Advertisement

Journal of Endocrinological Investigation

, Volume 34, Issue 3, pp 201–205 | Cite as

A study of the efficacy of radioiodine therapy with individualized dosimetry in Graves’ disease: Need to retarget the radiation committed dose to the thyroid

  • M. Schiavo
  • M. C. Bagnara
  • I. Calamia
  • I. Bossert
  • E. Ceresola
  • F. Massaro
  • M. Giusti
  • A. Pilot
  • G. Pesce
  • M. Caputo
  • M. Bagnasco
Original Articles

Abstract

Although Iodine-131 (131|) therapy is fully validated for Graves’ disease (GD), there is debate about radioiodine amount to be administered (prescribed activity), as well as the use of individualized dosimetry vs fixed 131| activity. The clinical outcome of 119 GD patients treated with 131| from 2003 to 2008 has been evaluated. The prescribed activity was calculated according to a dosimetric protocol taking into account several variables, including thyroid volume reduction during treatment. In addition, we performed a simulation according to other dosimetric protocols, by calculating the corresponding prescribed activities. The patients were followed up for at least 12 months after treatment. In the first period of observation (2003), a 120–200 Gray (Gy) radiation dose to the thyroid was prescribed, according to the guidelines published by the Italian Societies of Endocrinology, Nuclear Medicine and Medical Physics: hyperthyroidism cure with a single radioiodine administration was obtained in 53% of patients. This outcome raised up to 89% when a higher radiation dose to the target (200–250 Gy) was prescribed, although the administered activities were still lower, as a rule, than the most commonly employed fixed activities (400–600 Mega-Becquerel — MBq). Our method showed a high level of individual dose optimisation, particularly when compared to simplified methods. In conclusion, the protocol adopted in this study ensures a satisfactory rate of hyperthyroidism cure, while administering quite low 131| activities, provided that an adequate committed radiation dose to the thyroid is prescribed. In this context, the dose indication given by the aforementioned guidelines should probably be revised.

Key-words

Hyperthyroidism Graves’ disease radioiodine therapy dosimetry 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hertz S, Roberts A. Application of radioactive iodine in therapy of Graves’ disease. J Clin Invest 1942, 21: 624 (abstract).Google Scholar
  2. 2.
    Sawin CT, Becker DV. Radioiodine and the treatment of hyperthyroidism: the early history. Thyroid 1997, 7: 163–76.PubMedCrossRefGoogle Scholar
  3. 3.
    Read CH Jr, Tansey M Jr, Menda Y. A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves’ patients. J Clin Endocrinol Metab 2004, 89: 4229–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Tarantini B, Ciuoli C, Di Cairano G, et al. Effectiveness of radioiodine (131|) as definitive therapy in patients with autoimmune and non-autoimmune hyperthyroidism. J Endocrinol Invest 2006, 29: 594–8.PubMedGoogle Scholar
  5. 5.
    Wartofsky, Glinoer D, Solomon B, Lagasse R. Differences and similarities in the treatment of diffuse goiter in Europe and the United States. Exp Clin Endocrinol 1991, 97: 243–51.PubMedCrossRefGoogle Scholar
  6. 6.
    Bartalena L, Marcocci C, Bogazzi F, et al. Relationship between therapy for hyperthyroidism and the course of ophthalmopathy. N Engl J Med 1998, 338: 73–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Gomez-Arnaiz N, Andia E, Gumà A, et al. Ultrasonographic thyroid volume as a reliable prognostic index of radioiodine-131| treatment outcome in Graves’ disease hyperthyroidism. Horm Metab Res 2003, 35: 492–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Nordyke RA, Gilbert FI Jr. Optimal iodine-131 dose for eliminating hyperthyroidism in Graves’ disease. J Nucl Med 1991, 32: 411–6.PubMedGoogle Scholar
  9. 9.
    Watson AB, Brownlie BE, Frampton CM, et al. Outcome following standardized 185 MBq dose 131| therapy for Graves’ disease. Clin Endocrinol (Oxf) 1988, 28: 487–96.CrossRefGoogle Scholar
  10. 10.
    Alexander EK, Reed Larsen P. High dose 131| therapy for the treatment of hyperthyroidism caused by Graves’ disease. J Clin Endocrinol Metab 2002, 87: 1073–7.PubMedGoogle Scholar
  11. 11.
    Andrade VA, Gross JL, Maia AL. The effect of methimazole pretreatment on the efficacy of radioactive iodine therapy in Graves’ hyperthyroidism: one-year follow-up of a prospective, randomized study. J Clin Endocrinol Metab 2001, 86: 3488–93.PubMedGoogle Scholar
  12. 12.
    Allahabadia A, Daykin J, Sheppard MC, et al. Radioiodine treatment of hyperthyroidism-Prognostic factors for outcome. J Clin Endocrinol Metab 2001, 86: 3611–7.PubMedGoogle Scholar
  13. 13.
    Erem C, Kandemir N, Hacihasanoglu A, et al. Radioiodine treatment of hyperthyroidism: prognostic factors affecting outcome. Endocrine 2004, 25: 55–60.PubMedCrossRefGoogle Scholar
  14. 14.
    Chiovato L, Fiore E, Vitti P, et al. Outcome of thyroid function in Graves’ patients treated with radioiodine: role of thyroid-stimulating and thyrotropin blocking antibodies and of radioiodine-induced thyroid damage. J Clin Endocrinol Metab 1998, 83: 40–6.PubMedGoogle Scholar
  15. 15.
    Marcocci C, Gianchecchi D, Masini I, et al. Areappraisal of the role of methimazole and other factors on the efficacy and outcome of radioiodine therapy of Graves’ hyperthyroidism. J Endocrinol Invest 1990, 13: 513–20.PubMedGoogle Scholar
  16. 16.
    Regalbuto C, Marturano A, Condorelli A, et al. Radiometabolic treatment of hyperthyroidism with a calculated dose of131|-iodine: results of one-year follow-up. J Endocrinol Invest 2009, 32: 134–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Dottorini ME, IngleseE, Salvatori M, Signore A, Squatrito S, Vitti P. Linee Guida SIE-AIMN-AIFM 2005 “Il trattamento radiometabolico dell’ipertiroidismo” 2005 (www.aimn.it).
  18. 18.
    Royal College of Physicians. Radioiodine in the management of benign thyroid disease-Clinical guidelines. Report of a Working Party. London: RCP, 2007 (http://www.rcplondon.ac.uk/Pages/index.aspx).Google Scholar
  19. 19.
    Dietlein M, Dressler J, Grünwald F, et al. Guideline for radioiodine therapy for benign thyroid disease (version 4), Nuklearmedizin 2007, 46: 220–3.PubMedGoogle Scholar
  20. 20.
    Traino AC, Di Martino F, Lazzeri M, Stabin MG. Study of the correlation between administered activity and radiation committed dose to the thyroid in 131| therapy of Graves’ disease. Rad Prot Dosim 2001, 95: 117–24.CrossRefGoogle Scholar
  21. 21.
    Bartalena L, Marcocci C, Bogazzi F, et al. Use of corticosteroids to prevent progression of Graves’ ophthalmopathy after radioiodine therapy for hyperthyroidism. N Engl J Med 1989, 321: 1403–5.CrossRefGoogle Scholar
  22. 22.
    Massaro F, Vera L, Schiavo M, et al. Ultrasonography thyroid volume estimation in hyperthyroid patients treated with individual radioiodine dose. J Endocrinol Invest 2007, 30: 318–22.PubMedGoogle Scholar
  23. 23.
    Sandell EB, Kolthoff IM. Micro determination of iodine by a catalytic method. Mikrochemica Acta 1937, 1: 9–25.CrossRefGoogle Scholar
  24. 24.
    Bartalena L, Marcocci C, Bogazzi F, et al. Relationship between therapy for hyperthyroidism and the course of Graves’ ophtalmopathy. N Engl J Med 1998, 338: 73–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Snyder W, Ford M, Warner G, Watson S. “S”, absorbed dose per unit cumulated activity for selected radionuclides and organs, MIRD Pamphlet No. 11. New York: Society of Nuclear Medicine, 1975.Google Scholar
  26. 26.
    International Commission on Radiological Protection — ICRP Publication 53: Radiation Dose to Patients from Radiopharmaceuticals. Annals of the ICRP, Volume18/1–4, Elsevier, 1988.Google Scholar
  27. 27.
    Bogazzi F, Giovanetti C, Fessehatsion R, et al. Impact of lithium on efficacy of radioactive iodine therapy for Graves’ Disease: a cohort study on cure rate, time to cure and frequency of increased serum thyroxine after antithyroid drug withdrawal. J Clin Endocrinol Metab 2009, 95: 201–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Kobe C, Eschner W, Wild M, et al. Radioiodine therapy of benign thyroid disorders: what are the effective thyroidal half-life and uptake of 131|? Nucl Med Commun 2010, 31: 201–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Giovanella L. Increased cancer incidence after radioiodine treatment for hyperthyroidism. Cancer 2008, 112: 220.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2011

Authors and Affiliations

  • M. Schiavo
    • 1
  • M. C. Bagnara
    • 2
  • I. Calamia
    • 1
  • I. Bossert
    • 1
  • E. Ceresola
    • 1
  • F. Massaro
    • 1
  • M. Giusti
    • 3
  • A. Pilot
    • 2
  • G. Pesce
    • 1
  • M. Caputo
    • 1
  • M. Bagnasco
    • 1
  1. 1.Medical and Radiometabolic Therapy Unit — DIMI University of GenoaItaly
  2. 2.Medical Physics UnitItaly
  3. 3.Endocrinology UnitDISEM University of Genoa, Azienda Ospedaliera Universitaria San MartinoGenoaItaly

Personalised recommendations