Influence of iodine application during radioiodine therapy in case of impending therapy failure

Urbannek, V.; Schmidt, Matthias; Moka, D.; Hillger, H.; Voth, E.; Wellner, U.; Schicha, H.

doi:10.1055/s-0038-1632255

Cited by 12 publications

(14 citation statements)

References 10 publications

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“…Graves' disease and radioiodine therapy of apreliminary radioiodine test and therapeutic dosimetry ( 11). At ime-activitycurved rawn beforeR IT using formula II will reveal anyunexpected discrepancybetween the preliminary radioiodine test and RITa ta ne arly stage, allowing as econd radioiodine capsule or aphysiologicaldose of inactive iodine (e.g.600 µg 127 Ifor three days)t ob ea dministereds hould the effective half-lifeofradioiodinefallbelow three to four days (5,23). Furthermore,the electronic database will allowm ore accurate andstandardizedmonitoring of the success rate of RIT in Graves' disease.…”

Section: Graves'diseaseand Radioiodinetherapymentioning

confidence: 99%

Graves' disease and radioiodine therapy

Kobe

Eschner²,

Sudbrock³

et al. 2008

Nuklearmedizin

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SummaryAim: This study was performed to determine the results of ablative radioiodine therapy (RIT) when the achieved dose in the thyroid was above 200 Gy and to characterize predictive factors for treatment outcome. Patients, methods: A total of 571 consecutive patients were observed for 12 months between July 2001 and June 2004. Inclusion criteria were a confirmed diagnosis Graves' disease, compensation of hyperthyroidism and withdrawal of antithyroid drugs two days before preliminary radioiodine-testing and RIT. The intended dose was 250 Gy and the therapeutically achieved dose was calculated from serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The relation between success rate and the achieved dose, thyroid volume, age and sex of patients, TSH- and TRAb-values and presence of ophthalmopathy was analysed. Results: Relief from hyperthyroidism was achieved in 96% of patients who received more than 200 Gy, even for thyroid volumes >40 ml. The success of ablative RIT was not influenced by age or sex of patients, or by TSH- or TRAb values or concomitant ophthalmopathy. The mean achieved dose in the thyroid was 298 Gy with a standard deviation of 74.6 Gy. Conclusion: To achieve a dose of over 200 Gy with the above standard deviation, we recommend calculating an intended dose of 250 Gy and using a dosimetric approach with early and late uptake values in the radioiodine test, to allow early therapeutic intervention should the posttherapeutic thyroid dose fall unexpectedly below 200 Gy.

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Section: Graves'diseaseand Radioiodinetherapymentioning

confidence: 99%

Graves' disease and radioiodine therapy

Kobe

Eschner²,

Sudbrock³

et al. 2008

Nuklearmedizin

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“…Der Stationsarzt hat dabei jederzeit weitgehende Kontrolle über das rechnerische Vorgehen: Er kann festlegen, welche Messpunkte zur Bestimmung der effektiven HWZ herangezogen werden sollen; er kann auch über die Eingabe einer ¹fiktiven HWZª ausrechnen lassen, ob eine erwartete Verlängerung der Halbwertzeit durch Gabe kalten Iods [36]…”

Section: Dosimetrie Bei Der Radioiodtherapieunclassified

“…noch während des gleichen stationären Aufenthaltes durch eine Nachtherapie bzw. die Gabe von inaktivem Iod-127 ausgleichen lassen [36].…”

Section: Introductionunclassified

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Prä- und peritherapeutische Dosimetrie bei der Radioiodtherapie benigner Schilddrüsenerkrankungen

Eschner¹,

Moka²

2004

Der Nuklearmediziner

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ZusammenfassungBei der Radioiodtherapie (RIT) benigner Schilddrüsenerkrankun-gen ist in Deutschland eine prätherapeutische Behandlungsplanung und eine peritherapeutische Dosimetrie gesetzlich vorgeschrieben. Ziel dieser Vorgaben ist neben einer allgemeinen Qualitätssicherung die Optimierung der Therapie in Bezug auf das Erreichen der gewünschten Dosis im Zielvolumen bei gleichzeitiger Minimierung der Strahlenexposition für die anderen Gewebe. Bei der prätherapeutischen Bestimmung der Therapieaktivität mittels eines Radioiodtestes werden zwei Möglichkeiten diskutiert: der Kurzzeit-Radioiodtest mit I-123 nur mit Bestimmung des 24 h-Iod-Uptakes bei Verwendung einer Standardhalbwertszeit gegenüber dem Langzeit-Radioiodtest mit I-131 mit Bestimmung sowohl des 24 h-Iod-Uptakes als auch der effektiven Halbwertszeit. Dabei ist der Langzeittest zu bevorzugen, da nur er eine individuell auf den Patienten bezogene Behandlungsplanung erlaubt. Bei der peritherapeutischen Dosimetrie wird eine engmaschige Kontrolle der Schilddrüsen-und ggf. der Ganzkörperaktivität während des stationären Aufenthalts empfohlen, da nur so eine schnelle Reaktion auf eine veränderte Iodkinetik möglich ist. Die RIT sollte nach Absetzen der Thyreostase durchgeführt werden, da hierdurch geringere Therapieaktivitäten nötig sind und somit eine geringere Strahlenexposition auûerhalb des Zielvolumens auftritt. Schlüsselwörter Radiiodtherapie´Dosimetrie´Radioiodtest´benigne Schilddrü-senerkrankung AbstractFor treatment of benign thyroid diseases with radioiodine pretherapeutic therapy planning and peri-therapeutic dosimetry is mandatory by law in Germany in order to improve quality control, energy dose calculation in the thyroid and reduce radiation exposure of the residual body tissue. For pre-therapeutic determination of therapy activity by use of use a radioiodine (RI) test, two different test methods are possible: a short-time RI-test with I-123 using a calculated standard half-life for RI and determining only the 24 h uptake of RI in the thyroid, and a long-term RI-test using I-131 with both determination of the uptake and the effective half-life of RI. However, for precise, individual therapy planning the long-term RI-test proved to be the most accurate procedure. For peri-therapeutic dosimetry frequent in-patient measurements of the activity both of the thyroid and of the whole body are advisable because only with that a fast reaction to a shorttime altered kinetics of RI is possible. Thyrostatic medication should be withdrawn before RI treatment for reduction of therapy activities resulting in lower whole body radiation exposure.

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“…Diese Beratungspraxis hält einer wissenschaftlichen Risikoanalyse nicht Stand. Medizinisch sinnvoll und zugleich kosteneffektiv ist eine risikoadaptierte Beratung (61,62 (42,73,82). Hierdurch lässt sich die Rate an zweizeitigen Radioiodapplikationen während des gleichen stationären Aufenthaltes verringern (34,68).…”

Section: Primärtherapie Des Morbus Basedowunclassified

Prevention, screening and therapy of thyroid diseases and their cost-effectiveness

Dietlein¹,

Moka²,

Schmidt³

et al. 2003

Nuklearmedizin

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Summary:Cost-effectiveness analyses focused on benign thyroid diseases are under-represented in the literature. The calculation of costs per additionally gained life year is difficult: The benefit of prevention is shifted into the distant future. The influence of an untreated subclinical thyroid disease on life expectancy can only be demonstrated by a long-term follow-up and by epidemiological databases. Iodine supplementation and programs for the prevention of tobacco smoking (primary prevention) are very cost-effective. Smoking increases the risk both of multinodular goiter and of Graves’ disease. Screening programs (secondary prevention) are discussed for the laboratory parameters thyrotropin (TSH), calcium and calcitonin. TSH testing seems to be very cost-effective for epidemiological considerations in a certain lifespan (newborn, pregnancy, postpartal, older persons, hospitalisation due to acute diseases) and in persons with previously elevated TPO-antibodies or TSH-values >2 mU/l, but dedicated cost-effectiveness analyses are lacking. On the other hand, the cost-effectiveness of a routine TSH testing beyond the age of 35 years has been shown by a high-quality decision analysis. Therapeutic strategies (tertiary prevention) aim at the avoidance of complications (atrial fibrillation, myocardial infarction, death for cardiac reasons) and of iatrogenic complications. Examples of a tertiary prevention are: firstly the definitive therapy of Graves’ disease in patients who have an increased risk of relapse after antithyroid drugs (ATD), secondly the radioiodine therapy for subclinical hyperthyroidism and the radioiodine therapy of large goiters in older patients or in patients suffering from a relevant comorbidity. Cost-effectiveness analyses for different therapeutic strategies of Graves’ disease were published using a lifelong time-horizon. The ablative radioiodine dose-regime is cost-effective as a first line therapy if the risk of relapse after ATD exceeds 60%.

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Influence of iodine application during radioiodine therapy in case of impending therapy failure

Cited by 12 publications

References 10 publications

Graves' disease and radioiodine therapy

Graves' disease and radioiodine therapy

Prä- und peritherapeutische Dosimetrie bei der Radioiodtherapie benigner Schilddrüsenerkrankungen

Prevention, screening and therapy of thyroid diseases and their cost-effectiveness

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