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Is There Any Need for Adjusting 131I Activity for the Treatment of High Turnover Graves’ Disease Compared to Normal Turnover Patients? Results from a Retrospective Cohort Study Validated by Propensity Score Analysis

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Abstract

Purpose

To compare 131I-therapy outcomes in high turnover and normal turnover Graves’ disease patients and predict optimal first 131I activity for high turnover patients.

Methods

Retrospective cohort design (1:2) validated by propensity score analysis. Cohort 1, high turnover (2-h RAIU/24-h RAIU ≥ 1), n = 104, and cohort 2, normal turnover (ratio < 1), n = 208, patients were compared for post 131I outcome. The cure was defined as a combined euthyroid and stable hypothyroid state following 131I treatment. Logistic regression analysis was used for identifying prognostic factors. The propensity score was applied; 77 matched pairs (1:1 ratio) of high and normal turnover patients were selected as a validation set.

Results

First 131I cure rates of 28% in high turnover and 66% in normal turnover groups (p = 0.001) were noted. The therapy cycles (median, 2 vs. 1) and cumulative 131I activity (median, 15 vs. 7 mCi) were required to cure hyperthyroidism in cohort 1 and cohort 2, respectively. Age (> 44 years), higher grade of goitre, and 2-h RAIU (> 37%) were associated with 131I therapy failure. The high turnover patients needed a factor of 1.5–2 times more 131I activity to achieve a similar cure rate compared to the normal turnover patients. The first-dose cure rate was 31% vs. 60% by propensity score analysis (n = 154), no way different (28% vs.66%) from the whole group of 312 patients.

Conclusion

High turnover Graves’ disease patients, if administered standard 131I activity, the outcomes shall be poor. To improve the success rate, 131I activity should be increased by 1.5 to 2 times in the high turnover patients.

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Data Availability

Original raw data is available on request to corresponding author.

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Acknowledgements

We want to thank Dr. M.A Khan and Mr. Hem Chandra Sati, from Department of Biostatistics, AIIMS, New Delhi, for their help related to statistical analysis.

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  1. Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India

    Saurabh Arora & Chandrasekhar Bal

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  1. Saurabh Arora
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Contributions

Both authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Saurabh Arora and Chandrasekhar Bal. The first draft of the manuscript was written by Saurabh Arora, and Chandrasekhar Bal commented on previous versions of the manuscript. Both authors read and approved the final manuscript.

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Correspondence to Chandrasekhar Bal.

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Saurabh Arora and Chandrasekhar Bal declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki declaration as revised in 2013 and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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The institute ethics committee (Human studies), All India institute of Medical Sciences, New Delhi, approved this retrospective study (ref no: IECPG-598/24.10.2019) and the requirement to obtain informed consent was waived.

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Arora, S., Bal, C. Is There Any Need for Adjusting 131I Activity for the Treatment of High Turnover Graves’ Disease Compared to Normal Turnover Patients? Results from a Retrospective Cohort Study Validated by Propensity Score Analysis. Nucl Med Mol Imaging 55, 15–26 (2021). https://doi.org/10.1007/s13139-020-00674-3

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