Graves’ Disease Patients with Large Goiters Respond Best to Radioactive Iodine Doses of at Least 15 mCi: a Sonographic Volumetric Study
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Background and Objectives: Radioactive iodine therapy (RAI) is an important treatment modality of Graves’ disease (GD), but there is still not a consensus on the optimal dosage regimen. We studied the treatment success rate of different RAI doses, and examined which clinical markers were useful for determining the optimal RAI dosage for successful therapy in Korean patients. Materials and Methods: We retrospectively studied 123 patients with GD treated with RAI between 2004 and 2014 at Chonnam National University Hwasun Hospital. The responder group was defined as patients who developed hypothyroidism requiring levothyroxine replacement following RAI, regardless of the RAI dosage. Results: A total of 54 patients (43.9%) became hypothyroid after the first dose, and 31 needed two to four additional doses to achieve hypothyroidism. In the responder group as a whole (85 patients), the mean total dose of RAI was 15.5±7.0 mCi and the mean thyroid volume (TV) was 35.4±23.4 mL. When divided into low dose (＜15 mCi, n=46) and high dose (≥15 mCi, n=39) responder groups, TV was significantly lower in the low-dose responder group (25.7±11.4 vs. 48.4±31.3, p＜0.001). The optimal cut-off TV for the low-dose responder group was ＜32.37 mL (sensitivity 80.9%, specificity 76.7%). Conclusion: TV had significant effects on the outcome of RAI in GD patients. The optimal fixed RAI dose for Korean GD patients with a large goiter (≥33 mL) should be at least 15 mCi to achieve the best outcome.
Abstract
Background and Objectives: Radioactive iodine therapy (RAI) is an important treatment modality of Graves’ disease (GD), but there is still not a consensus on the optimal dosage regimen. We studied the treatment success rate of different RAI doses, and examined which clinical markers were useful for determining the optimal RAI dosage for successful therapy in Korean patients. Materials and Methods: We retrospectively studied 123 patients with GD treated with RAI between 2004 and 2014 at Chonnam National University Hwasun Hospital. The responder group was defined as patients who developed hypothyroidism requiring levothyroxine replacement following RAI, regardless of the RAI dosage. Results: A total of 54 patients (43.9%) became hypothyroid after the first dose, and 31 needed two to four additional doses to achieve hypothyroidism. In the responder group as a whole (85 patients), the mean total dose of RAI was 15.5±7.0 mCi and the mean thyroid volume (TV) was 35.4±23.4 mL. When divided into low dose (＜15 mCi, n=46) and high dose (≥15 mCi, n=39) responder groups, TV was significantly lower in the low-dose responder group (25.7±11.4 vs. 48.4±31.3, p＜0.001). The optimal cut-off TV for the low-dose responder group was ＜32.37 mL (sensitivity 80.9%, specificity 76.7%). Conclusion: TV had significant effects on the outcome of RAI in GD patients. The optimal fixed RAI dose for Korean GD patients with a large goiter (≥33 mL) should be at least 15 mCi to achieve the best outcome.
참고문헌 (18)
- Bonnema SJ, "Radioiodine therapy in benign thyroid diseases: effects, side effects, and factors affecting therapeutic outcome", Endocr Rev, 33(6), pp.920~980 (2012)
- Metso S, "Increased cancer incidence after radioiodine treatment for hyperthyroidism", Cancer, 109(10), pp.1972~1979 (2007)
- Abraham P, "Current and emerging treatment options for Graves' hyperthyroidism", Ther Clin Risk Manag, 6, pp.29~40 (2010)
- Lewis A, "Outcome of 131I therapy in hyperthyroidism using a 550MBq fixed dose regimen", Ulster Med J, 82(2), pp.85~88 (2013)
- Gupta SK, "Fixed dose (555 MBq; 15 mCi) radioiodine for the treatment of hyperthyroidism: outcome and its predictors", Intern Med J, 40(12), pp.854~857 (2010)
- Turner J, "Radioiodine therapy for Graves' disease: multivariate analysis of pretreatment parameters and early outcome", Eur J Nucl Med, 11(6-7), pp.191~193 (1985)
- Farrar JJ, "Iodine-131 treatment of hyperthyroidism: current issues", Clin Endocrinol (Oxf), 35(3), pp.207~212 (1991)
- Peters H, "Radioiodine therapy of Graves' hyperthyroidism: standard vs. calculated 131iodine activity. Results from a prospective, randomized, multicentre study", Eur J Clin Invest, 25(3), pp.186~193 (1995)
- Jarlov AE, "Is calculation of the dose in radioiodine therapy of hyperthyroidism worth while?", Clin Endocrinol (Oxf), 43(3), pp.325~329 (1995)
- Bonnema SJ, "Radioiodine therapy in benign thyroid diseases: effects, side effects, and factors affecting therapeutic outcome", Endocr Rev, 33(6), pp.920~980 (2012)
- Metso S, "Increased cancer incidence after radioiodine treatment for hyperthyroidism", Cancer, 109(10), pp.1972~1979 (2007)
- Abraham P, "Current and emerging treatment options for Graves' hyperthyroidism", Ther Clin Risk Manag, 6, pp.29~40 (2010)
- Lewis A, "Outcome of 131I therapy in hyperthyroidism using a 550MBq fixed dose regimen", Ulster Med J, 82(2), pp.85~88 (2013)
- Gupta SK, "Fixed dose (555 MBq; 15 mCi) radioiodine for the treatment of hyperthyroidism: outcome and its predictors", Intern Med J, 40(12), pp.854~857 (2010)
- Turner J, "Radioiodine therapy for Graves' disease: multivariate analysis of pretreatment parameters and early outcome", Eur J Nucl Med, 11(6-7), pp.191~193 (1985)
- Farrar JJ, "Iodine-131 treatment of hyperthyroidism: current issues", Clin Endocrinol (Oxf), 35(3), pp.207~212 (1991)
- Peters H, "Radioiodine therapy of Graves' hyperthyroidism: standard vs. calculated 131iodine activity. Results from a prospective, randomized, multicentre study", Eur J Clin Invest, 25(3), pp.186~193 (1995)
- Jarlov AE, "Is calculation of the dose in radioiodine therapy of hyperthyroidism worth while?", Clin Endocrinol (Oxf), 43(3), pp.325~329 (1995)