Skip to main content
SpringerLink
Log in

Radioiodine Therapy of Hyperthyroidism (Toxic Goiter, Hyperfunctioning Nodule) and Non-Toxic Goiter: Procedures and Guidelines

  • Chapter
  • First Online:
Book cover Therapeutic Nuclear Medicine

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

  • 2721 Accesses

Abstract

The purpose of the present chapter on the radioiodine-131 (I-131) therapy of benign thyroid disorders is to provide advice to nuclear medicine clinicians on how to treat toxic goiter, hyperfunctioning nodules and non-toxic goiter employing optimal I-131 activities. For this purpose, recommendations have been formulated based on the EANM procedure guidelines, recent literature and expert opinion regarding indications for I-131 therapy and alternative treatment modalities, as well as the adequate radioiodine activities in different thyroid disorders and the administration and patient preparation techniques to be used. Recommendations also are provided on pretherapeutic “radioiodine testing”. Furthermore, potential adverse effects are reviewed. The main side-effect of radioiodine treatment is hypothyroidism and levothyroxine medication is needed in all patients with elevated TSH after I-131 therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

Ab:

Antibody

ATD:

Antithyroid drug

FNAB:

Fine needle aspiration biopsy

fT4:

Free levothyroxine in serum

fT3:

Free triiodothyronine in serum

I-131:

Iodine-131 (radioiodine)

LT4:

Levothyroxine medication

PTU:

Propylthiouracil

rhTSH:

Recombinant human TSH

SD:

Standard deviation

Tg:

Thyroglobulin

TPO:

Thyroidal peroxidase

Xe-131:

Xenon-131

References

  • Bachmann J, Kobe C, Bor S, Rahlff I, Dietlein M, Schicha H, Schmidt M (2009) Radioiodine therapy for thyroid volume reduction of large goiters. Nucl Med Commun 30:466–471

    Article  PubMed  Google Scholar 

  • Bal CS, Kumar A, Pandey RM (2002) A randomized controlled trial to evaluate the adjuvant effect of lithium on radioiodine treatment of hyperthyroidism. Thyroid 12:399–405

    Article  CAS  PubMed  Google Scholar 

  • Bockisch A, Jamitzky T, Derwanz R, Biersack HJ (1993) Optimized dose planning of radioiodine therapy of benign thyroidal diseases. J Nucl Med 34:1632–1638

    CAS  PubMed  Google Scholar 

  • Boeleart K, Syed AA, Manji N, Sheppard MC, Holder RL, Gough SC, Franklyn JA (2009) Prediction of cure and risk of hypothyroidism in patients receiving I-131 for hyperthyroidism. Clin Endocrinol 70:129–138

    Article  Google Scholar 

  • Bogazzi F, Bartalena L, Brogioni S, Scarcello G, Burelli A, Compomori A, Manetti L, Rossi G, Pinchera A, Martino E (1999) Comparison of radioiodine with radioiodine plus lithium in the treatment of Graves’ hyperthyroidism. J Clin Endocrinol Metab 84:499–530

    CAS  PubMed  Google Scholar 

  • Boice Jr JD (2005) Radiation induced thyroid cancer—what’s new? J Natl Cancer Inst 97:703–705

    Article  PubMed  Google Scholar 

  • Bonnema SJ, Andersen PB, Knudsen DU, Hegedus L (2002) MR Imaging of large multinodular goiters: observer agreement on volume versus observer disagreement on dimension of the involved trachea. Am J Roentgenol 179:259–266

    Article  Google Scholar 

  • Bonnema SJ, Bennedbaek FN, Veje A, Marving J, Hegedus L (2004) Propylthiouracil before I-131 therapy of hyperthyroid diseases; effect on cure rate evaluated by a randomized clinical trial. J Clin Endocrinol Metab 89:4439–4444

    Article  CAS  PubMed  Google Scholar 

  • Bonnema SJ, Nielsen VE, Boel-Jørgensen H, Grupe P, Andersen PB, Bastholt L, Hegedus L (2007) Improvement of goiter volume reduction after 0.3 mg recombinant human thyrotropin-stimulated radioiodine therapy in patients with a very large goiter: a double-blinded, randomized trial. J Clin Endocrinol Metab 92:3424–3434

    Article  CAS  PubMed  Google Scholar 

  • Braga M, Walpert N, Burch HB, Solomon BL, Cooper DS (2002) The effect of methimazole on cure rates after radioiodine treatment for Graves’ hyperthyroidism: a randomized clinical trial. Thyroid 12:135–139

    Article  CAS  PubMed  Google Scholar 

  • Brunn J, Block U, Ruf G, Bos I, Kunze WP, Schriba PC (1981) Volumetric analysis of thyroid lobes by real-time ultrasound. Dtsch Med Wschr 106:1338–1340

    Article  CAS  PubMed  Google Scholar 

  • Cappelen T, Unhjem JF, Amundsen AL, Kravdal G, Følling I (2006) Radiation exposure to family members of patients with thyrotoxicosis treated with iodine-131. Eur J Nucl Med Mol Imaging 33:81–86

    Article  CAS  PubMed  Google Scholar 

  • Col NF, Surks MI, Daniels GH (2004) Subclinical thyroid disease. Clinical applications. JAMA 291:239–243

    Article  CAS  PubMed  Google Scholar 

  • Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM (2009) Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214

    Article  PubMed  Google Scholar 

  • de Rooy A, Vandenbroucke JP, Smit JW, Stokkel MP, Dekkers OM (2009) Clinical outcomes after estimated versus calculated activity of radioiodine for the treatment of hyperthyroidism: systematic review and meta-analysis. Eur J Endocrinol 161:771–777

    Article  Google Scholar 

  • Dickman PW, Holm LE, Lundell G, Boice JD Jr, Hall P (2003) Thyroid cancer risk after thyroid examination with I-131: a population-based cohort study in Sweden. Int J Cancer 106:580–587

    Article  CAS  PubMed  Google Scholar 

  • Dietlein M, Dressler J, Eschner W, Lassman M, Leisner B, Reiners C, Schicha H (2007a) Procedure guideline for radioiodine test (version 3). Nuklearmedizin 46:198–202

    CAS  PubMed  Google Scholar 

  • Dietlein M, Dressler J, Grünwald F, Leisner B, Moser E, Reiners C, Schicha H, Schneider P, Schober O (2007b) Guideline for radioiodine therapy for benign thyroid diseases (version 4). Nuklearmedizin 46:220–223

    CAS  PubMed  Google Scholar 

  • Dillehay GL, Ellerbroek NA, Balon H, Brill DR, Grigsby PW, Macklis RM, Mauch PM, Mian TA, Potters L, Silberstein EB, Williams TR, Wong JC, Gaspar LE (2006) American society for therapeutic radiology and oncology. Practice guideline for the performance of therapy with unsealed radiopharmaceutical sources. Int J Radiat Oncol Biol Phys 64:1299–1307

    Article  PubMed  Google Scholar 

  • Dobyns BM, Sheline GE, Workman JB, Tompkins EA, McConahey WM, Becker DV (1974) Malignant and benign neoplasms of the thyroid in patients treated for hyperthyroidism: a report of the cooperative thyrotoxicosis therapy follow-up study. J Clin Endocrinol Metab 38:976–998

    Article  CAS  PubMed  Google Scholar 

  • Dunkelmann S, Endlicher D, Prillwitz A, Rudolph F, Groth P, Schuemichen C (1999) Results of a TcTUs-optimized radioiodine therapy of multifocal and disseminated functional thyroid autonomy. Nuklearmedizin 38:131–139

    CAS  PubMed  Google Scholar 

  • Eskes SA, Wiersinga WM (2009) Amiodarone and thyroid. Best Pract Res Clin Endocrinol Metab 23:735–751

    Article  CAS  PubMed  Google Scholar 

  • Fast S, Nielsen V, Bonnema S, Hegedus L (2008) Time to reconsider nonsurgical therapy of benign nontoxic multinodular goiter. Focus on recombinant human TSH (rhTSH) augmented radioiodine therapy. Eur J Endocrinol 160:517–528

    Article  PubMed  Google Scholar 

  • Fast S, Nielsen VE, Grupe P, Bonnema SJ, Hegedus L (2009) Optimizing 131I uptake after rhTSH stimulation in patients with nontoxic multinodular goiter: evidence from a prospective, randomized, double-blind study. J Nucl Med 50:732–737

    Article  CAS  PubMed  Google Scholar 

  • Franklyn JA, Maisonneuve P, Sheppard M, Betteridge J, Boyle P (1999) Cancer incidence and mortality after radioiodine treatment for hyperthyroidism: a population based cohort study. Lancet 353:2111–2115

    Article  CAS  PubMed  Google Scholar 

  • Freitas JE (2000) Therapeutic options in the management of toxic and nontoxic nodular goiter. Semin Nucl Med 30:88–97

    Article  CAS  PubMed  Google Scholar 

  • Gammage MD, Parle JV, Holder RL, Roberts LM, Hobbs FDR, Wilson S, Sheppard MC, Franklyn JA (2007) Association between serum free thyroxine concentration and atrial fibrillation. Arch Intern Med 167:928–934

    Article  CAS  PubMed  Google Scholar 

  • Hall P, Holm LE (1997) Late consequences of radioiodine for diagnosis and therapy in Sweden. Thyroid 7:205–208

    Article  CAS  PubMed  Google Scholar 

  • Hall P, Lundell G, Holm LE (1993) Mortality in patients treated for hyperthyroidism with iodine-131. Acta Endocrinol (Cph) 128:230–234

    CAS  Google Scholar 

  • Heeringa J, Hoogendoorn EH, van der Deure WM, Hofman A, Peeters RP, Hop CJ, den Heijer M, Visser TJ, Witteman JCM (2008) High-normal thyroid function and risk of atrial fibrillation—the Rotterdam study. Arch Intern Med 168:2219–2224

    Article  PubMed  Google Scholar 

  • Hegedus L, Bonnema SJ, Bennedbaek FN (2003) Management of simple nodular goiter: current status and future perspectives. Endocr Rev 24:102–132

    Article  PubMed  Google Scholar 

  • International Commission on Radiological Protection (2004) Release of patients after therapy with unsealed radionuclides. Ann ICRP 34:1–79. Erratum in: Ann ICRP 34(3–4): 281

    Google Scholar 

  • Kaptein EM, Levenson H, Siege ME, Gadallah M, Akmal M (2000) Radioiodine dosimetry in patients with end-stage renal disease receiving continuous ambulatory peritoneal dialysis therapy. J Clin Endocrinol Metab 85:3058–3064

    CAS  PubMed  Google Scholar 

  • Kobe C, Weber I, Eschner W, Sudbrock F, Schmidt M, Dietlein M, Schicha H (2008a) Graves’ disease and radioiodine therapy: is success of ablation dependent on the choice of thyreostatic medication? Nuklearmedizin 47:153–166

    CAS  PubMed  Google Scholar 

  • Kobe C, Eschner W, Sudbrock F, Weber I, Marx K, Dietlein M, Schicha H (2008b) Graves’ disease and radioiodine therapy: is success of ablation dependent on the achieved dose above 200 Gy? Nuklearmedizin 47:13–17

    CAS  PubMed  Google Scholar 

  • Kobe C, Eschner W, Wild M, Rahlff I, Sudbrock F, Schmidt M, Dietlein M, Schicha H (2010) Radioiodine therapy of benign thyroid disorders: what are the effective thyroidal half-life and uptake of I-131? Nucl Med Commun 31:201–205

    Article  CAS  PubMed  Google Scholar 

  • Koch W, Rosa F, Knesewitsch P, Hahn K (2005) Guideline on radiation protection in medicine requires documentation of radioiodine therapy and follow-up: what are the benefits of an electronic database? Nuklearmedizin 44:49–55

    CAS  PubMed  Google Scholar 

  • Leslie WD, Ward L, Salamon EA, Ludwig S, Rowe RC, Cowden EA (2003) A randomized comparison of radioiodine in Graves’ hyperthyroidism. J Clin Endocrinol Metab 88:978–983

    Article  CAS  PubMed  Google Scholar 

  • Lucignani G (2007) Long-term risks in hyperthyroid patients treated with radioiodine: is there anything new? Eur J Nucl Med Mol Imaging 34:1504–1509

    Article  PubMed  Google Scholar 

  • Manders JMB, Corstens FHM (2002) Radioiodine therapy of euthyroid multinodular goiters. Eur J Nucl Med 29(Suppl 2):S466–S470

    Article  CAS  Google Scholar 

  • Marinelli LD, Quimby EH, Hine G (1950) Dosimetry of radioactive isotopes; biological observations and practical applications. Strahlentherapie 81:587–594

    CAS  PubMed  Google Scholar 

  • McDermott MT, Woodmansee WW, Haugen BR, Smart A, Ridgway EC (2003) The management of subclinical hyperthyroidism by thyroid specialists. Thyroid 13:1133–1139

    Article  PubMed  Google Scholar 

  • Moka D, Dietlein M, Schicha H (2002) Radioiodine therapy and thyrostatic drugs and iodine. Eur J Nucl Med Mol Imaging 29(Suppl 2):S486–S491

    Article  CAS  PubMed  Google Scholar 

  • Moschetta M, Ianora AA, Testini M, Vacca M, Scardapane A, Angelelli G (2010) Multidetector computed tomography in the preoperative evaluation of retrosternal goiters: a useful procedure for patients for whom magnetic resonance imaging is contraindicated. Thyroid 20:181–187

    Article  PubMed  Google Scholar 

  • Nielsen VE, Bonnema SJ, Hegedus L (2006a) Transient goiter enlargement after administration of 0.3 mg of recombinant human thyrotropin in patients with benign non-toxic nodular goiter: a randomized, double-blind, cross-over trial. J Clin Endocrinol Metab 91:1317–1322

    Article  CAS  PubMed  Google Scholar 

  • Nielsen VE, Bonnema SJ, Boel-Jorgensen H, Grupe P, Hegedus L (2006b) Stimulation with 0.3 mg recombinant human thyrotropin prior to iodine 131 therapy to improve the size reduction of benign non-toxic nodular goiter: a prospective randomized double-blind trial. Arch Intern Med 166:1476–1482

    Article  CAS  PubMed  Google Scholar 

  • Nieuwlaat WA, Huysmans DA, van den Bosch HC, Sweep CG, Ross HA, Corstens FH, Hermus AR (2003) Pretreatment with a single, low dose of recombinant human thyrotropin allows dose reduction of radioiodine therapy in patients with nodular goiter. J Clin Endocrinol Metab 88:3121–3129

    Article  CAS  PubMed  Google Scholar 

  • Papini E, Petrucci L, Guglielmi R, Panunzi C, Rinaldi R, Bacci V, Crescenzi A, Nardi F, Fabbrini R, Pacella CM (1998) Long-term changes in nodular goiter: a 5-year prospective randomized trial of levothyroxine suppressive therapy for benign cold thyroid nodules. J Clin Endocrinol Metab 83:780–783

    Article  CAS  PubMed  Google Scholar 

  • Reiners C, Schneider P (2002) Radioiodine therapy of thyroid autonomy. Eur J Nucl Med 29(Suppl 2):S471–S478

    Article  CAS  Google Scholar 

  • Reinhardt MJ, Joe A, von Mallek D, Zimmerlin M, Manka-Waluch A, Palmedo H, Krause TM (2002) Dose selection for radioiodine therapy of borderline hyperthyroid patients with multifocal and disseminated autonomy on the basis of 99mTc-pertechnetate thyroid uptake. Eur J Nucl Med Mol Imaging 29:480–485

    Article  CAS  PubMed  Google Scholar 

  • Reinhardt MJ, Kim B, Wissmeyer M, Juengling F, Brockmann H, von Mallek D, Ezziddin S, Joe AY, Krause T (2006) Dose selection for radioiodine therapy of borderline hyperthyroid patients according to thyroid uptake of 99mTc-pertechnetate: applicability to unifocal thyroid autonomy? Eur J Nucl Med Mol Imaging 33:608–612

    Article  CAS  PubMed  Google Scholar 

  • Salvatori M, Luster M (2010) Radioiodine therapy dosimetry in benign thyroid disease and differentiated thyroid carcinoma. Eur J Nucl Med Mol Imaging 37:821–828

    Article  PubMed  Google Scholar 

  • Santos RB, Romaldini JH, Ward LS (2004) Propylthiouracil reduces the effectiveness of radioiodine treatment in hyperthyroid patients with Graves’ disease. Thyroid 14:525–530

    Article  CAS  PubMed  Google Scholar 

  • Schmidt M, Gorbauch E, Dietlein M, Faust M, Stützer H, Eschner W, Theissen P, Schicha H (2006) Incidence of postradioiodine immunogenic hyperthyroidism/Graves′ disease in relation to a temporary increase in thyrotropin receptor antibodies after radioiodine therapy for autonomous thyroid disease. Thyroid 16:281–288

    Article  CAS  PubMed  Google Scholar 

  • Silva MN, Rubió IG, Romão R, Gebrin EM, Buchpiguel C, Tomimori E, Camargo R, Cardia MS, Medeiros-Neto G (2004) Administration of a single dose of recombinant human thyrotrophin enhances the efficacy of radioiodine treatment of large compressive multinodular goiters. Clin Endocrinol (Oxf) 60:300–308

    Article  CAS  Google Scholar 

  • Sisson JC, Avram AM, Rubello Gross MD (2007) Radioiodine treatment of hyperthyroidism: fixed or calculated doses; intelligent design of science? Eur J Nucl Med Mol Imaging 34:1129–1130

    Article  PubMed  Google Scholar 

  • Stabin MG, Brill AB (2008) State of the art in nuclear medicine dose assessment. Semin Nucl Med 38:308–320

    Article  PubMed  Google Scholar 

  • Stokkel M, Handkiewicz J, Lassmann M, Dietlein M, Luster M (2010) EANM procedure guidelines for therapy of benign thyroid disease. Eur J Nucl Med Mol Imaging 37:2218–2228

    Article  PubMed  Google Scholar 

  • Surks MI, Ortiz E, Daniels GH et al (2004) Subclinical thyroid disease. Scientific review and guidelines for diagnosis and management. JAMA 291:229–238

    Article  Google Scholar 

  • Walter MA, Crist-Crain M, Schindler C, Mueller-Brand J, Mueller B (2006) Outcome of radioiodine therapy without, on or 3 days off carbimazole: a prospective interventional three-group comparison. Eur J Nucl Med Mol Imaging 33:730–737

    Article  CAS  PubMed  Google Scholar 

  • Weetman AP (2007) Radioiodine treatment for benign thyroid diseases. Clin Endocrinol 66:757–764

    Article  CAS  Google Scholar 

  • Wesche MF, Tiel-V Buul MM, Lips P, Smits NJ, Wiersinga WM (2001) A randomized trial comparing levothyroxine with radioactive iodine in the treatment of sporadic nontoxic goiter. J Clin Endocrinol Metab 86:998–1005

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany

    Markus Dietlein & Matthias Schmidt

Authors
  1. Markus Dietlein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthias Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Markus Dietlein .

Editor information

Editors and Affiliations

  1. THERANOSTICS Center for Molecular, Radiotherapy and Molecular Imaging, ENETS Center of Excellence, Bad Berka, Germany

    Richard P. Baum

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Dietlein, M., Schmidt, M. (2012). Radioiodine Therapy of Hyperthyroidism (Toxic Goiter, Hyperfunctioning Nodule) and Non-Toxic Goiter: Procedures and Guidelines. In: Baum, R. (eds) Therapeutic Nuclear Medicine. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2012_673

Download citation

  • DOI: https://doi.org/10.1007/174_2012_673

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-36718-5

  • Online ISBN: 978-3-540-36719-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation