Predictive factors of radioiodine therapy failure in Graves’ Disease: A meta-analysis

Shalaby, Mahmoud; Hadedeya, Deena; Toraih, Eman A.; Razavi, Michael; Lee, Grace S.; Hussein, Mohammad; Weidenhaft, Mandy; Serou, Michael; Ibraheem, Kareem; Abdelgawad, Mohamed; Kandil, Emad

doi:10.1016/j.amjsurg.2021.03.068

Cited by 7 publications

(7 citation statements)

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“…Therefore, it would be difficult to evaluate the effect of the RAI dose on remission. However, the RAI dose was not associated with the success of RAI therapy in previous studies [ 15 ].…”

Section: Discussionmentioning

confidence: 85%

“…Many previous researchers have made efforts to predict the success of the 1st RAI therapy. A recent meta-analysis reported that male sex, a longer time from GD diagnosis to RAI therapy (>6 months), previous ATD use, a higher free T4 level, a higher 24-hour RAIU (≥60%), and a larger thyroid volume (>35 mL) increased the risk of RAI therapy failure [ 15 ]. In this study, a longer time from GD diagnosis to RAI therapy and a larger goiter size were also significantly associated with failure of the 1st RAI therapy.…”

Section: Discussionmentioning

confidence: 99%

“…This study has the limitations inherent to retrospective studies. The initial thyroid hormone or anti-TSHR antibody levels at the time of GD diagnosis could not be collected and analyzed, because of the nature of a tertiary referral hospital, although previous studies have reported that free T4 or TSHR antibody levels at the time of diagnosis predicted remission [ 15 , 21 , 28 ]. Instead, the levels of free T4, TSH, and TSHR antibody just before RAI therapy were used in the analysis, but they did not predict remission after RAI therapy.…”

Section: Discussionmentioning

confidence: 99%

“…This may be be-Copyright © 2022 Korean Endocrine Society cause RAI therapy was performed as a second-line treatment. A meta-analysis showed that ATD use before RAI therapy had 1.48 to 2.05-fold higher risk of RAI treatment failure [14,15]. Park et al [19] also reported that the remission rate of RAI therapy as a second-line treatment was 63%.…”

Section: Discussionmentioning

confidence: 99%

“…The success rate of initial RAI therapy was reported to be 74% to 81% in a previous randomized controlled study [ 13 ], which is higher than that of ATD therapy. Nonetheless, the response rate of RAI is still limited, especially in patients with previous ATD use [ 14 , 15 ]. For this reason, some patients (6% to 10% of GD patients according to previous research) require repeated RAI therapy [ 10 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Repeated Radioactive Iodine Therapy for Graves’ Disease

et al. 2022

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Background: Radioactive iodine (RAI) therapy is a successful therapeutic modality for Graves’ disease. However, RAI therapy can fail, and RAI therapy after antithyroid drugs (ATDs) has a lower remission rate. Therefore, many patients require repeated RAI therapy. This study investigated the clinical outcomes of repeated RAI therapy for Graves’ disease.Methods: Patients who underwent RAI therapy as second-line therapy after failure of ATD treatment between 2001 and 2015 were reviewed. Remission was defined as hypothyroid or euthyroid status without ATD, and with or without levothyroxine at 12 months after RAI therapy.Results: The 1-year remission rate after 2nd RAI therapy (66%, 152/230) is significantly higher than that after 1st RAI therapy (48%, 393/815) or long-term ATD treatment after 1st RAI therapy failure (42%). The clinical response to 2nd RAI therapy was more rapid. The median time intervals from the 2nd RAI therapy to ATD discontinuation (1.3 months) and to the start of levothyroxine replacement (2.5 months) were significantly shorter than those for the 1st RAI therapy. A smaller goiter size, a longer time interval between the 1st and 2nd RAI therapies, and a longer ATD discontinuation period predicted remission after the 2nd RAI therapy. Finally, in 78 patients who failed the 2nd RAI therapy, the mean ATD dosage significantly reduced 5.1 mg over 12 months.Conclusion: Repeated RAI therapy can be a good therapeutic option, especially in patients with smaller goiters and those who are more responsive to the 1st RAI therapy.

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“…Therefore, it would be difficult to evaluate the effect of the RAI dose on remission. However, the RAI dose was not associated with the success of RAI therapy in previous studies [ 15 ].…”

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Repeated Radioactive Iodine Therapy for Graves’ Disease

et al. 2022

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Hyperthyroidism

Lee,

Pearce

2023

JAMA

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ImportanceOvert hyperthyroidism, defined as suppressed thyrotropin (previously thyroid-stimulating hormone) and high concentration of triiodothyronine (T3) and/or free thyroxine (FT4), affects approximately 0.2% to 1.4% of people worldwide. Subclinical hyperthyroidism, defined as low concentrations of thyrotropin and normal concentrations of T3 and FT4, affects approximately 0.7% to 1.4% of people worldwide. Untreated hyperthyroidism can cause cardiac arrhythmias, heart failure, osteoporosis, and adverse pregnancy outcomes. It may lead to unintentional weight loss and is associated with increased mortality.ObservationsThe most common cause of hyperthyroidism is Graves disease, with a global prevalence of 2% in women and 0.5% in men. Other causes of hyperthyroidism and thyrotoxicosis include toxic nodules and the thyrotoxic phase of thyroiditis. Common symptoms of thyrotoxicosis include anxiety, insomnia, palpitations, unintentional weight loss, diarrhea, and heat intolerance. Patients with Graves disease may have a diffusely enlarged thyroid gland, stare, or exophthalmos on examination. Patients with toxic nodules (ie, in which thyroid nodules develop autonomous function) may have symptoms from local compression of structures in the neck by the thyroid gland, such as dysphagia, orthopnea, or voice changes. Etiology can typically be established based on clinical presentation, thyroid function tests, and thyrotropin-receptor antibody status. Thyroid scintigraphy is recommended if thyroid nodules are present or the etiology is unclear. Thyrotoxicosis from thyroiditis may be observed if symptomatic or treated with supportive care. Treatment options for overt hyperthyroidism from autonomous thyroid nodules or Graves disease include antithyroid drugs, radioactive iodine ablation, and surgery. Treatment for subclinical hyperthyroidism is recommended for patients at highest risk of osteoporosis and cardiovascular disease, such as those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L.Conclusions and RelevanceHyperthyroidism affects 2.5% of adults worldwide and is associated with osteoporosis, heart disease, and increased mortality. First-line treatments are antithyroid drugs, thyroid surgery, and radioactive iodine treatment. Treatment choices should be individualized and patient centered.

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Predictors of Poor Response to Radioactive Iodine Treatment in Graves’ Disease

Kawkgi

2023

Clinical Thyroidology

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Predictive factors of radioiodine therapy failure in Graves’ Disease: A meta-analysis

Cited by 7 publications

References 34 publications

Clinical Outcomes of Repeated Radioactive Iodine Therapy for Graves’ Disease

Clinical Outcomes of Repeated Radioactive Iodine Therapy for Graves’ Disease

Hyperthyroidism

Predictors of Poor Response to Radioactive Iodine Treatment in Graves’ Disease

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