Success rate of radioiodine therapy in Graves' disease: The influence of thyrostatic medication

被引:105
作者
Sabri, O
Zimny, M
Schulz, G
Schreckenberger, M
Reinartz, P
Willmes, K
Buell, U
机构
[1] Rhein Westfal TH Aachen, Dept Nucl Med, D-52057 Aachen, Germany
[2] Rhein Westfal TH Aachen, Dept Neuropsychol, D-52057 Aachen, Germany
关键词
D O I
10.1210/jc.84.4.1229
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
There is controversy whether simultaneous thyrostatic medication influences the outcome of radioiodine (I-131) therapy in Graves' disease by reducing the absorbed energy dose of I-131 when delivering a standard dose. We therefore sought to ascertain whether the outcome of ablative I-131 therapy is in any way affected by simultaneous thyrostasis (carbimazole) by aiming for a constant absorbed dose of 200-250 Gy. We prospectively studied 207 patients with Graves' disease (106 with and 101 without simultaneous carbimazole at the time of I-131 therapy). All patients were reexamined 3, 6, and 12 months after I-131 therapy. The 101 nonthyrostatic patients showed a highly sig nificantly greater success rate (93%) than the 106 thyrostatic patients (49%). Stepwise logistic regression demonstrated that failure was related to the administration of carbimazole during I-131 therapy (P < 0.00005) and the absorbed dose (P < 0.025), but was not related to free T-3, free T-4, TSH receptor antibodies, or thyroid volume. The success rate was 100% in 93 nonthyrostatic patients with absorbed doses of 200 Gy or more, but was only 12.5% (1 of 8) for absorbed doses less than 200 Gy. Correlation between success and absorbed dose was significantly higher for nonthyrostatic than for thyrostatic patients (r = 0.93 vs, r = 0.24). Sixteen patients who discontinued thyrostasis 1-3 days before I-131 therapy showed 94% successes. Simultaneous thyrostasis is the decisive factor against a successful I-131 therapy even if the significantly reduced I-131 uptake/half-life values under thyrostasis are compensated with a higher delivered dose to ensure a comparable absorbed dose, possibly due to the additionally effective radioprotective properties of carbimazole. Therefore, if clinically feasible, we recommend discontinuing thyrostasis at least 1 day before beginning I-131 therapy, because even in hyperthyroid nonthyrostatic patients the success rate was 100%.
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页码:1229 / 1233
页数:5
相关论文
共 37 条
  • [1] ALEVIZAKI CC, 1985, EUR J NUCL MED, V10, P450
  • [2] Relation between therapy for hyperthyroidism and the course of Graves' ophthalmopathy
    Bartalena, L
    Marcocci, C
    Bogazzi, F
    Manetti, L
    Tanda, ML
    Dell'Unto, E
    Bruno-Bossio, G
    Nardi, M
    Bartolomei, MP
    Lepri, A
    Rossi, G
    Martino, E
    Pinchera, A
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1998, 338 (02) : 73 - 78
  • [3] USE OF CORTICOSTEROIDS TO PREVENT PROGRESSION OF GRAVES OPHTHALMOPATHY AFTER RADIOIODINE THERAPY FOR HYPERTHYROIDISM
    BARTALENA, L
    MARCOCCI, C
    BOGAZZI, F
    PANICUCCI, M
    LEPRI, A
    PINCHERA, A
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1989, 321 (20) : 1349 - 1352
  • [4] Berg GEB, 1996, J NUCL MED, V37, P228
  • [5] DISCONTINUING ANTITHYROID DRUG-THERAPY BEFORE ABLATION WITH RADIOIODINE IN GRAVES-DISEASE
    BURCH, HB
    SOLOMON, BL
    WARTOFSKY, L
    BURMAN, KD
    [J]. ANNALS OF INTERNAL MEDICINE, 1994, 121 (08) : 553 - +
  • [6] Outcome of thyroid function in Graves' patients treated with radioiodine: Role of thyroid-stimulating and thyrotropin-blocking antibodies and of radioiodine-induced thyroid damage
    Chiovato, L
    Fiore, E
    Vitti, P
    Rocchi, R
    Rago, T
    Dokic, D
    Latrofa, F
    Mammoli, C
    Lippi, F
    Ceccarelli, C
    Pinchera, A
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1998, 83 (01) : 40 - 46
  • [7] CHOI BCK, 1982, METHOD INFORM MED, V21, P149
  • [8] EFFECT OF PRETREATMENT WITH CARBIMAZOLE ON EARLY OUTCOME FOLLOWING RADIO-IODINE (I-131) THERAPY
    CONNELL, JMC
    HILDITCH, TE
    MCCRUDEN, DC
    ROBERTSON, J
    ALEXANDER, WD
    [J]. EUROPEAN JOURNAL OF NUCLEAR MEDICINE, 1984, 9 (10): : 464 - 466
  • [9] CUNNIEN AJ, 1982, J NUCL MED, V23, P978
  • [10] DEBRUIN TWA, 1994, J INTERN MED, V236, P507