A Randomized Comparison of Radioiodine Doses in Graves’ Hyperthyroidism
Abstract
The optimal method for determining iodine-131 treatment doses for Graves' hyperthyroidism is unknown, and techniques have varied from a fixed dose to more elaborate calculations based upon gland size, iodine uptake, and iodine turnover. Patients with Graves' hyperthyroidism (n = 88) who had not been previously treated with radioactive iodine were randomized to one of four dose calculation methods: low-fixed, 235 MBq; high-fixed, 350 MBq; low-adjusted, 2.96 MBq (80 micro Ci)/g thyroid adjusted for 24 h radioiodine uptake; and high-adjusted, 4.44 MBq (120 micro Ci)/g thyroid adjusted for 24 h radioiodine uptake. Subjects were followed for mean of 63 months (range, 10-94 months) for the following clinical outcomes: euthyroid without medication, hyperthyroid requiring further radioiodine, and hypothyroid requiring life-long L-T(4). Mean treatment doses were similar in the different outcome groups. We could not demonstrate any advantage to using an adjusted dose method. Survival analysis did not demonstrate any difference in the time to outcome between the fixed and adjusted dose methods. The use of a fixed dose method simplifies the approach to treatment with potential cost savings.
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One study found that experienced physicians' estimate of thyroid size is accurate compared with anatomic imaging, but other investigators have not confirmed this observation.
“One study found that this estimate by experienced physicians is accurate compared with anatomic imaging (86); however, other investigators have not confirmed this observation (87).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [86]
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- Authors
- Leslie, W. D., Ward, L., Salamon, E. A., Ludwig, S., Rowe, R. C., & Cowden, E. A.
- Affiliations
- St. Boniface Hospital (CA)
- Corresponding author
- Leslie, William D.
- ORCID
- Leslie, William D.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2003-03
- Volume
- 88
- Issue
- 3
- Pages
- 978-983
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2136386868
- Cited by
- 204
- References
- 27
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 8 · 2023: 2 · 2022: 8 · 2021: 6 · 2020: 12 · 2019: 8 · 2018: 5 · 2017: 10 · 2016: 10 · 2015: 10 · 2014: 15 · 2013: 9 · 2012: 11
- FWCI
- 5.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (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' hyperthyroidism, radioiodine therapy, iodine-131 dose, dose calculation methods, fixed dose, hypothyroidism, recurrence, long-term outcomes
- MeSH terms
- Adult, Aged, Female, Graves Disease, Humans, Iodine Radioisotopes, Male, Middle Aged, Prospective Studies, Radiotherapy Dosage
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