Efficacy of Fixed High Dose Radioiodine Therapy for Hyperthyroidism - a 14 year Experience: A focus on Influence of Pre-treatment Factors on Outcomes

Khalid, Y.; Barton, D. M.; Baskar, V.; Kumar, H; Jones, P.; West, T. E. T.; Buch, H. N.
September 2011
British Journal of Medical Practitioners;2011, Vol. 4 Issue 3, p7
Academic Journal
Background: Radioiodine therapy (RAI) is commonly used as a definitive treatment for hyperthyroidism. However there is no agreement on the regime or the dose of RAI used and success rate is quite variable. In addition, the literature on the factors governing the success of the initial dose is conflicting. Objective: We have adopted a standard 550 MBq dose for all patients with hyperthyroidism. The aims of our study were (1) to assess the success rate of this regime in terms of cure of hyperthyroidism and (2) to evaluate the role of pre-treatment factors including age, gender, use of antithyroid medication prior to RAI, aetiology of hyperthyroidism and free thyroxine levels at diagnosis, as predictors of response to RAI. Patients and methods: The study is a retrospective analysis of 584 patients treated at this centre over a 14 year period. All patients received a fixed 550MBq dose following withdrawal of antithyroid medication for 7 days. Repeat dose was administered if patients remained hyperthyroid at the end of one year after the initial dose. Success rate in terms of cure of hyperthyroidism was calculated. The association of pre-treatment factors and failure to respond to the first dose of RAI was studied using univariate and multivariate analyses. Results: Mean age was 56 years (range 20-90 years) with female preponderance (82%). Of the 478 patients in whom the aetiology could be ascertained by the criteria used, 344(72%) patients had Graves’ disease and 134(28%) patientshad toxic nodular disease. At the end of one year 545(93%) patients were either hypothyroid (411(70%)) or euthyroid (134(23%)) and were considered to be cured, while 39(7%) patients remained hyperthyroid and required further doses of RAI. Free thyroxine level at the time of diagnosis was the only pre-treatment factor, which independently influenced post-RAI outcome and a higher free thyroxine level predicted a lower cure rate. Conclusion: A standard 550MBq dose of RAI has a low failure rate when used for the treatment of hyperthyroidism. In our experience, only high free thyroxine levels at diagnosis was associated with a lower cure rate.


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