Optimal iodine-131 dose for eliminating hyperthyroidism in Graves' disease

Since hypothyroidism is commonplace after treatment of Graves' disease with radioiodine, the goal should be cure of hyperthyroidism rather than avoidance of hypothyroidism. To find the optimal dose to accomplish cure, we treated 605 patients with stepwise increasing doses of 3, 4, 5, 6, 8, and 10 mCi, analyzing the relationship of dose, age, sex, gland weight, and thyroidal uptake to cure. Estimates of cure at doses above 10 mCi were made from the literature. Cure was directly related to dose between 5 and 10 mCi. There was no significant relationship between cure and age (chi-square, p = 0.74), sex (chi-square, p = 0.12), and 24-hr uptake if over 30% (chi-square for slope, p greater than 0.10). Cure and gland weight had an inverse relationship (chi-square for slope, 0.01 less than p less than 0.02). We concluded that the optimal 131I dose for curing hyperthyroidism is approximated by starting with 10 mCi and increasing it for unusually large glands or for special patient circumstances.     

介入栓塞与^131I治疗Graves病近期疗效的对比分析

目的对比分析甲状腺动脉介入栓塞和131I治疗Graves病近期疗效的差异。方法对接受131I和甲状腺动脉栓塞治疗的各42例Graves病患者,行造影、SPECT/CT显像检查治疗前后甲状腺形态、大小,放射免疫法检测治疗前后3、6和12个月血清中FT3、FT4、TSH浓度及促甲状腺受体抗体(TRAb)活度和治疗后并发症出现的关系,并对以上数据进行统计学分析。结果两种治疗方法近期疗效无显著差异,介入治疗组治疗后早期严重并发症的发生率明显高于131I治疗组,而131I治疗组有更高的甲状腺功能减退(甲减)发生率。结论甲状腺动脉介入栓塞和131I治疗Graves病患者疗效肯定,131I可用于初诊及其他方法疗效不佳的患者,介入栓塞治疗可用于抗甲状腺药物疗效不佳、无法手术及甲状腺摄131I率低不能行131I治疗者,特别对一些难治性、顽固性甲状腺功能亢进有效。介入疗法可作为Graves病可选择的手段。     

A mathematical model of optimized radioiodine-131 therapy of Graves' hyperthyroidism

BACKGROUND: The current status of radioiodine-131 (RaI) dosimetry for Graves' hyperthyroidism is not clear. Recurrent hyperthyroidism and iatrogenic hypothyroidism are two problems which interact such that trying to solve one leads to exacerbation of the other. Optimized RaI therapy has therefore begun to be defined just in terms of early hypothyroidism (ablative therapy) as physicians have given up on reducing hypothyroidism. METHODS: Optimized therapy is evaluated both in terms of the greatest separation of cure rate from hypothyroidism rate (non-ablative therapy) or in terms of early hypothyroidism (ablative therapy) by mathematical modeling of outcome after radioiodine and critically discussing the three common methods of RaI dosing for Graves' disease. RESULTS: Cure follows a logarithmic relationship to activity administered or absorbed dose, while hypothyroidism follows a linear relationship. The effect of including or omitting factors in the calculation of the administered I-131 activity such as the measured thyroid uptake and effective half-life of RaI or giving extra compensation for gland size is discussed. CONCLUSIONS: Very little benefit can be gained by employing complicated methods of RaI dose selection for non-ablative therapy since the standard activity model shows the best potential for cure and prolonged euthyroidism. For ablative therapy, a standard MBq/g dosing provides the best outcome in terms of cure and early hypothyroidism.     

The outcome of 131I treatment in Graves' patients pretreated or not with methimazole

Despite extensive use of iodine-131 ((131)I) treatment for Graves' hyperthyroidism, the optimal regimen of pretreatment with antithyroid drugs is still a matter of discussion. Our aim was to evaluate the success of (131)I treatment in patients with Graves' disease without and with pretreatment with methimazole (MMI). In a prospective randomized study 156 patients with Graves' disease were treated with fixed activity of 550 MBq (131)I. First group of 59 patients received only (131)I. The second group of 50 patients received MMI which was stopped seven days before (131)I. The third group of 47 patients received MMI until (131)I application. Patients were followed clinically and biochemically 1, 3, 6 and 12 months after (131)I treatment. Absorbed dose of (131)I and thyroid volume were measured in each patient. Our result showed that (131)I treatment success after twelve months was equally effective in the first and second group (96.6% and 96%, respectively), while in the third group, success was significantly lower (63.8%). Accordingly, the absorbed dose of (131)I was significantly higher in the first and in second group (144±104 Gy and 164±107 Gy, respectively), and lower in the third group (105±58 Gy). Thyroid volume gradually decreased without any significant difference between the three groups. In conclusion, our study provides evidence that application of (131)I is equally effective in the nonpretreated with MMI group and in the group discontinuing MMI one week before (131)I treatment, and it is more effective in these two groups as compared to the group in which pretreatment with MMI was administered till the day of (131)I application.     

Lack of preoperative spinous process tenderness does not affect clinical success of percutaneous vertebroplasty

PURPOSE: Some operators use the lack of point tenderness over compression fractures to exclude patients from undergoing percutaneous vertebroplasty procedures. The purpose of this study was to determine whether this lack of tenderness portends a poorer clinical outcome after vertebroplasty than is achieved in patients with such tenderness. MATERIALS AND METHODS: The authors conducted a retrospective review of consecutive percutaneous vertebroplasty procedures performed at their institution to define two populations. Group 1 included 90 patients with tenderness to palpation over the spinous process of the fractured vertebra, whereas group 2 included 10 patients without such tenderness. This second group presented with back pain and demonstrated tenderness distant from the fracture (n = 5), tenderness lateral to the fracture (n = 4), or no focal tenderness at all (n = 1). All were treated because of edema seen on magnetic resonance (MR) imaging and/or increased activity on bone scan. Clinical outcomes were assessed by quantitative measurements of pre- and postoperative levels of pain (11-point scale) and mobility (five-point scale). RESULTS: Pain improvement of three points or greater occurred in 77 of the 85 patients (91%) in group 1 who complied with follow-up and nine of nine such patients (100%) in group 2, with mean postoperative pain levels of 1.82 and 0.33 points, respectively (P =.14). Forty of 45 patients (89%) in group 1 with impaired preoperative mobility reported improvement postoperatively, as did two of three such patients (67%) in group 2. Mean levels of postoperative impaired mobility for groups 1 and 2 were 0.27 and 0.67 points, respectively (P =.27). CONCLUSION: Pain on palpation over the fractured vertebra is not a necessary requirement in selecting patients who will benefit from percutaneous vertebroplasty. Other factors, such as MR evidence of edema or increased uptake on bone scan, should be weighed considerably in the decision to treat a patient.     

The treatment of hyperthyroidism with iodine-131

Radioiodine (131I) treatment of well-differentiated thyroid carcinoma is a well-evaluated therapeutic model for nuclear medicine which has never been equaled by subsequent developments. It is still a unique method of treating cancer. The treatment of thyroid cancer begins with a systematic approach to the most common first symptom or sign; a neck mass. Data have accumulated to show that well-differentiated thyroid cancer does kill commonly enough to warrant aggressive treatment, even in young individuals. There is also evidence that the more complete the thyroidectomy, the lower the death and recurrence rate of the thyroid cancer, and the more effective the use of 131I in both detecting and treating metastases. There are now considerable data demonstrating that 131I after surgery decreases both the recurrence rate and death rate from well-differentiated thyroid cancer. After uptake is "ablated", there is a 1%--2% recurrence rate in patients with the most extensive disease at the time of the initial treatment. This recurrence is effectively retreated with another dose of 131I. Surgery and 131I should be used as long as they are effective before resorting to teletherapy. There are now considerable data to show that the morbidity of surgical and 131I treatment is reasonable in contrast to the recurrence and death rate from nonaggressively treated well-differentiated thyroid carcinoma. Serious consideration should be given to using a low iodine diet before treatment with radioiodine.     

Graves甲亢合并贫血患者的临床特征和 131I治疗效果的分析

目的:分析Graves甲状腺功能亢进症（简称甲亢）合并贫血患者的临床特征并评价 131I治疗的效果。 方法:回顾性分析2018年1月至2019年12月在中国科学技术大学附属第一医院行 131I治疗的164例[男性32例、女性132例,年龄（45.47±13.44）岁]Graves甲亢患...     

131I治疗Graves甲状腺功能亢进症中碳酸锂的应用

131I治疗Graves甲状腺功能亢进症(甲亢)的有效性取决于其在甲状腺内的滞留时间,且受治疗前抗甲状腺药物使用、肿大甲状腺容积和甲状腺24 h摄碘率等因素的影响.锂具有阻止有机碘和甲状腺激素自甲状腺内释出的作用而不影响甲状腺对131I的摄取,因此,131I治疗Graves甲亢前后辅以短程、小剂量碳酸锂,具有提高甲状腺...     

^131I治疗Graves病甲亢后早发甲低影响因素

目的分析     

131I治疗甲状腺功能亢进症的影响因素

甲状腺功能亢进症131I治疗剂量的确定受甲状腺吸碘率、有效半衰期、甲状腺质量、抗甲状腺药物等众多因素影响,131I治疗的预后情况是这些因素共同作用的结果.     

The present status of I-131 therapy for Graves' hyperthyroidism in Japan (survey by questionnaire)

A survey on the I-131 therapy of Graves' hyperthyroidism was undertaken by questionnaire in 1,246 hospitals of Japan. One thousand and ninety seven of them (88.0%) responded to the questionnaire. In this paper, we report the results and analysis of the replies to the questionnaire. In the 121 hospitals (11.03%) of the respondents, I-131 therapy is being performed for Graves' hyperthyroidism. A gradual increase was observed in the annual number of I-131 treated Graves' disease patients during the period of 1998-2001, from 1,740 to 2,484. I-131 treatment was selected mainly for the cases with side effects from antithyroid drug (ATD) therapy, followed by the cases with complication of heart or hepatic diseases, recurrences of hyperthyroidism after surgery, radioiodine treatment, and long-term ATD treatment. The 41% of respondents used I-131 in order to restore euthyroidism, 34% aimed for hyperthyroidism and 41% used the dose properly between the two according to the patients. Administration dosage of I-131 was estimated mainly on the basis of thyroid uptake and volume in 93% of the respondents and 48% calculated the radiation dose by also determining the effective half-life in the thyroid gland. Thyroid size was estimated by scintigram (51%), US (33%), CT (22%) and palpation (12%). ATD treatment was used before I-131 administration by 70% of the respondents and 34% after radioiodine therapy. A low-iodine diet was given to the patients for a week (46%) or two weeks (47%) before I-131 administration. However, after treatment only 46% of the respondents continued low-iodine diet for a week.     

Iodine-131 uptake and turnover rate vary over short intervals in Graves' disease

From a Dutch questionnaire, it was apparent that nearly all institutions used percentage of radioiodine uptake for calculation of the radioiodine dose in Graves' disease. Although there is a general belief that fluctuations in radioiodine uptake may occur, with few exceptions relatively long intervals were accepted between the uptake measurement and the actual therapy dose. With the aim of optimizing the pretherapeutic work-up, we evaluated the stability of iodine uptake over time in patients with Graves' disease who were referred for 131I therapy. 131I uptake was measured in 300 consecutive patients for the calculation of the required 131I therapy dose; data were complete for 291 patients (97%). After discontinuing thyroid medication for 3 days, standardized thyroid probe measurements were performed 5 and 24 h after ingestion of a capsule containing 0.37 MBq 131I-NaI. Measurements were performed at the time of scintigraphic diagnosis (test 1), as well as immediately before 131I therapy (test 2). The time interval between test 1 and test 2 ranged from 2 to 421 (median 40) days. A relative increase or decrease greater than 10% between tests 1 and 2 occurred in 180 of 291 cases (62%) at 5 h and in 158 of 291 patients (54%) at 24 h. These changes were not related to the interval between the tests or to initial uptake values, thyroid mass, gender or age. Rapid turnover of radioiodine (5 h/24 h uptake ratio > 1) was noted in 17% of the patients during test 1 and in 15% during test 2. Rapid turnover was persistent (present in both tests 1 and 2) in only 9%. We conclude that patients with Graves' disease show considerable changes in 131I uptake over relatively short periods of time, and the turnover rate of 131I in this condition is not constant.     

131I治疗青少年和儿童甲状腺功能亢进症

甲状腺功能亢进症(甲亢)是青少年和儿童常见的内分泌疾病,影响青少年和儿童各个系统的发育成熟,特别是骨骼系统和神经系统,其自然缓解率低,需要采取积极、安全、有效的治疗方法.抗甲状腺药物(ATD)、甲状腺次全切除术和131I治疗是治疗青少年和儿童甲亢的三种方法.ATD常为内科医师的首选,但其治疗缓解率较低,服药时间长,停药后复发率高,并且其不良反应在青少年和儿童比成年人多见;甲状腺切除术的成功率和并发症与手术医师的技术水平有极大的关系,且术后颈部会留有瘢痕;131I用于甲亢治疗已经有60余年,数干名青少年和儿童患者接受过此治疗,到目前为止未发现治疗后甲状腺癌及其他恶性肿瘤的发病率、患者的生育率、流产率和后代畸形率等与普通人群有明显差别,其治疗缓解率高,不良反应少,可以作为对ATD效果不佳、有服药禁忌证或服药后出现不良反应的青少年和儿童甲亢治疗的首选.131I治疗甲亢后最常见的转归是甲减,可给予甲状腺激素替代治疗,但因青少年和儿童对甲状腺激素的依赖性大,对射线的敏感性强,宜采用小剂量131I以达到理想控制.     

131I治疗青少年和儿童甲状腺功能亢进症

甲状腺功能亢进症(甲亢)是青少年和儿童常见的内分泌疾病,影响青少年和儿童各个系统的发育成熟,特别是骨骼系统和神经系统,其自然缓解率低,需要采取积极、安全、有效的治疗方法.抗甲状腺药物(ATD)、甲状腺次全切除术和131I治疗是治疗青少年和儿童甲亢的三种方法.ATD常为内科医师的首选,但其治疗缓解率较低,服药时间长,停药后复发率高,并且其不良反应在青少年和儿童比成年人多见;甲状腺切除术的成功率和并发症与手术医师的技术水平有极大的关系,且术后颈部会留有瘢痕;131I用于甲亢治疗已经有60余年,数干名青少年和儿童患者接受过此治疗,到目前为止未发现治疗后甲状腺癌及其他恶性肿瘤的发病率、患者的生育率、流产率和后代畸形率等与普通人群有明显差别,其治疗缓解率高,不良反应少,可以作为对ATD效果不佳、有服药禁忌证或服药后出现不良反应的青少年和儿童甲亢治疗的首选.131I治疗甲亢后最常见的转归是甲减,可给予甲状腺激素替代治疗,但因青少年和儿童对甲状腺激素的依赖性大,对射线的敏感性强,宜采用小剂量131I以达到理想控制.     

Food and fluid intake and hydration status does not affect ultrasound measurements of subcutaneous adipose tissue in active adults

ObjectivesTo investigate the impact of acute food and fluid intake or hydration status on the standardised brightness-mode ultrasound measurement of subcutaneous adipose tissue thickness.DesignThirty active adults (female n = 10) participated in a randomised cross over study.MethodsParticipants completed three body composition assessment sessions via standardised brightness-mode ultrasound and Dual-energy X-ray absorptiometry. Participants were assessed under standardised presentation during ‘food only’ and ‘food plus water’ sessions at baseline and reassessed after their allotted intake. ‘Hypohydration plus water’ was undertaken in a hypohydrated state at baseline and reassessed after water intake.ResultsThe sum of eight subcutaneous adipose tissue thickness was lower when measured after ‘food only’ or ‘food plus water’ compared to baseline (?0.1 to ?0.9 mm; p < 0.01). However, these changes were less than the 95% confidence interval of the technical error of measurement of the investigator. Body mass, dual-energy x-ray absorptiometry total and trunk mass, lean mass and trunk lean mass estimates increased (p < 0.01) following ‘food only’ or ‘food plus water’, and decreased with hypohydration (p < 0.01). Total and regional fat mass estimates were not impacted.ConclusionsThe sum of eight subcutaneous adipose tissue thickness measured via standardised brightness-mode ultrasound was unaffected by acute food and fluid consumption or hydration status changes. Comparatively, these interventions altered dual-energy x-ray absorptiometry body composition estimates, especially that of lean mass components. Standardised brightness-mode ultrasound can therefore be used to monitor changes in fat patterning when standardised client presentation is not practically achievable.     

Long-term follow-up study of I-131 therapy for Graves' disease--index associated with late-onset hypothyroidism

We have studied the follow-up of thyroid function in the patients with late-onset hypothyroidism and euthyroidism after I-131 therapy of hyperthyroidism. Thirty three patients who did not need the thyroid treatment until ten years after I-131 therapy were classified as euthyroid group. And eleven patients who needed the thyroid supplement of thyroid hormone for late-onset hypothyroidism were classified as hypothyroid group. Patients in both groups who required only a single dose of I-131 for successful treatment of hyperthyroidism had similar age, gland size, 24 hour I-131 uptake, pretreatment serum T3 uptake level and T4 concentration, and I-131 treatment dose. Subclinical hypothyroidism occurred in 28.6% of euthyroid group and 66.7% of hypothyroid group four months after I-131 therapy. The levels of T3 were recovered to higher than normal range at 6 months in euthyroid group, while the levels of T3 were kept within the normal range in the seventy percent of hypothyroid group. Patients who were still lower in the level of T3 uptake than normal range at 6 months had a higher incidence of late-onset hypothyroidism. Our observation showed no significant difference in the course of follow-up studies after I-131 therapy between the patients with late-onset hypothyroidism and euthyroidism.     

Early prediction of hypotheroidism following 131I treatment for Graves' disease

The aim of this study was twofold. Firstly to assess the post treatment predictive value of various biochemical and immunological tests for early hypothyroidism after ¹³¹I therapy for Graves' disease, and secondly to determine whether or not pretreatment with Carbimazole protects against post treatment hypothyroidism. The early changes observed in serum T₃, T₄, TSH, thyroid microsomal and thyroglobulin antibody levels were found to be of no predictive value. A sharp rise, around 2 months, in TRAb levels following ¹³¹I therapy indicated that hypothyroidism was likely to occur. This rise was thought to reflect a greater degree of thyroid damage. Lower levels of thyroglobulin in patients who had become hypothyroid by 12 months after treatment would support this view. Five weeks Carbimazole pretreatment in this relatively small group of patients did not appear to protect against hypothyroidism.     

^131I治疗青少年儿童甲状腺功能亢进症

甲状腺功能亢进症（甲亢）是青少年和儿童常见的内分泌疾病,影响青少年和儿童各个系统的发育成熟,特别是骨骼系统和神经系统,其自然缓解率低,需要采取积极、安全、有效的治疗方法。抗甲状腺药物（ATD）、甲状腺次全切除术和^131I治疗是治疗青少年和儿童甲亢的三种方法。ATD常为内科医师的首选,但其治疗缓解率较低,服药时间长,停药后复发率高,并且其不良反应在青少年和儿童比成年人多见;甲状腺切除术的成功率和并发症与手术医师的技术水平有极大的关系,且术后颈部会留有瘢痕;^131I用于甲亢治疗已经有60余年,数千名青少年和儿童患者接受过此治疗,到目前为止未发现治疗后甲状腺癌及其他恶性肿瘤的发病率、患者的生育率、流产率和后代畸形率等与普通人群有明显差别,其治疗缓解率高,不良反应少,可以作为对ATD效果不佳、有服药禁忌证或服药后出现不良反应的青少年和儿童甲亢治疗的首选。^131I治疗甲亢后最常见的转归是甲减,可给予甲状腺激素替代治疗,但因青少年和儿童对甲状腺激素的依赖性大,对射线的敏感性强,宜采用小剂量^131I以达到理想控制。