Radioiodine therapy of Graves' hyperthyroidism: standard vs. calculated 131 iodine activity*. Results from a prospective, randomized, multicentre study
Abstract
Abstract. The present prospective, randomized, multicentre study was performed to directly compare for the first time the effectiveness of a standard activity of 555 MBq 131 iodine vs. an activity calculated to deliver 100 Gy for treatment of Graves' thyro‐toxicosis. Therapeutic success was defined as the elimination of hyperthyroidism 6 months after radio‐iodine application (range 4.5–8 months). A success rate of more than 90% in eliminating hyperthyroidism was reported for both approaches, but only in retrospective investigations. Investigated prospec‐tively, hyperthyroidism was eliminated in only 71% of the patients receiving standard activity (70/98) and 58% of those randomized for calculated activity (62/107). In the patients with standard activity, therapeutic success was inversely related to thyroid size. The rate was 100% for thyroid volumes ≤15 mL, 95% for 16–30 mL, 68% for 31–45 mL, 44% for 46–50 mL, 20% for 61–75 mL and 25% for ≥75 mL. In those patients with an activity calculated to deliver 100 Gy (except in those with a volume ≥15 mL) this size/outcome dependency was almost compensated. The rates were 86%, 65%, 45%, 61%, 41% and 45%, respectively. Furthermore, detailed statistical analysis revealed a strong correlation between the success of therapy and the radiation dose actually absorbed by the thyroid. The rate was 11 % for a target dose of 50Gy, 50% for 100 Gy, 67% for 150Gy, 80 % for 200 Gy, 84 % for 250 Gy, 88 % for 300 Gy, 90 % for 350 Gy and 93% for 400 Gy. Based on the results obtained in the present study, we strongly recommend individual calculation of the 131 iodine activity to be administered for treatment of Graves' hyperthyroidism. However, the target dose should be in the range of 200Gy.
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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 [89]
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 [89]
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Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938 · see citing works
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Background
- Authors
- PETERS, H., FISCHER, C., BOGNER, U., REINERS, C., & SCHLEUSENER, H.
- Affiliations
- Freie Universität Berlin (DE)
- Heidelberg University (DE)
- University of Duisburg-Essen (DE)
- Corresponding author
- SCHLEUSENER, H.
- Venue
- European Journal of Clinical Investigation
- Publisher
- Wiley
- Published
- 1995-03
- Volume
- 25
- Issue
- 3
- Pages
- 186-193
- ISSN
- 0014-2972 (ISSN-L)
- 1365-2362
- OpenAlex
- W2064969958
- Cited by
- 174
- References
- 39
- Citations by year
- 2025: 5 · 2024: 5 · 2023: 4 · 2022: 6 · 2021: 3 · 2020: 5 · 2019: 7 · 2018: 6 · 2017: 3 · 2016: 5 · 2015: 10 · 2014: 10 · 2013: 4 · 2012: 9
- FWCI
- 2.38
- Type
- journal article
- Language
- en
- Open access
- closed
- 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
- radioiodine therapy, Graves' disease, hyperthyroidism, iodine-131, dose calculation, absorbed dose, thyroid volume, treatment success, thyrotoxicosis
- MeSH terms
- Adult, Age Factors, Autoantibodies, Female, Graves Disease, Humans, Iodine Radioisotopes, Male, Middle Aged, Prospective Studies, Radiotherapy Dosage, Thyroid Gland, Thyrotropin, Thyroxine, Triiodothyronine
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