Low-Dose Radioiodine Given Six-Monthly in Graves' Disease

Hoskin, P.; Spathis, G.S.; McCready, V. R.; Cosgrove, David O.; Harmer, C.

doi:10.1177/014107688507801103

Cited by 8 publications

(6 citation statements)

References 12 publications

(7 reference statements)

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“…In a previous report [9] the mean time to become euthyroid after a single treatment with 131I was 5.1 months; however, Fig. 5 shows that, in the present study, a large range of values for the time to become euthyroid was observed.…”

Section: Discussioncontrasting

confidence: 80%

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Dose-response study on thyrotoxic patients undergoing positron emission tomography and radioiodine therapy

et al. 1994

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With the acknowledged problems associated with assessment of functioning thyroid mass and hence radiation dose, our policy had been to give 75 MBq iodine-131 at 6-monthly intervals to patients with Graves' disease until they became euthyroid. Since positron emission tomography (PET) has been available at this hospital, the radiation dose to the thyroid has been calculated with an accuracy of approximately 20%, the thyroid mass being determined from an iodine-124 PET scan. A dose-response study has been carried out on 65 patients who have received single or cumulative radiation doses of < 80 Gy. The results show that patients who receive a low radiation dose (< 20 Gy) at their first treatment have a high probability of remaining toxic at 12 months. In contrast, patients who receive higher radiation doses (> 40 Gy) at their first treatment have a high probability of control. The probability of becoming euthyroid increases more rapidly with increasing radiation dose than the probability of becoming hypothyroid. Following this dose-response study, a new treatment protocol has been introduced. A 124I PET tracer study prior to 131I therapy will be performed to enable a prescribed thyroid dose of 50 Gy to be delivered to patients with Graves' disease. Further 131I therapy will only be considered if patients are still toxic at 12 months.

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Section: Discussioncontrasting

confidence: 80%

“…Nevertheless, when offered a choice, the patient usually opts for this form of treatment. We have also found that 6-monthly scheduling of low-dose radioiodine in Graves' disease reduces the time taken to become euthyroid compared with yearly low-dose treatments [9].…”

Section: Introductionmentioning

confidence: 61%

Dose-response study on thyrotoxic patients undergoing positron emission tomography and radioiodine therapy

et al. 1994

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“…Darüber hinaus werden mit unterschiedlicher Frequenz hyperthyreote Exazerbationen und unbefriedigende Strumaregressionen registriert. Da alle Verfahren einer Dosisberechnung erfahrungsgemäß unter erheblichen, aber unvermeidlichen Ungenauigkeiten leiden, wuchs insbesondere für die Behandlung von Hyperthyreosen die Tendenz zu einer möglichst geringen Anfangsdosierung, um stufenweise ein Optimum zu erreichen (2,13,14,21,22). Auch dabei mußten Ineffekti-vitäten der Therapie hingenommen werden (21,25) oder es wurden selektiv nur leichtere Fälle mit kleiner Struma mit niedrigen Aktivitäten fraktioniert, die übrigen sogleich höher dosiert behandelt (21).…”

Section: Patienten Und Methodenunclassified

“…Abweichend von der meist geübten sog. Einzeittherapie (4, 6, 7, 9, 11, 23, 24, 31) wurden nach früherer Erarbeitung einer Fraktionierung dieses Verfahrens (17) (27) und nach jeder Form einer Radiojodtherapie stetig kumulieren kann (1,8,11,14,22,23,25).…”

Section: Introductionunclassified

Ergebnisse der fraktionierten Radiojodtherapie bei 696 Hyperthyreosen und 690 blanden Strumen

Klein¹,

Klein²,

Horster³

1989

Nuklearmedizin

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During the course of twenty years 696 patients with hyperthyroidism and 690 cases of non-toxic goitre were treated with 1311 in fractionated activities and controlled on an average 4,4 (1-18) years later. Treatment strategy included three special features: a. the first and any further activity amounted to not more than 1.85 MBq per g estimated thyroid weight; b. each therapeutic activity was accompanied by oral prednisone or prednisolone for 2-6 weeks; and c. after completion of radiotherapy each patient was put on thyroid medication which was not interrupted for purposes of control. Therefore, the rate of postirradiation hypothyroidism could not be determined. All patients were found to be permanently euthyroid and none of the former hyperthyroidisms had relapsed. 84% of the hyperthyroid goitres and 78% of the non-toxic goitres had disappeared completely, 14% and 21 %, respectively, were markedly reduced. Complete disappearance of the goitre was achieved with the first 1311 activity in 35% of the patients with hyperthyroidism and in 48% of the nontoxic goitres, whereas 34% of the first and 35% of the second group required a second activity; the rest received three or more activities. The mean total activities of1311 necessary for complete reduction of the goitres depended on their size and amounted to 292, 507 and 1136 MBq, respectively, in euthyroid goitres with sizes I, II and III. The corresponding figures in hyperthyroid goitres were 403, 577 and 1129 MBq, respectively. 314 patients had endocrine ophthalmopathy which was cured in 54% and significantly improved in 37%.

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“…Gradual application of small radioiodine activities, i.e. 74MBq (2mCi) every 6 or 12 months until the patient becomes euthyroid, is also commonly used for radioiodine treatment [29,30]. However, this approach primarily aims at achieving normal thyroid function and accepts the persistence of hyperthyroidism in a substantial number of patients.…”

Section: Introductionmentioning

confidence: 99%

Radioiodine therapy of Graves' hyperthyroidism: standard vs. calculated ¹³¹ iodine activity*. Results from a prospective, randomized, multicentre study

Peters

Fischer²,

Bogner

et al. 1995

Eur J Clin Investigation

167

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The present prospective, randomized, multicentre study was performed to directly compare for the first time the effectiveness of a standard activity of 555 MBq 131iodine vs. an activity calculated to deliver 100 Gy for treatment of Graves' thyrotoxicosis. Therapeutic success was defined as the elimination of hyperthyroidism 6 months after radioiodine application (range 4.5-8 months). A success rate of more than 90% in eliminating hyperthyroidism was reported for both approaches, but only in retrospective investigations. Investigated prospectively, hyperthyroidism was eliminated in only 71% of the patients receiving standard activity (70/98) and 58% of those randomized for calculated activity (62/107). In the patients with standard activity, therapeutic success was inversely related to thyroid size. The rate was 100% for thyroid volumes < or = 15 mL, 95% for 16-30 mL, 68% for 31-45 mL, 44% for 46-50 mL, 20% for 61-75 mL and 25% for > or = 75 mL. In those patients with an activity calculated to deliver 100 Gy (except in those with a volume < or = 15 mL) this size/outcome dependency was almost compensated. The rates were 86%, 65%, 45%, 61%, 41% and 45%, respectively. Furthermore, detailed statistical analysis revealed a strong correlation between the success of therapy and the radiation dose actually absorbed by the thyroid. The rate was 11% for a target dose of 50 Gy, 50% for 100 Gy, 67% for 150 Gy, 80% for 200 Gy, 84% for 250 Gy, 88% for 300 Gy, 90% for 350 Gy and 93% for 400 Gy.(ABSTRACT TRUNCATED AT 250 WORDS)

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Low-Dose Radioiodine Given Six-Monthly in Graves' Disease

Cited by 8 publications

References 12 publications

Dose-response study on thyrotoxic patients undergoing positron emission tomography and radioiodine therapy

Dose-response study on thyrotoxic patients undergoing positron emission tomography and radioiodine therapy

Ergebnisse der fraktionierten Radiojodtherapie bei 696 Hyperthyreosen und 690 blanden Strumen

Radioiodine therapy of Graves' hyperthyroidism: standard vs. calculated ¹³¹ iodine activity*. Results from a prospective, randomized, multicentre study

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Low-Dose Radioiodine Given Six-Monthly in Graves' Disease

Cited by 8 publications

References 12 publications

Dose-response study on thyrotoxic patients undergoing positron emission tomography and radioiodine therapy

Dose-response study on thyrotoxic patients undergoing positron emission tomography and radioiodine therapy

Ergebnisse der fraktionierten Radiojodtherapie bei 696 Hyperthyreosen und 690 blanden Strumen

Radioiodine therapy of Graves' hyperthyroidism: standard vs. calculated 131 iodine activity*. Results from a prospective, randomized, multicentre study

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Radioiodine therapy of Graves' hyperthyroidism: standard vs. calculated ¹³¹ iodine activity*. Results from a prospective, randomized, multicentre study