Outcome of radioiodine‐131 therapy in hyperfunctioning thyroid nodules: a 20 years’ retrospective study
Abstract
Summary: Objective To investigate the risk of hypothyroidism after radioiodine (131 I) treatment for hyperfunctioning thyroid nodules. Design Retrospective analysis of patients treated with 131 I for hyperfunctioning thyroid nodules and followed up for a maximum of 20 years. Patients A total of 346 patients treated with 131 I in the years 1975–95, for a single hyperfunctioning nodule. Measurements Hypothyroidism was defined as TSH levels > 3·7 mU/l. Kaplan–Meier survival analysis was used to analyse permanence of euthyroidism after 131 I. A stepwise Cox proportional hazard model was used to identify factors influencing the progression to hypothyroidism. Results The cumulative incidence of hypothyroidism was 7·6% at 1 year, 28% at 5 years, 46% at 10 years and 60% at 20 years. Age (P < 0·01), 24‐th 131 I uptake (P < 0·05) and previous treatment with methimazole (MMI, P < 0·1) were associated with a faster progression towards hypothyroidism, while thyroid and nodule size, thyroid status at diagnosis and degree of extranodular thyroid parenchymal suppression had no influence. In hyperthyroid patients with partial parenchymal suppression, however, previous MMI treatment was the most important prognostic factor (P < 0·01). Conclusions After 20 years of follow‐up, 60% of patients treated with 131 I for a single hyperfunctioning nodule are hypothyroid. Factors increasing the risk of hypothyroidism are age, 131 I uptake and MMI pretreatment. The prognostic value of this last factor, however, depends on the degree of suppression of the extranodular thyroid parenchyma at the scan.
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A study following 684 patients with TA treated with RAI reported a progressive increase in overt and subclinical hypothyroidism, with prevalence 7.6% at 1 year, 28% at 5 years, 46% at 10 years, and 60% at 20 years.
“A study following 684 patients with TA treated with RAI reported a progressive increase in overt and subclinical hypothyroidism (259).At 1 year, the investigators noted a 7.6% prevalence, with 28% at 5 years, 46% at 10 years, and 60% at 20 years.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [259]
A faster progression to hypothyroidism after RAI for TA was observed among patients who were older and who had incomplete TSH suppression due to prior therapy with ATDs.
“They observed a faster progression to hypothyroidism among patients who were older and who had incomplete TSH suppression (correlating with only partial extranodular parenchymal suppression) due to prior therapy with ATDs.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [259]
The prevalence of hypothyroidism after RAI for TA is progressive and hastened by the presence of antithyroid antibodies or a nonsuppressed TSH at the time of treatment.
“The prevalence of hypothyroidism after RAI is progressive and hastened by the presence of antithyroid antibodies or a nonsuppressed TSH at the time of treatment (257,259,260).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [259]
Long-term follow-up studies show a progressive risk of clinical or subclinical hypothyroidism of about 8% by 1 year and 60% by 20 years for TA.
“Long-term follow-up studies show a progressive risk of clinical or subclinical hypothyroidism of about 8% by 1 year and 60% by 20 years for TA (259), and an average of 3% by 1 year and 64% by 24 years for TMNG (250).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [259]
In TA patients, hypothyroidism progressively increases over time regardless of RAI activity adjustment for nodule size.
“A long-term follow-up study of patients with TA, in which patients with nodules <4 cm were administered an average of 13 mCi (481 MBq) and those with larger nodules an average of 17 mCi (629 MBq), showed a progressive increase in hypothyroidism over time in both groups, suggesting that hypothyroidism develops over time regardless of activity adjustment for nodule size (259).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [259]
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- Authors
- Ceccarelli, C., Bencivelli, W., Vitti, P., Grasso, L., & Pinchera, A.
- Affiliations
- University of Pisa (IT)
- Corresponding author
- Ceccarelli, Claudia
- ORCID
- Vitti, Paolo
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2005-01-25
- Volume
- 62
- Issue
- 3
- Pages
- 331-335
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W2064046172
- Cited by
- 109
- References
- 23
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 10 · 2023: 10 · 2022: 6 · 2021: 6 · 2020: 7 · 2019: 3 · 2018: 4 · 2017: 6 · 2016: 8 · 2015: 2 · 2014: 7 · 2013: 2 · 2012: 7
- FWCI
- 2.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- radioiodine therapy, iodine-131, hyperfunctioning thyroid nodules, hypothyroidism, long-term outcomes, prognostic factors, 131I uptake, age, euthyroidism
- MeSH terms
- Adult, Age Factors, Aged, Epidemiologic Methods, Female, Humans, Hyperthyroidism, Hypothyroidism, Iodine Radioisotopes, Male, Methimazole, Middle Aged, Radiation Injuries, Antithyroid Agents, Thyroid Gland, Thyrotropin, Thyroid Nodule, Treatment Outcome, Disease Progression
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