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Dosimetry-based treatment for Graves' disease.
Steve L Hyer1, Brenda Pratt2, Matthew Gray2
1Department of Endocrinology, Epsom and St Helier University Hospitals NHS Trust.
Nuclear Medicine Communications
|April 4, 2018
Summary
A personalized dosimetry approach for Graves' disease using 60 Gy radioiodine effectively rendered many patients euthyroid long-term. This method used lower activities and delayed hypothyroidism in 26% of patients.
Area of Science:
- Endocrinology
- Nuclear Medicine
- Thyroidology
Background:
- Graves' disease is a common autoimmune disorder leading to hyperthyroidism.
- Radioiodine therapy is a standard treatment, but optimal dosimetry remains debated.
- Previous approaches often used fixed activities, leading to variable outcomes.
Purpose of the Study:
- To evaluate the long-term efficacy of a personalized dosimetry strategy in Graves' disease.
- To determine if a planned absorbed dose of 60 Gy can achieve euthyroidism.
- To assess the impact on the long-term incidence of hypothyroidism.
Main Methods:
- Retrospective analysis of 284 Graves' disease patients treated with radioiodine.
- Radioiodine activity was calculated to deliver a planned 60 Gy absorbed dose.
- Patients were followed prospectively for up to 10 years, excluding those with cardiac disease.
Main Results:
- 62% of patients achieved euthyroid or hypothyroid status after a single radioiodine administration.
- The median administered activity was 77 MBq, significantly lower than standard protocols.
- Long-term euthyroidism without medication was observed in 38% at 3 years, 26% at 10 years.
- Larger thyroid volume correlated with the need for re-treatment; nodules did not impact outcomes.
Conclusions:
- Personalized dosimetry for Graves' disease is effective in achieving long-term euthyroidism.
- This approach utilizes significantly lower radioiodine activities than typically recommended.
- A personalized strategy delayed the onset of hypothyroidism in 26% of patients, suggesting improved thyroid preservation.
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