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. 2019 Mar;63(3):537-544.
doi: 10.1007/s12020-018-01833-5. Epub 2018 Dec 31.

Thyroid stunning in radioiodine-131 therapy of benign thyroid diseases

Christian Happel  1 , Wolfgang Tilman Kranert  2 , Hanns Ackermann  3 , Ina Binse  4 , Benjamin Bockisch  2 , Daniel Gröner  2 , Ken Herrmann  4 , Frank Grünwald  2
Affiliations

Thyroid stunning in radioiodine-131 therapy of benign thyroid diseases

Christian Happel et al. Endocrine. 2019 Mar.

Abstract

Purpose: Existence and cause of thyroid stunning was controversially discussed for decades but the underlying mechanism remains unclear. Numerous studies describe thyroid stunning in radioiodine-131 therapy (RIT) of differentiated thyroid carcinoma. However, there are no studies evaluating thyroid stunning in benign thyroid diseases caused by the radioiodine uptake test (RIUT). Therefore, the influence of pre-therapeutic tracer radiation dose on therapeutic iodine-131 uptake was evaluated retrospectively.

Methods: A total of 914 RIT patients were included. Exclusion criteria were anti-thyroid drugs, pre- and/or intra-therapeutic effective half-lives (EHL) beyond 8.04 days and externally performed RIUT or 24 h RIUT. All patients received RIUT 1 week before RIT. Thyroid volume was estimated via ultrasound. Tracer radiation dose to the thyroid was calculated retrospectively. The dependence of changes in the pre-therapeutic to the therapeutic extrapolated-maximum-131I-uptake (EMU) from the dose in RIUT was evaluated statistically.

Results: EMU in RIUT ranged from 0.10 to 0.82 (median: 0.35) and EMU in RIT ranged from 0.10 to 0.74 (median: 0.33). Averaged over the whole cohort the therapeutic EMU decreased significantly (2.3% per Gray intra-thyroidal tracer radiation dose). A disease-specific evaluation showed dose-dependent thyroid stunning from 1.2% per Gray in solitary toxic nodules (n = 327) to 21% per Gray in goiters (n = 135) which was significant for the subgroups of disseminated autonomies (n = 114), multifocal autonomies (n = 178) and goiters (p < 0.05) but not for Graves' diseases (n = 160) and solitary toxic nodules (p > 0.05).

Conclusions: The presented data indicate for the first time a significant dependence of pre-therapeutic radiation dose on thyroid stunning in goiter and disseminated and multifocal autonomy. To achieve the desired intra-thyroidal radiation dose, RIT activity should be adapted depending on the dose in RIUT.

Keywords: Benign thyroid disease; Radioiodine therapy; Radioiodine uptake test; Thyroid; Thyroid stunning.

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References

    1. R. Lorenz, A. Buck, C. Reiners, In-patient nuclear medicine therapy in Germany from 2010 to 2012 – analysis of structured quality reports. Nuklearmedizin 54, 61–68 (2015) - DOI - PubMed
    1. M. Freesmeyer, F. Gühne, C. Kühnel, T. Opfermann, T. Winkens, A. Werner Determination of effective half-life of 131I in patients with differentiated thyroid carcinoma: comparison of cystatin C and creatinine-based estimation of renal function. Endocrine (2018). https://doi.org/10.1007/s12020-018-1800-4
    1. O. Dohan, A. de la Vieja, V. Paroder, C. Riedel, M. Artani, M. Reed, C.S. Ginter, N. Carrasco, The sodium/iodine symporter (NIS): characterization, regulation, and medical significance. Endocr. Rev. 24, 48–77 (2003) - DOI - PubMed
    1. E. Bell, F. Grünwald. Radiojodtherapie bei Benignen und Malignen Schilddrüsenerkrankungen (Springer-Verlag Berlin Heidelberg, New York, 1999).
    1. R.W. Rawson, J.E. Rall, W. Peacock, Limitations in the treatment of cancer of the thyroid with radioactive iodine. Trans. Assoc. Am. Physicians 64, 179–198 (1951) - PubMed

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