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DOI: 10.3413/nukmed-0087
Graves' disease and radioiodine therapy
Is success of ablation dependent on the achieved dose above 200 Gy?Morbus Basedow und RadioiodtherapieIst der Erfolg der Radioiodablation oberhalb von 200 Gy dosisabhängig?Publication History
EReceived:
03 January 2007
accepted in revised form:
26 June 2007
Publication Date:
02 January 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034924/200801/lookinside/thumbnails/10-3413-nukmed-0087_de-1.jpg)
Summary
Aim: This study was performed to determine the results of ablative radioiodine therapy (RIT) when the achieved dose in the thyroid was above 200 Gy and to characterize predictive factors for treatment outcome. Patients, methods: A total of 571 consecutive patients were observed for 12 months between July 2001 and June 2004. Inclusion criteria were a confirmed diagnosis Graves' disease, compensation of hyperthyroidism and withdrawal of antithyroid drugs two days before preliminary radioiodine-testing and RIT. The intended dose was 250 Gy and the therapeutically achieved dose was calculated from serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The relation between success rate and the achieved dose, thyroid volume, age and sex of patients, TSH- and TRAb-values and presence of ophthalmopathy was analysed. Results: Relief from hyperthyroidism was achieved in 96% of patients who received more than 200 Gy, even for thyroid volumes >40 ml. The success of ablative RIT was not influenced by age or sex of patients, or by TSH- or TRAb values or concomitant ophthalmopathy. The mean achieved dose in the thyroid was 298 Gy with a standard deviation of 74.6 Gy. Conclusion: To achieve a dose of over 200 Gy with the above standard deviation, we recommend calculating an intended dose of 250 Gy and using a dosimetric approach with early and late uptake values in the radioiodine test, to allow early therapeutic intervention should the posttherapeutic thyroid dose fall unexpectedly below 200 Gy.
Zusammenfassung
Ziel der Studie war die Überprüfung der Dosisabhängigkeit oberhalb von 200 Gy und möglicher Einflussfaktoren auf den Erfolg der ablativen Radioiodtherapie (RIT) des Morbus Basedow. Patienten, Methodik: Von Juli 2001 bis Juni 2004 konnten 571 Patienten 12 Monate nach Radioiodtherapie beobachtet werden. Einschlusskriterien waren ein gesicherter Morbus Basedow, eine Rekompensation der Stoffwechsellage und ein Absetzen der thyreostatischen Medikation zwei Tage vor dem Radioiodtest und der RIT. Die Zieldosis war 250 Gy. Peritherapeutisch wurde die tatsächlich an der Schilddrüse erreichte Dosis durch serielle Uptake-Messungen bestimmt. Endpunkt der Studie war die Schilddrüsenfunktion 12 Monate nach RIT. Als Erfolg wurde die Beseitigung der Hyperthyreose gewertet. Die Erfolgsrate wurde verglichen mit der an der Schilddrüse erreichten Dosis, dem Schilddrüsenvolumen, dem Alter und Geschlecht , dem TSH- und TRAK-Wert sowie dem Vorliegen einer endokrinen Orbitopathie. Ergebnisse: Ab einer an der Schilddrüse erreichten Dosis von 200 Gy betrug der Therapieerfolg 96%. Dies galt auch für Schilddrüsenvolumina >40 ml. Alter und Geschlecht, TSH- und TRAK-Wert sowie eine endokrine Orbitopathie blieben ohne Einfluss auf den Therapieerfolg. Die durchschnittlich an der Schilddrüse erreichte Dosis betrug 298 Gy bei einer Standardabweichung von 74,6 Gy. Schlussfolgerung: Um bei o. g. Standardabweichung bei allen Patienten sicher über 200 Gy zu erreichen, wird bei peritherapeutischer Dosimetrie mit der Möglichkeit einer Nachtherapie eine Zieldosis im Radioiodtest von 250 Gy empfohlen.
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References
- 1 Baczyk M, Junik R, Ziemnicka K. et al. Iodine prophylaxis intensification: Influence on radioiodine uptake and activity of 131I used in the treatment of hyperthyroid patients with Graves' disease. Nuklearmedizin 2005; 44: 197-199.
- 2 Brunn J, Block U, Ruf G. et al. Volumetric analysis of thyroid lobes by real-time ultrasound. Dtsch Med Wschr 1981; 106: 1338-1340.
- 3 Dietlein M, Dressler J, Eschner W. et al. Procedure guideline for radioiodine test (version 2). Nuklearmedizin 2003; 42: 116-119.
- 4 Dietlein M, Dressler J, Grünwald F. et al. Guideline for radioiodine therapy for benign thyroid diseases (version 3). Nuklearmedizin 2004; 43: 217-220.
- 5 Dietlein M, Moka D, Reinholz U. et al. Who might benefit from administration of additional inactive iodine during radioiodine therapy for Graves' disease?. Nuklearmedizin 2007; 46: 77-84.
- 6 Dominello A, Guinea AmReeve TS, Robinson B. et al. Progressive increase in thyroid function after subtotal thyroidectomy for Graves' disease. Asian J Surg 2000; 23: 131-135.
- 7 Dunkelmann S, Neumann V, Staub U. et al. Results of a risk adapted and functional radioiodine therapy in Graves' disease. Nuklearmedizin 2005; 44: 238-242.
- 8 Dunkelmann S, Künstner E, Nabavi U. et al. Lithium as an adjunct to radioiodine therapy in Graves' disease for prolonging the intrathyroidal effective half-life of radioiodine. Nuklearmedizin 2006; 45: 213-218.
- 9 Eschner W, Moka D. Prä- und peritherapeutische Dosimetrie bei der Radioiodtherapie benigner Schilddrüsenerkrankungen. Der Nuklearmediziner 2004; 27: 90-97.
- 10 Gotthardt M, Stubinger M, Pansegrau J. et al. Decrease of 99mTc-uptake in autonomous thyroid tissue in Germany since the 1970s: Clinical implications for radioiodine therapy. Nuklearmedizin 2006; 45: 122-125.
- 11 Gotthardt M, Rubner C, Bauhofer A. et al. What is the best pre-therapeutic dosimetry for successful radioiodine therapy of multifocal autonomy?. Nuklearmedizin 2006; 45: 206-212.
- 12 Koch W, Rosa E, Knesewitsch P. et al. Guideline on radiation protection in medicine requires documentation of radioiodine therapy and follow-up: What are the benefits of an electronic database?. Nuklearmedizin 2005; 44: 49-55.
- 13 Ku CF, Lo CY, Chan WF. et al. Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves' disease. Anz J Surg 2005; 75: 528-531.
- 14 Meller B, Haase A, Seyfarth M. et al. Reduced radioiodine uptake at increased iodine intake and 131I-induced release of "cold" iodine stored in the thyroid. Nuklearmedizin 2005; 44: 137-142.
- 15 Moka D, Dietlein M, Schicha H. Radioiodine therapy and thyrostatic drugs and iodine. Eur J Nucl Med Mol Imaging 2002; 29 (Suppl 2) 486-491.
- 16 Peters H, Fischer C, Bogner U. et al. Radioiodine therapy of Graves' hyperthyroidism: standard vs. calculated 131Iodine activity Results from aprospective, randomized, multicentre study. Eur J Clin Invest 1995; 25: 883-884.
- 17 Pfeilschifter J, Elser H, Haufe S. et al. Impact of pretreatment variables on the outcome of standardized 131Itherapy with 150 Gray in Graves' disease. Nuklearmedizin 1997; 36: 81-86.
- 18 Reinhardt MJ, Brink I, Joe AY. et al. Radioiodine therapy in Graves' disease based on tissue-absorbed dose calculations: effect on pre-treatment thyroid volume on clinical outcome. Eur J Nucl Med Mol Imaging 2002; 29: 1118-1124.
- 19 Sabri O, Zimny M, Schulz G. et al. Success rate of radioiodine therapy in Graves' disease: The influence of thyrostatic medication. J Clin Endocrinol Metab 1999; 84: 1229-1233.
- 20 Schneider E, Korber C, Korber-Hafner N. et al. Does an individual estimation of halflife improve the results of radioiodine therapy of Graves' disease?. Nuklearmedizin 2002; 41: 240-244.
- 21 Snyder WS, Ford MR, Warner GG. et al. MIRD Pamphlet No.11: “S” Absorbed dose per unit cumulated activity for selected radionuclides and organs. Society of Nuclear Medicine; New York: 1975
- 22 Urbannek V. Radioiodtherapie bei Morbus Basedow-Vergleich verschiedener Therapieregime bezüglich der Thyreostatikagabe. Dissertation, Universität zu Köln. 2003
- 23 Urbannek V, Schmidt M, Moka D. et al. Effect of iodine application during radioiodine therapy in patients with impending therapy failure. Nuklearmedizin 2000; 39: 108-112.
- 24 Willemsen UF, Knesewitsch P, Kreisig T. et al. Functional results of radioiodine therapy with a 300 Gy absorbed dose in Graves' disease. Eur J Nucl Med 1993; 20: 1051-1055.
- 25 Zöphel K, Wunderlich G, Kopprasch C. et al. Predictive value of thyrotropin receptor antibodies using the second generation TRAb human assay after radioiodine treatment in Graves' disease. Nuklearmedizin 2003; 42: 63-70.
- 26 Zöphel K, Wunderlich G, Grüning T. et al. Where does subclinical hypothyroidism start? Implications for definition of the upper reference limit for thyroid stimulating hormone. Nuklearmedizin 2005; 44: 56-61.