Iodine‐131 treatment of hyperthyroidism: current issues

Farrar, Jeremy; Toft, A. D.

doi:10.1111/j.1365-2265.1991.tb03523.x

Cited by 67 publications

(37 citation statements)

References 57 publications

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“…However, compliance may be poor. Since radiation exposure after the 10th week of gestation may cause fetal hypothyroidism, leading to therapeutic abortion (16), lobectomy may be favored even more strongly in women under 50 years of age.…”

Section: Discussionmentioning

confidence: 99%

“…In the base-case analysis, we assumed no increased risk of thyroid cancer in patients receiving RAI. RAI exposure after the 10th week of gestation may cause fetal hypothyroidism and may be an indication for therapeutic abortion (16,69).…”

Section: Data Used In the Modelmentioning

confidence: 99%

“…Furthermore, long-term carcinogenic risk or genetic injury resulting from RAI remain, at this time, only theoretical concerns. Finally, some authors consider RAI to be the least expensive treatment for hyperthyroidism and encourage its greater use (16). Longterm therapy with antithyroid drugs (ATDs) is seldom used because, while surgery and RAI will cure the patient, ATDs will never do so due to the intrinsic nature of the adenoma (neoplasm generally due to a somatic mutation of the thyrotropin (TSH) receptor).…”

Section: Introductionmentioning

confidence: 99%

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Managing toxic thyroid adenoma: a cost-effectiveness analysis

2002

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Objective: To examine the cost-effectiveness of therapeutic strategies for patients with toxic thyroid adenoma. Design: A decision analytic model was used to examine strategies, including thyroid lobectomy after a 3-month course of antithyroid drugs (ATDs), radioactive iodine (RAI), and lifelong ATDs followed by either RAI (ATD-RAI) or surgery (ATD-surgery) in patients suffering severe drug reactions. Methods: Outcomes were measured in quality-adjusted life years. Data on the prevalence of co-incident thyroid cancer, complications and treatment efficacies were derived from a systematic review of the literature (1966 -2000). Costs were examined from the health care system perspective. Costs and effectiveness were examined at their present values. Discounting (3% per year), variations of major cost components, and every variable for which disagreements exist among studies or expert opinion were examined by sensitivity analyses. Results: For a 40-year-old woman, surgery was both the most effective and the least costly strategy (e1391),while ATD-RAI cost the most (e5760). RAI was more effective than surgery if surgical mortality exceeded 0.6% (base-case 0.001%). RAI become less costly for women of more than 72 years (more than 66 in discounted analyses). For women of 85, ATD-RAI may be more effective than RAI and have an inexpensive marginal cost-effectiveness ratio (e4975) if lifelong follow-up results in no decrement in quality of life. Conclusions: Age, surgical mortality, therapeutic costs and patient preference must all be considered in choosing an appropriate therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Data Used In the Modelmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Managing toxic thyroid adenoma: a cost-effectiveness analysis

2002

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“…Toxic MNG is relatively resistant to RAI treatment requiring doses higher than widely appreciated and, unlike Graves' disease, hypothyroidism is relatively uncommon (21). There remains controversy regarding the outcome following RAI in patients with STN, with some studies reporting STN to be more radio-resistant compared with Graves' disease (22), whereas others failed to observe an excess of persistent hyperthyroidism in patients with STN (11). In our series of patients, 77.4% patients with Graves' disease became hypothyroid compared with 39.3% and 33.3% with STN and MNG respectively.…”

Section: Factors Regression Coefficient (B )mentioning

confidence: 99%

Objective estimates of the probability of developing hypothyroidism following radioactive iodine treatment of thyrotoxicosis

Ahmad

Young

2002

European Journal of Endocrinology

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Objective: Several risk factors have been shown individually to influence the outcome following radioactive iodine (RAI) therapy in the treatment of hyperthyroidism. However, no attempt has been made to determine their independent prognostic values that could be used in a regression model to provide objective estimates of the probability of developing hypothyroidism. Study design and methods: We audited records of all hyperthyroid patients treated with first dose RAI between 1980 and 1996. Patients were aetiologically categorized into Graves' disease, solitary toxic nodule and toxic multinodular goiter. Following RAI, outcome was categorized as hypothyroidism, euthyroidism and persistent hyperthyroidism. Multiple logistic regression analysis was used to identify significant risk factors, their prognostic values and probability estimates of developing hypothyroidism in the presence of one or more of these factors. Results: The cumulative incidence of hypothyroidism was 55.8% at 1 year and 86.1% at 10 years. Graves' disease (odds ratio: 4.29), presence of thyroid autoantibodies (odds ratio: 3.51), no antithyroid treatment given prior to RAI (odds ratio: 2.50), non-palpable goiter (odds ratio: 2.48) and high RAI dose (odds ratio: 1.90), were identified as significant independent risk factors. We then developed a predictive table that provides objective estimates of developing hypothyroidism. In the absence of all risk factors we can predict an 11.9% probability of developing hypothyroidism; this increases linearly to a 96.4% probability in the presence of all factors. Conclusions: These objective estimates would help in understanding the relative contributions of the known risk factors, and to predict the probability of developing hypothyroidism following RAI treatment. This would not only help patients make an informed consent for a treatment that would lead to life-long replacement therapy but may also prove useful in calculating the RAI dose that may reduce or delay the onset of developing hypothyroidism.

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“…Radioiodine (131I) is widely used in treating the hyper¬ thyroidism of Graves' disease, and has been found to be safe and highly effective (1,2). The only significant com¬ plication associated with 131I is hypothyroidism, which continues to occur at a linear rate throughout life (3).…”

Section: Introductionmentioning

confidence: 99%

Antithyroid Drugs Inhibit Radioiodine-Induced Increases in Thyroid Autoantibodies in Hyperthyroid Graves' Disease

Nakazato

Yoshida²,

Mori³

et al. 1999

Thyroid

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Methimazole (MMI) has been reported to affect prognosis in hyperthyroid Graves' disease patients treated with radioiodine (131I). In the present study, serum concentrations of thyroxine (T4), triiodothyronine (T3), thyroglobulin (Tg), thyrotropin-binding inhibitory immunoglobulin (TBII), thyroglobulin antibody (TgAb), and thyroid-peroxidase antibody (TPOAb) were measured serially for 1 year in patients with Graves' disease after 131I treatment either given alone (group 1, 41 patients) or followed by an antithyroid drug (group 2, 19 patients). The effect of antithyroid drugs on these parameters was analyzed retrospectively. Mean serum concentrations of T4 and T3 both decreased to normal within 3 months after 131I treatment in both groups. Serum Tg concentrations in group 1 showed significant transient increases (about four times the basal value) 1 month after 131I administration. Titers of TBII, TgAb, and TPOAb in group 1 also increased transiently after 131I treatment, with the maximum increase at 3 months. Antithyroid drugs significantly lessened 131I-induced increases in serum concentrations of Tg and all thyroid autoantibodies tested. One year after 131I treatment, 33 of 41 patients (80%) were euthyroid or hypothyroid in group 1; this was true for only 4 of 19 group II patients (22%). The results indicate that administering antithyroid drugs after 131I treatment reduced 131I-induced damage to the thyroid and reduced therapeutic efficacy of 131I in hyperthyroidism. Drug treatment also inhibited release of Tg and blunted 131I-induced increases in titers of thyroid autoantibodies.

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Iodine‐131 treatment of hyperthyroidism: current issues

Cited by 67 publications

References 57 publications

Managing toxic thyroid adenoma: a cost-effectiveness analysis

Managing toxic thyroid adenoma: a cost-effectiveness analysis

Objective estimates of the probability of developing hypothyroidism following radioactive iodine treatment of thyrotoxicosis

Antithyroid Drugs Inhibit Radioiodine-Induced Increases in Thyroid Autoantibodies in Hyperthyroid Graves' Disease

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