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Clinical outcomes 1 year after empiric 131I therapy for hyperthyroid disorders: real life experience and predictive
Lavinia Vija Racaru1, Charlotte Fontan, Mathilde Bauriaud-Mallet
1aNuclear Medicine Department, Institut Universitaire de Cancérologie Oncopole, Institut Claudius Regaud bFaculty of Medicine, Paul Sabatier University cNuclear Medicine Department dEndocrinology Department, Larrey Hospital, University Hospitals of Toulouse eCancer Research Center of Toulouse, Paul Sabatier University, Toulouse, France.
Abstract:
Radioiodine is a therapeutic option in Europe for Graves' disease (GD) and toxic multinodular goiter (MNG).
Purpose:
To compare empiric and calculated I activities using 2013 EANM recommendations. To look for predictive factors of therapeutic response to an empiric activity of I. To assess clinical situations favoring calculated treatment modalities.
Patients And Methods:
Prospective monocentric study of clinical outcomes at 1 year follow-up in 86 patients with GD and MNG who received empiric I therapeutic activities (348-939 MBq). Differences between empiric and calculated activities were confronted to clinical outcomes. Physicians were not aware of the calculated activity at the time of prescription.
Results:
One year after treatment, 9% (5/57) of GD patients and 7% (2/29) of MNG patients were still in a hyperthyroid state. Thyroid volume was reduced by 67% for GD and by 50% for MNG. In GD, empiric I activities were higher than calculated ones (564±131 vs. 316±319 MBq, P<0.001) in 93% (53/57) of patients. Pretherapeutic thyroid volume (>26 ml for GD; >40 ml for MNG) was associated with persistent hyperthyroidism.
Conclusion:
Empirically administered I for GD and MNG was associated with very high efficacy in thyroid function control and no side effects. Thyroid volume reduction did not preclude treatment efficacy. Activity calculation could be a useful method for treating patients with GD and thyroid volumes higher than 26 ml or patients with MNG and thyroid volumes higher than 40 ml. A selective approach based on pretherapeutic thyroid volume and radioiodine biokinetics might improve treatment success.
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