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Efficacy of I-131 Treatment Dosage for Hyperthyroidism With Current Institution Formula

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Salam, Sanna, Nso, Nso, Kondaveeti, Ravali, Ching, Tsung Han Scottie, Nassar, Mahmoud, Sachmechi, Issac·2023·Journal of Endocrinology and Metabolism
DOI 10.14740/jem874
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Abstract

Background: I-131 (radioactive iodine (RAI)) therapy effectively targets overactivity of the thyroid gland; however, the literature provides conflicting outcomes regarding dosage optimization of I-131 for patients with hyperthyroidism and associated clinical complications. This retrospective study aimed to validate the therapeutic efficacy of an empirically derived I-131 institution formula in resolving hyperthyroidism by establishing a euthyroid or hypothyroid state. Methods: This retrospective chart review was undertaken for 89 adult patients (> 18 years) who received I-131 therapy from 2016 to 2020 at H&H/Queens, New York. The I-131 dose range was determined in accordance with their thyroid gland weight and thyroid uptake percentages; however, the follow-up assessment was performed for a duration of 6 - 12 months. IRB approval with reference HS-STUDY-21-01760 was obtained. All the subjects consented using a written consent document in a private room. All the patient’s data are stored confidentially in a password-protected computer, which is accessible only to the study group. The primary endpoint (i.e., treatment success) was defined by the interim development of a euthyroid state, hypothyroidism, subclinical/questionable/suspected hypothyroidism, or a questionable euthyroid state. The secondary endpoints included the frequency of repeat RAI doses and post-ablation thyroid function tests (TFTs). Results: The univariate and multivariate analysis of patient data indicated an 83% I-131 treatment success rate defined by the achievement of a euthyroid state and hypothyroidism in 6.7% and 70.8% of patients, along with the attainment of questionable euthyroid status, questionable hypothyroidism, subclinical hypothyroidism, and suspected hypothyroidism in 1.1%, 1.1%, 2.2%, and 1.1% of patients, respectively. In addition, a low number (i.e., 9%) of patients with hyperthyroidism required repeat I-131 treatment dosages to achieve a hypothyroid or euthyroid state. The results indicated a clinically significant impact of I-131 treatment dosages on post-ablation thyroid-stimulating hormone (TSH), triiodothyronine (T3), and free thyroxin (FT4) levels. Conclusion: The results of this study testified to the therapeutic efficacy of the current institution’s formula for I-131 treatment dosages in treating hyperthyroidism. In addition, 83% treatment success and a low retreatment requirement strengthened current evidence favoring the optimization of RAI therapy for hyperthyroidism. J Endocrinol Metab. 2023;13(2):49-56 doi: https://doi.org/10.14740/jem874

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  • Approximately 5-10% of hypothyroid patients report persistent symptoms such as fatigue and mood disturbances even when TSH levels are normalized.

    “approximately 5–10% of patients report persistent symptoms such as fatigue and mood disturbances, even when TSH levels are normalized [5, 6].”

    From Evaluating the effectiveness of combined T4 and T3 therapy or desiccated thyroid versus T4 monotherapy in hypothyroidism: a systematic review and meta-analysis (2024) · cites this paper as [6]

    The Primary and secondary endpoints section discusses symptoms only as a reason to suspect hypothyroidism when laboratory results are inconclusive or unconfirmed. The post-treatment results report thyroid-status and TSH outcomes, but our copy does not address persistent fatigue or mood disturbances despite normalized TSH, or the claimed 5–10% frequency (searched for those symptoms and the percentage). Page numbers were not available in our copy. (LLM, conf=0.76)

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Research works printed but not linked: 1

  1. Mumtaz M, Lin LS, Hui KC, Mohd Khir AS. Radioiodine I-131 for the therapy of graves' disease. Malays J Med Sci. 2009;16(1):25-33. pubmed pmc

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Authors
Salam, S., Nso, N., Kondaveeti, R., Ching, T. H. S., Nassar, M., & Sachmechi, I.
Affiliations
Mount Sinai Queens (US)
ORCID
Venue
Journal of Endocrinology and Metabolism
Publisher
Elmer Press, Inc.
Published
2023-06
Volume
13
Issue
2
Pages
49-56
ISSN
  • 1923-2861 (ISSN-L)
  • 1923-287X
DOI
10.14740/jem874
OpenAlex
W4382811330
Cited by
4
References
51
Citations by year
2025: 1 · 2024: 2 · 2023: 1
FWCI
0.82
Type
journal article
Language
en
Open access
Licence
Locations
Journal of Endocrinology and Metabolism (publishedVersion, cc-by-nc)
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, hyperthyroidism, dose optimization, thyroid weight, thyroid uptake, hypothyroidism, euthyroidism, repeat ablation, thyroid-stimulating hormone, free thyroxine, triiodothyronine, treatment success rate, thyroiditis, Graves' disease, thyroid nodules

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