Long-term risks in hyperthyroid patients treated with radioiodine: is there anything new?

  • Giovanni LucignaniEmail author
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Surgery, radioiodine (RAI) and antithyroid drugs remain the main treatments in use today to cure Graves’ disease, solitary toxic thyroid nodules and toxic multinodular goitre [1, 2]. The treatment selection depends on many factors, including the clinician’s and patient’s preferences, the availability of a skilled surgeon, cost and local limitations on the therapeutic use of radioisotopes. A survey conducted more than 15 years ago among North American thyroid specialists concerning the treatment of a hypothetical patient with Graves’ disease found that 69% chose RAI as the preferred treatment. In Europe and Japan, RAI is less popular, being chosen as first-line therapy by only 22% and 11% of thyroid specialists, respectively [3]. It is worth noting that cost per “cure” has been calculated to be US $5,644 per patient who receives thionamides, $2,063 per patient given RAI and $9,826 per patient who undergoes thyroidectomy; the most cost-effective primary treatment modality for...


Hyperthyroidism Thyroid Volume Antithyroid Drug Hyperthyroid Patient Subclinical Hyperthyroidism 
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  1. 1.
    Treatment guidelines for patients with hyperthyroidism and hypothyroidism
  2. 2.
    American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism
  3. 3.
    Wartofsky L, Glinoer D, Solomon B, Nagataki S, Lagasse R, Nagayama Y, et al. Differences and similarities in the diagnosis and treatment of Graves’ disease in Europe, Japan, and the United States. Thyroid 1991;1:129–35.PubMedGoogle Scholar
  4. 4.
    Patel NN, Abraham P, Buscombe J, Vanderpump MP. The cost effectiveness of treatment modalities for thyrotoxicosis in a U.K. center. Thyroid 2006;16(6):593–8.PubMedCrossRefGoogle Scholar
  5. 5.
    EANM procedure guideline for therapy with iodine-131
  6. 6.
    Society of Nuclear Medicine procedure guideline for therapy of thyroid disease with iodine-131 (sodium iodide)
  7. 7.
    Weetman AP. Radioiodine treatment for benign thyroid diseases. Clin Endocrinol (Oxf) 2007;66(6):757–64.CrossRefGoogle Scholar
  8. 8.
    Metso S, Jaatinen P, Huhtala H, Auvinen A, Oksala H, Salmi J. Increased cardiovascular and cancer mortality after radioiodine treatment for hyperthyroidism. J Clin Endocrinol Metab 2007;92(6):2190–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Metso S, Auvinen A, Huhtala H, Salmi J, Oksala H, Jaatinen P. Increased cancer incidence after radioiodine treatment for hyperthyroidism. Cancer 2007;109(10):1972–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Vanderpump M. Cardiovascular and cancer mortality after radioiodine treatment of hyperthyroidism. J Clin Endocrinol Metab 2007;92(6):2033–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Rivkees SA, Dinauer C. An optimal treatment for pediatric Graves’ disease is radioiodine. J Clin Endocrinol Metab 2007;92(3):797–800.PubMedCrossRefGoogle Scholar
  12. 12.
    Lee JA, Grumbach MM, Clark OH. The optimal treatment for pediatric Graves’ disease is surgery. J Clin Endocrinol Metab 2007;92(3):801–3.PubMedCrossRefGoogle Scholar
  13. 13.
    Sisson JC, Avram AM, Rubello D, Gross MD. Radioiodine treatment of hyperthyroidism: fixed or calculated doses; intelligent design or science? Eur J Nucl Med Mol Imaging 2007;34(7):1129–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Carlier T, Salaun PY, Cavarec MB, Valette F, Turzo A, Bardies M, et al. Optimized radioiodine therapy for Graves’ disease: two MIRD-based models for the computation of patient-specific therapeutic 131I activity. Nucl Med Commun 2006;27(7):559–66.PubMedCrossRefGoogle Scholar
  15. 15.
    Canzi C, Zito F, Voltini F, Reschini E, Gerundini P. Verification of the agreement of two dosimetric methods with radioiodine therapy in hyperthyroid patients. Med Phys 2006;33(8):2860–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Muhammad W, Faaruq S, Hussain A, Kakakhail MB, Fatmi S, Matiullah. Quantitative analysis of the factors responsible for over or under dose of 131I therapy patients of hyperthyroidism. Radiat Prot Dosimetry. 2007 May 27; [Epub ahead of print].Google Scholar
  17. 17.
    Massaro F, Vera L, Schiavo M, Lagasio C, Caputo M, Bagnasco M, et al. Ultrasonography thyroid volume estimation in hyperthyroid patients treated with individual radioiodine dose. J Endocrinol Invest 2007;30(4):318–22.PubMedGoogle Scholar
  18. 18.
    Flux G, Bardies M, Chiesa C, Monsieurs M, Savolainen S, Strand SE, et al. Clinical radionuclide therapy dosimetry: the quest for the “Holy Gray”. Eur J Nucl Med Mol Imaging 2007 Jun 13; [Epub ahead of print].Google Scholar
  19. 19.
    Health protection of individuals against the dangers of ionising radiation in relation to medical exposure: Council Directive 97/43 EURATOM 1997.Google Scholar
  20. 20.
    Rosenthal MS. Patient misconceptions and ethical challenges in radioactive iodine scanning and therapy. J Nucl Med Technol 2006;34(3):143–50; quiz 151–2.PubMedGoogle Scholar
  21. 21.
    Franklyn JA. Thyroid disease and its treatment: short- and long-term consequences. J R Coll Physicians Lond 1999;33(6):564–7.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Institute of Radiological SciencesUniversity of Milan, Unit of Nuclear Medicine, Hospital San PaoloMilanItaly

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