Reduction in thyroid volume after radioiodine therapy of Graves' hyperthyroidism: results of a prospective, randomized, multicentre study

PETERS, H.; FISCHER, C.; BOGNER, U.; REINERS, C.; SCHLEUSENER, H.

doi:10.1046/j.1365-2362.1996.98243.x

Cited by 75Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

Reduction in thyroid volume after radioiodine therapy of Graves' hyperthyroidism: results of a prospective, randomized, multicentre study

PETERS, H., FISCHER, C., BOGNER, U., REINERS, C., SCHLEUSENER, H.·1996·European Journal of Clinical Investigation

DOI 10.1046/j.1365-2362.1996.98243.x

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Abstract

The reduction in thyroid size in 92 patients treated with radioiodine for Graves' thyrotoxicosis was monitored by ultrasound volumetry. The patients were randomly treated with either a standard 131 I activity of 555 MBq or an activity calculated to deliver a thyroid dose of 100 Gy. Within 1 year after radioiodine treatment, a remarkable volume reduction of about 71% (median) (quantile 25% (Q 25) = 49%, Q 75 = 82%, n = 67) was observed. The bulk of this reduction (median 57%, Q 25 = 21%, Q 75 = 74%, n = 92) was found within the first 6 months. Statistical analysis reveals that the effect was clearly related to the thyroid dose actually achieved during therapy. The median reduction obtained 6 months after radioiodine application was 45% for <100 Gy, 56% for 100–200 Gy and 67% for >200 Gy (n = 28, 39, 25 respectively). Twelve months after radioiodine application, the effect became less evident: 53%, 68% and 75% respectively (n = 17, 29, 21). The higher median thyroid dose actually achieved by standard than by calculated activity (215 Gy vs. 116 Gy) explains the more pronounced volume reduction in the standard group than in the calculated group: 60% vs. 47% 6 months (n = 47, 45) after radioiodine treatments and 74% vs. 66% 12 months (n = 31, 36) after radioiodine application. The relative reduction in thyroid size was just as marked in patients with large thyroids as in those with small glands. The goitre prevalence (thyroid volume > 20 mL in women and > 25 mL in men) was reduced from 73% to only 16% 1 year after radioiodine treatment. In patients with a thyroid volume of more than 60 mL, the median pretherapeutic thyroid volume of 102 mL was reduced to 29 mL. In conclusion, radioiodine treatment in Graves' hyperthyroidism sufficiently reduces thyroid volume in a dose‐dependent manner. The findings of this study demonstrate that radioiodine is also an attractive mode of therapy for Graves' patients with substantial thyroid enlargement.

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Evidence shows that to achieve a hypothyroid state, more than 150 microcuries per gram (5.55 MBq/g) needs to be delivered.
“Evidence shows that to achieve a hypothyroid state, >150 lCi/g (5.55 MBq/g) needs to be delivered (88)(89)(90).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [90]
In individuals with large thyroid glands (>80 g), the response to RAI may be poor.
“In individuals with large thyroid glands (>80 g), the response to RAI may be poor (88,90) and surgery also may be preferable for these patients.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [90]
There are poor remission rates with low-administered activities of RAI.
“Because of an increased risk of thyroid nodules and cancer associated with low-level thyroid irradiation in children (314,(352)(353)(354)) and poor remission rates with low-administered activities of RAI (88)(89)(90), it is important that RAI activities >150 lCi (>5.55 MBq/g) rather than smaller activities of RAI be administered to achieve hypothyroidism (312).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [90]
The administered activity of RAI to patients with very large goiters is high, and a tendency exists to underestimate the size of the gland and thereby administer insufficient RAI activities to these patients.
“The administered activity of RAI to patients with very large goiters is high, and a tendency exists to underestimate the size of the gland (and thereby administer insufficient RAI activities to these patients) (90).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [90]

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Authors: PETERS, H., FISCHER, C., BOGNER, U., REINERS, C., & SCHLEUSENER, H.
Affiliations: Freie Universität Berlin (DE)
Heidelberg University (DE)
University of Würzburg (DE)
Corresponding author: SCHLEUSENER, H.
ORCID: PETERS, H.
REINERS, C.
Venue: European Journal of Clinical Investigation
Publisher: Wiley
Published: 1996-01
Volume: 26
Issue: 1
Pages: 59-63
ISSN: 0014-2972 (ISSN-L)
1365-2362
DOI: 10.1046/j.1365-2362.1996.98243.x
OpenAlex: W2014302771
Cited by: 74
References: 0
Citations by year: 2026: 1 · 2025: 2 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 4 · 2019: 3 · 2018: 2 · 2017: 1 · 2016: 2 · 2015: 3 · 2014: 4 · 2013: 4 · 2012: 5
FWCI: 1.83
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 2858 d)
Locations: European Journal of Clinical Investigation (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
Keywords: Graves' disease, Graves' hyperthyroidism, radioiodine therapy, iodine-131, thyroid volume reduction, thyroid dose, dose-response relationship, goiter, thyroid size, thyrotoxicosis, prospective study, dose reduction
MeSH terms: Adult, Aged, Aged, 80 and over, Data Interpretation, Statistical, Dose-Response Relationship, Radiation, Female, Goiter, Graves Disease, Humans, Iodine Radioisotopes, Male, Middle Aged, Prospective Studies, Time Factors

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Reduction in thyroid volume after radioiodine therapy of Graves' hyperthyroidism: results of a prospective, randomized, multicentre study

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