Annals of Surgical Oncology

, Volume 21, Issue 13, pp 4174–4180 | Cite as

Failure of Radioactive Iodine in the Treatment of Hyperthyroidism

  • David F. Schneider
  • Philip E. Sonderman
  • Michaela F. Jones
  • Kristin A. Ojomo
  • Herbert Chen
  • Juan C. Jaume
  • Diane F. Elson
  • Scott B. Perlman
  • Rebecca S. Sippel
Endocrine Tumors



Persistent or recurrent hyperthyroidism after treatment with radioactive iodine (RAI) is common and many patiedlxnts require either additional doses or surgery before they are cured. The purpose of this study was to identify patterns and predictors of failure of RAI in patients with hyperthyroidism.


We conducted a retrospective review of patients treated with RAI from 2007 to 2010. Failure of RAI was defined as receipt of additional dose(s) and/or total thyroidectomy. Using a Cox proportional hazards model, we conducted univariate analysis to identify factors associated with failure of RAI. A final multivariate model was then constructed with significant (p < 0.05) variables from the univariate analysis.


Of the 325 patients analyzed, 74 patients (22.8 %) failed initial RAI treatment, 53 (71.6 %) received additional RAI, 13 (17.6 %) received additional RAI followed by surgery, and the remaining 8 (10.8 %) were cured after thyroidectomy. The percentage of patients who failed decreased in a stepwise fashion as RAI dose increased. Similarly, the incidence of failure increased as the presenting T3 level increased. Sensitivity analysis revealed that RAI doses <12.5 mCi were associated with failure while initial T3 and free T4 levels of at least 4.5 pg/mL and 2.3 ng/dL, respectively, were associated with failure. In the final multivariate analysis, higher T4 (hazard ratio [HR] 1.13; 95 % confidence interval [CI] 1.02–1.26; p = 0.02) and methimazole treatment (HR 2.55; 95 % CI 1.22–5.33; p = 0.01) were associated with failure.


Laboratory values at presentation can predict which patients with hyperthyroidism are at risk for failing RAI treatment. Higher doses of RAI or surgical referral may prevent the need for repeat RAI in selected patients.


Hyperthyroidism Total Thyroidectomy Radioactive Iodine High Heart Rate Methimazole 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported by NIH T32 CA009614-23.


David F. Schneider, Philip E. Sonderman, Michaela F. Jones, Kristin A. Ojomo, Herbert Chen, Juan C. Jaume, Diane F. Elson, Scott B. Perlman, and Rebecca S. Sippel have no conflicts of interest to disclose.

Supplementary material

10434_2014_3858_MOESM1_ESM.tiff (1.5 mb)
Percentage failure by RAI dose and initial T3 levels. Data are expressed as the percentage of patients within the indicated RAI dose (a) or initial T3 level (b) who failed RAI. RAI radioactive iodine. Supplementary material 1 (TIFF 1521 kb)


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • David F. Schneider
    • 1
  • Philip E. Sonderman
    • 1
  • Michaela F. Jones
    • 1
  • Kristin A. Ojomo
    • 1
  • Herbert Chen
    • 1
  • Juan C. Jaume
    • 2
  • Diane F. Elson
    • 2
  • Scott B. Perlman
    • 3
  • Rebecca S. Sippel
    • 1
  1. 1.Section of Endocrine Surgery, Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Division of Endocrinology, Diabetes, and Metabolism, Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Section of Nuclear Medicine, Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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