Ultrasound combined with Ki-67 to construct the prognostic model for radioactive iodine therapy outcomes in Graves’ disease patients

Abstract

To develop a prognostic model for radioactive iodine therapy outcome in patients with Graves' disease. Enrolled 127 patients. Information on radioactive iodine therapy, ultrasound indexes of thyroid, and other lifestyle factors was collected. The competing risk model was used to estimate the multivariable-adjusted hazard ratios and 95% confidence intervals for non-healing or recurrence of hyperthyroidism. The performance of the model was assessed by Receiver Operator Characteristic analysis and the Brier score, and internally validated by bootstrap resampling. Then, a nomogram was developed. Forty-one cases (32.2%) of non-healing or recurrence of hyperthyroidism were documented. Positive Ki-67 expression, a higher dose of per unit thyroid volume, and females showed lower risks of non-healing or recurrence of hyperthyroidism (all P < 0.05). The HR (95% CI) were 0.42 (0.23, 0.79), 0.01 (0.00, 0.02), and 0.47 (0.25, 0.89), respectively. The Bootstrap validation showed that the model had the highest accuracy and good calibration for predicting cumulative risk of non-healing or recurrence of hyperthyroidism at 180 days after radioactive iodine therapy (AUC = 0.772; 95% CI: 0.640-0.889, Brier score = 0.153). By decision curve analysis, the nomogram was shown to have a satisfactory net benefit between thresholds of 0.20 and 0.40. Ki-67, ultrasound volumetry, and scintigraphy techniques can play important roles in evaluating radioactive iodine therapy therapy outcome in Graves' disease patients. The prediction nomogram shows reasonable accuracy in predicting non-healing or recurrence of hyperthyroidism.