Radioiodine Treatment in Patients with Graves’ Disease

Ross, Douglas S.

doi:10.1007/978-1-4939-2534-6_7

Cited by 3 publications

(4 citation statements)

References 59 publications

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“…Разрушающее действие 131 I на ткань ЩЖ оказывают бета-частицы, которые обладают небольшой длиной пробега в тканях (1-3 мм) [1]. В литературе широко обсуждается вопрос о возможном ухудшении течения ЭОП после проведения РЙТ.…”

Section: Discussionunclassified

“…Радиойодтерапия (РЙТ) -эффективный, безопасный и экономически выгодный метод лечения пациентов с болезнью Грейвса (БГ) [1]. Целями РЙТ являются ликвидация тиреотоксикоза путем разрушения гиперфункционирующей ткани щитовидной железы (ЩЖ) и достижение стойкого гипотиреоидного состояния.…”

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Clinical and immunological predictors of Graves’ orbitopathy after radioiodine therapy of Graves’ disease

Sheremeta,

Bessmertnaya,

Elfimova

et al. 2023

Probl Endokrinol (Mosk)

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BACKGROUND: Data on the effect of 131I on the course of Graves’ orbitopathy (GO) are contradictory. A number of studies indicate a deterioration in the course of GO against the background of RAIT, in other studies such a connection has not been established. Cytokines that regulate inflammation could potentially be biomarkers for assessing GO activity and predicting the course of GO after RAIT.AIM: The purpose of this study was to evaluate the dynamics of eye symptoms and analyze immunological parameters: cytokine TGF-β1 and cytokine receptors: sTNFα-R1, sTNFα-R2, sIL-2R, sIL-6R over time after RAIT, as possible predictors of GO activation.MATERIALS AND METHODS: The study included 59 patients (118 orbits) with GD in the state of euthyroidism and subclinical hyperthyroidism and low active and inactive GO, aimed at conducting RAIT. Concentrations of cytokine TGF-β1, sTNFα-RI and sTNFα-R2, sIL-2R, sIL-6R, TSH receptor antibodies (rTSH-Ab), free thyroxine (FT4) and free triiodothyronine (FT3), thyroid-stimulating hormone (TSH) in the blood serum were determined. Ultrasound examination of the thyroid gland, multispiral computed tomography (MSCT)/magnetic resonance imaging (MRI) of the orbits was performed. The examination was carried out 3, 6, 12 months after the RAIT.RESULTS: The deterioration of the course of the GO (1–2 points according to CAS) was noted after 3 months. (32.5%) and to a lesser degree after 6 and 12 months (13.2% and 8.45%, respectively). Dynamics were not noted, approximately, in the same number of patients (40.5%, 41.5%, 45.8%, respectively). An improvement in the course of the GO was noted after 6 and 12 months (45.3, 45.8, respectively). After 3 and 6 months, the achievement of hypothyroidism and a significant increase in the level of rTSH-Ab were noted. In the analysis of cytokines and their receptors a significant decrease in the level of TGF-β1 was noted after 3, 6 and 12 months. There was also a significant decrease in sTNF-R1 and sIL-2R at 3 and 6 months. The level of sTNFα-R2 significantly decreased 3 months after RAIT. The level of sIL-6R has not changed significantly. After 3 months in patients with positive dynamics of image intensification, the level of TGF-β1 did not significantly change compared with the level before RAIT, in patients with worsening of the course of GO or without dynamics, the level of TGF-β1 significantly decreased. After 6 months, there was the same trend, not reaching statistical significance. The IgG4 level and the IgG4/IgG ratio increased to 6 and 12 months, which corresponded to an increase in diplopia index.CONCLUSION: The main limiting factor in the conduct of RAIT is the activity of the autoimmune process in the orbits. Since patients with inactive (CAS 0–2) or low activity (CAS 3–4) GO were referred for RAIT, there was no pronounced activation of GO after RAIT. There was a slight deterioration in the course of GO by only 1–2 points according to CAS after 3 months. (32.5%) and to a lesser degree after 6 months (13.2%). In the study, it was found that the main predictors of the deterioration of the course of GO after RAIT are uncompensated hypothyroidism, a high level of rTSH-Ab and a decrease in the level of cytokine TGF-β1.

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Section: Discussionunclassified

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Clinical and immunological predictors of Graves’ orbitopathy after radioiodine therapy of Graves’ disease

Sheremeta,

Bessmertnaya,

Elfimova

et al. 2023

Probl Endokrinol (Mosk)

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“…РЙТ входит в рекомендации American Thyroid Association, European Thyroid Association и российские рекомендации по ведению пациентов с БГ [3, 41,42]. Принцип действия 131 I основывается на способности излучения 2 видов лучей: с диагностической целью и для проведения дозиметрии используют γ-лучи, с терапевтической -β-лучи, приводящие к избирательному повреждению ткани и некрозу клеток [43].…”

Section: современные аспекты применения рйт при бгunclassified

“…Попадая в организм, изотоп 131 I быстро всасывается и поступает из крови в фолликулярные клетки ЩЖ, где далее связывается с тирозильными остатками тиреоглобулина. Через 8-16 нед после РЙТ тиреоциты снижают выработку йодтиронинов [43]. Цель РЙТ при БГ -достижение стойкого гипотиреоза с последующим назначением тиреоидных гормонов.…”

Section: современные аспекты применения рйт при бгunclassified

Radioactive iodine in the treatment of Graves' disease: history and modern concept of radionuclide therapy

Sheremeta¹,

Korchagina

Pesheva

et al. 2022

Terapevticheskii arkhiv

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Radioactive iodine 131I is a theranostic isotope used both for diagnosis and therapy of benign thyroid diseases and thyroid cancer for 85 years. The formation of nuclear medicine is closely linked with the use of 131I. The history of radioiodine therapy began in 1941, when endocrinologist Saul Hertz for the first time used 131I to treat patients with Graves' disease. Since 1946 radioactive iodine 131I became widely available, and its effectiveness became public knowledge after reports on thyrotoxicosis treatment published in the Journal of the American Medical Association by multidisciplinary groups of scientists physicists and endocrinologists. In 1951, isotope 131I became the first Food and Drug Administration approved RP for the treatment of thyroid disorders. Around the same time on the basis of the First Moscow Medical Institute studies on the use of radioiodine isotopes in patients with thyrotoxicosis began. The head of the Soviet group on the studying of radioactive iodine was the physician-scientist Vera Georgievna Spesivtseva. The research works of medical physicists Edith Quimby and Leonidas Marinelli in optimizing therapeutic strategies using radioactive substances in the late 1940s and the wording of the ALARA (As Low As Reasonably Achievable) principle of minimizing exposure of ionizing radiation by the International Commission on Radiological Protection in 1954 contributed to the greater introduction of radionuclides into the medicine.

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