients failed to achieve it (remained either hyperthyroid or euthyroid on antithyroid medication). Patients who became hypothyroid were significantly younger with higher proportion of presence of thyroid antibodies and pyramidal lobe and lower percentage thyroid uptake than those who failed. Multiple logistic regression analysis revealed that age (odds ratio; OR = 2.074), pyramidal lobe (OR = 3.317), thyroid antibodies (OR = 8.198), and percentage thyroid uptake (OR = 3.043) were found to be significant prognostic risk factors for post-RAI hypothyroidism. Gender was found to have nonsignificant association with the development of hypothyroidism. Receiver operating characteristic analysis revealed age <42 years and thyroid uptake <15% as threshold values for the development of post-RAI hypothyroidism.Conclusion:We conclude that fixed (15 mCi) RAI dose is highly effective in rendering hypothyroidism in patients with GD. Age (≤42 years), thyroid uptake (≤15%) and presence of pyramidal lobe are strong predictors of hypothyroidism and must be considered for selecting optimal RAI dose.

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Factors Predicting Treatment Failure in Patients Treated with Iodine-131 for Graves′ disease

Cited by 7 publications

References 15 publications

Technetium uptake predicts remission and relapse in Grave's disease patients on antithyroid drugs for at least 1 year in South Indian subjects

Technetium uptake predicts remission and relapse in Grave's disease patients on antithyroid drugs for at least 1 year in South Indian subjects

Прогностическое Значение Факторов Риска Развития Рецидива Тиреотоксикоза При радиойодотерапии

Predictive value of pyramidal lobe, percentage thyroid uptake and age for ablation outcome after 15 mCi fixed dose of radioiodine-131 in Graves' disease

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