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. 2018 Jun;39(6):486-492.
doi: 10.1097/MNM.0000000000000826.

Dosimetry-based treatment for Graves' disease

Steve L Hyer  1 , Brenda Pratt  2 , Matthew Gray  2 , Sarah Chittenden  2 , Yong Du  3 , Clive L Harmer  4 , Glenn D Flux  2
Affiliations

Dosimetry-based treatment for Graves' disease

Steve L Hyer et al. Nucl Med Commun. 2018 Jun.

Abstract

Objective: The aim of this retrospective study was to assess the long-term outcome of a personalized dosimetry approach in Graves' disease aiming to render patients euthyroid from a planned thyroid absorbed dose of 60 Gy.

Patients and methods: A total of 284 patients with Graves' disease were followed prospectively following administration of radioiodine calculated to deliver an absorbed dose of 60 Gy. Patients with cardiac disease were excluded. Outcomes were analysed at yearly intervals for up to 10 years with a median follow-up of 37.5 months.

Results: A single radioiodine administration was sufficient to render a patient either euthyroid or hypothyroid in 175 (62%) patients, the remainder requiring further radioiodine. The median radioactivity required to deliver 60 Gy was 77 MBq. Less than 2% patients required 400-600 MBq, the standard activity administered in many centres. In the cohort receiving a single administration, 38, 32 and 26% were euthyroid on no specific thyroid medication at 3, 5 and 10 years, respectively. Larger thyroid volumes were associated with the need for further therapy. The presence of nodules on ultrasonography did not adversely affect treatment outcome.

Conclusion: A personalized dosimetric approach delayed the long-term onset of hypothyroidism in 26% of patients. This was achieved using much lower administered activities than currently recommended. Future studies will aim to identify those patients who would benefit most from this approach.

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Figures

Fig. 1
Fig. 1
Treatment outcomes for patients with Graves’ disease (n=227) (solid lines) and for Graves with nodules (n=57) (dotted lines). EU, euthyroidism; hypo, hypothyroidism; hyper, hyperthyroidism; RAI, radioactive iodine.
Fig. 2
Fig. 2
Radiation response to 60 Gy for the euthyroid group on the basis of age at administration.
See this image and copyright information in PMC

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