Determination of the optimal minimum radioiodine dose in patients with Graves' disease: a clinical outcome study

被引:46
作者
Howarth, D
Epstein, M
Lan, L
Tan, P
Booker, J
机构
[1] John Hunter Hosp, Dept Endocrinol, Newcastle, NSW, Australia
[2] St George Hosp, High Dependency Unit, Sydney, NSW, Australia
[3] Pacific Med Imaging, Newcastle, NSW, Australia
关键词
radioiodine; iodine-131; Graves' disease; hyperthyroidism;
D O I
10.1007/s002590100621
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
The study was performed under the auspices of the International Atomic Energy Commission, Vienna, Austria, with the aim of determining the optimal minimum therapeutic dose of iodine-131 for Graves' disease. The study was designed as a single-blinded randomised prospective outcome trial. Fifty-eight patients were enrolled, consisting of 50 females and 8 males aged from 17 to 75 years. Each patient was investigated by clinical assessment, biochemical and immunological assessment, thyroid ultrasound, technetium-99m thyroid scintigraphy and 24-h thyroid I-131 uptake. Patients were then randomised into two treatment groups, one receiving 60 Gy and the other receiving 90 Gy thyroid tissue absorbed dose of radioiodine. The end-point markers were clinical and biochemical response to treatment. The median followup period was 37.5 months (range, 24-48 months). Among the 57 patients who completed final follow-up, a euthyroid state was achieved in 26 patients (46%), 27 patients (47%) were rendered hypothyroid and four patients (7%) remained hyperthyroid. Thirty-four patients (60%) remained hyperthyroid at 6 months after the initial radioiodine dose (median dose 126 MBq), and a total of 21 patients required additional radioiodine therapy (median total dose 640 MBq; range 370-1,485 MBq). At 6-month follow-up, of the 29 patients who received a thyroid tissue dose of 90 Gy, 17 (59%) remained hyperthyroid. By comparison, of the 28 patients who received a thyroid tissue dose of 60 Gy, 17 (61%) remained hyperthyroid. No significant difference in treatment response was found (P=0.881). At 6 months, five patients in the 90-Gy group were hypothyroid, compared to two patients in the 60-Gy group (P=0.246). Overall at 6 months, non-responders to low-dose therapy had a significantly larger thyroid gland mass (respective means: 35.9 ml vs 21.9 ml) and significantly higher levels of serum thyroglobulin (respective means: 597.6 mug/l vs 96.9 mug/l). Where low-dose radioiodine treatment of Graves' disease is considered, a dose of 60 Gy will yield a 39% response rate at 6 months while minimising early hypothyroidism. No significant advantage in response rate is gained by using a dose of 90 Gy. For more rapid therapeutic effect at the expense of an increased rate of hypothyroidism, doses in excess of 120 Gy may be required. Ultrasound determination of thyroid mass and measurement of serum thyroglobulin levels may be predictive of those patients who will be less responsive to low-dose therapy.
引用
收藏
页码:1489 / 1495
页数:7
相关论文
共 28 条
  • [21] Rink T, 2000, NUKLEARMED-NUCL MED, V39, P133
  • [22] Autoantibodies to thyroglobulin in health and disease
    Rose, NR
    Burek, CL
    [J]. APPLIED BIOCHEMISTRY AND BIOTECHNOLOGY, 2000, 83 (1-3) : 245 - 251
  • [23] Success rate of radioiodine therapy in Graves' disease: The influence of thyrostatic medication
    Sabri, O
    Zimny, M
    Schulz, G
    Schreckenberger, M
    Reinartz, P
    Willmes, K
    Buell, U
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1999, 84 (04) : 1229 - 1233
  • [24] RANDOM DOSAGE OF 131I IN TREATMENT OF HYPERTHYROIDISM - RESULTS OF A PROSPECTIVE STUDY
    SKILLMAN, TG
    MAZZAFERRI, EL
    GWINUP, G
    [J]. AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 1969, 257 (06) : 382 - +
  • [25] LONG-TERM FOLLOW-UP-STUDY OF COMPENSATED LOW-DOSE I-131 THERAPY FOR GRAVES-DISEASE
    SRIDAMA, V
    MCCORMICK, M
    KAPLAN, EL
    FAUCHET, R
    DEGROOT, LJ
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1984, 311 (07) : 426 - 432
  • [26] Radioiodine treatment, ablation, and ophthalmopathy: A balanced perspective
    Tallstedt, L
    Lundell, G
    [J]. THYROID, 1997, 7 (02) : 241 - 245
  • [27] TROTTER WR, 1962, DIS THYROID, P1
  • [28] Tsuruta M, 1993, Ann Nucl Med, V7, P193