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Clinical outcomes after estimated versus calculated activity of radioiodine for the treatment of hyperthyroidism: systematic review and meta-analysis
Abstract
Background: Despite the long experience with radioiodine for hyperthyroidism, controversy remains regarding the optimal method to determine the activity that is required to achieve long-term euthyroidism. Objectives: To compare the effect of estimated versus calculated activity of radioiodine in hyperthyroidism. Design: Systematic review and meta-analysis. Methods: We searched the databases Medline, EMBASE, Web of Science, and Cochrane Library for randomized and nonrandomized studies, comparing the effect of activity estimation methods with dosimetry for hyperthyroidism. The main outcome measure was the frequency of treatment success, defined as persistent euthyroidism after radioiodine treatment at the end of follow-up in the dose estimated and calculated dosimetry group. Furthermore, we assessed the cure rates of hyperthyroidism. Results: Three randomized and five nonrandomized studies, comparing the effect of estimated versus calculated activity of radioiodine on clinical outcomes for the treatment of hyperthyroidism, were included. The weighted mean relative frequency of successful treatment outcome (euthyroidism) was 1.03 (95% confidence interval (CI) 0.91–1.16) for estimated versus calculated activity; the weighted mean relative frequency of cure of hyperthyroidism (eu- or hypothyroidism) was 1.03 (95% CI 0.96–1.10). Subgroup analysis showed a relative frequency of euthyroidism of 1.03 (95% CI 0.84–1.26) for Graves' disease and of 1.05 (95% CI 0.91–1.19) for toxic multinodular goiter. Conclusion: The two main methods used to determine the activity in the treatment of hyperthyroidism with radioiodine, estimated and calculated, resulted in an equally successful treatment outcome. However, the heterogeneity of the included studies is a strong limitation that prevents a definitive conclusion from this meta-analysis.
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“This outcome can be accomplished equally well by either administering a fixed activity or by calculating the activity based on the size of the thyroid and its ability to trap RAI (85).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [85]
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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
“This outcome can be accomplished equally well by either administering a fixed activity or by calculating the activity based on the size of the thyroid and its ability to trap RAI (85).”
BackgroundDe Leo, S., Lee, S. Y., & Braverman, L. E. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00278-6 · Cited by 883
Bonnema, S. J., & Hegedűs, L. D. (2012) · Endocrine Reviews · doi:10.1210/er.2012-1030 · Cited by 340
Lee, S. L. (2012) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0b013e328357fa0c · Cited by 307
“Calculated dose and dosimetry have been shown by meta-analysis to be equally effective [27].”
BackgroundFranklyn, J. A., & Boelaert, K. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60782-4 · Cited by 262
Metadata
- Authors
- de Rooij, A., Vandenbroucke, J. P., Smit, J. W. A., Stokkel, M. P. M., & Dekkers, O. M.
- Affiliations
- Leiden University Medical Center (NL)
- Corresponding author
- Dekkers, O M
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-11
- Volume
- 161
- Issue
- 5
- Pages
- 771-777
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2099188249
- Cited by
- 102
- References
- 26
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 10 · 2023: 2 · 2022: 8 · 2021: 7 · 2020: 11 · 2019: 6 · 2018: 6 · 2017: 8 · 2016: 7 · 2015: 7 · 2014: 7 · 2013: 6 · 2012: 6
- FWCI
- 2.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of 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, hyperthyroidism, euthyroidism, Graves' disease, toxic multinodular goiter, treatment success
- MeSH terms
- Dose-Response Relationship, Radiation, Humans, Hyperthyroidism, Iodine Radioisotopes, Radiotherapy Dosage, Treatment Outcome
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