1
|
Zannat R, Lee J, Muzaffar J, Read ML, Brookes K, Sharma N, Boelaert K, McCabe CJ, Nieto HR. The potential interaction between medical treatment and radioiodine treatment success: A systematic review. Front Endocrinol (Lausanne) 2023; 13:1061555. [PMID: 36686426 PMCID: PMC9845773 DOI: 10.3389/fendo.2022.1061555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Radioactive iodine (RAI) therapy is a critical component in the post-surgical management of thyroid cancer patients, as well as being a central therapeutic option in the treatment of hyperthyroidism. Previous work suggests that antithyroid drugs hinder the efficacy of RAI therapy in patients. However, the effects of other background medications on RAI treatment efficacy have not been evaluated. Therefore, we performed a systematic review and meta-analysis investigating the potential off-target effects of medication on RAI therapy in patients with thyroid cancer and hyperthyroidism. Methods Systematic review and meta-analysis according to the 2020 PRISMA guidelines. Databases searched: MEDLINE, EMBASE and Cochrane Library for studies published between 2001 and 2021. Results Sixty-nine unique studies were identified. After screening, 17 studies with 3313 participants were included. One study investigated thyroid cancer, with the rest targeted to hyperthyroidism. The majority of studies evaluated the effects of antithyroid drugs; the other drugs studied included lithium, prednisone and glycididazole sodium. Antithyroid drugs were associated with negative impacts on post-RAI outcomes (n = 5 studies, RR = 0.81, p = 0.02). However, meta-analysis found moderate heterogeneity between studies (I2 = 51%, τ2 = 0.0199, p = 0.08). Interestingly, lithium (n = 3 studies), prednisone (n = 1 study) and glycididazole (n = 1 study) appeared to have positive impacts on post-RAI outcomes upon qualitative analysis. Conclusion Our systematic review strengthens previous work on antithyroid medication effects on RAI, and highlights that this field remains under researched especially for background medications unrelated to thyroid disease, with very few papers on non-thyroid medications published. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php, identifier CRD42021274026.
Collapse
Affiliation(s)
- Riazul Zannat
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Lee
- Department of Ear, Nose and Throat Surgery, Warwick Hospital, University Hospitals of South Warwickshire NHS Foundation Trust, Birmingham, United Kingdom
| | - Jameel Muzaffar
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Martin L. Read
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Katie Brookes
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Neil Sharma
- Department of Ear, Nose and Throat Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Kristien Boelaert
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Christopher J. McCabe
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Health Partners, University of Birmingham, Birmingham, United Kingdom
| | - Hannah R. Nieto
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
2
|
Bolakale-Rufai IK, Abioro I, Ngene SO, Woldeamanuel Y. Efficacy of methimazole before the administration of radioactive iodine in the management of Graves' disease: a systematic review and meta-analysis. SAO PAULO MED J 2023; 141:e2022225. [PMID: 36629663 PMCID: PMC10065113 DOI: 10.1590/1516-3180.2022.0225.r1.19102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/19/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The efficacy of anti-thyroid drugs in conjunction with radioactive iodine therapy in the management of Graves' disease is still controversial. OBJECTIVE To compare the efficacy of pretreatment with methimazole before the administration of radioactive iodine for the treatment of Graves' disease. DESIGN AND SETTING A systematic review and meta-analysis was conducted at a teaching/tertiary hospital in Ibadan, Nigeria. METHODS A systematic search of the PubMed, Embase, Cochrane Library, and Web of Science databases was performed from inception to December, 2021. RESULTS Five studies with 297 participants were included. There was no difference in the risk of persistent hyperthyroidism when radioactive iodine was used in conjunction with methimazole compared with when radioactive iodine was used alone (relative risk: 1.02, 95% confidence interval, CI: 0.62-1.66; P = 0.95, I2 = 0%). Subgroup analysis based on the duration between discontinuation of methimazole and the administration of radioactive iodine showed a lower risk of persistent hyperthyroidism when methimazole was discontinued within 7 days before radioactive iodine use, although this did not reach statistical significance (risk ratio: 0.85, CI: 0.28-2.58). CONCLUSIONS The use of methimazole before radioactive iodine administration was not associated with an increased risk of persistent hyperthyroidism. Concerns about medication toxicity and adverse effects should be considered when clinicians make decisions on combination therapies for the treatment of Graves' disease. PROSPERO REGISTRATION CRD42020150013, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=150013.
Collapse
Affiliation(s)
| | - Imodoye Abioro
- MD. Physician, Department of Medicine, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
| | - Samuel Osobuchi Ngene
- MPH. Postgraduate Scholar, Swansea University Medical School, Swansea University, Wales, United Kingdom
| | - Yohannes Woldeamanuel
- MD, PhD. Expert Physician, Medical Scientist and Instructor at Department of Neurology, School of Medicine, Stanford University, California, United States
| |
Collapse
|
3
|
Chai J, Zhang R, Zheng W, Zhang G, Jia Q, Tan J, Meng Z, Wang R. Effect of Lugol's solution on 131I therapy efficacy in Graves' disease. Clin Exp Med 2022:10.1007/s10238-022-00859-4. [PMID: 35840869 DOI: 10.1007/s10238-022-00859-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Lugol's solution could control thyroid function and suppress 131I uptake in hyperthyroidism. This study aimed to investigate the appropriate time to withdraw Lugol's solution before 131I therapy (RIT) in Graves' disease (GD) patients, and how this should influence 131I uptake and RIT outcome. METHODS Two groups (125 cases and 1805 cases) of GD patients received RIT, who were pre-treated with and without Lugol's solution (RI-CI group and RI group). The RI-CI group was further divided into the following sub-groups depending on the duration span between Lugol's solution withdrawal and RIT: sub-group A, 4-7 d (n = 49); sub-group B, 8-14 d (n = 41); and sub-group C, 15-30 d (n = 35). The highest radioactive iodine uptake rate (RAIUmax), effective half-life (Teff), TRAb, and free triiodothyronine (FT3) and free thyroxine (FT4) levels were compared, and therapeutic outcome was evaluated. RESULTS There were no significant differences in RAIUmax, TRAb, and Teff among the four sub-groups (P > 0.05). Both FT3 and FT4 levels in sub-groups A and B were lower than those in group RI and sub-group C (P < 0.05). The outcome of non-hyperthyroidism (euthyroidism + hypothyroidism) in groups RI-CI and RI was significantly different at post-RIT month 1 and 3 (P < 0.05). However, intergroup differences at 6 and 12 months were not significant (P > 0.05). CONCLUSIONS Withdrawal of Lugol's solution 4-7 or 8-14 d before RIT does not influence 131I uptake and RIT efficacy in GD. Moreover, in order to avoid a rapid increase in thyroid hormone levels at the same time, Lugol's solution should be withdrawn 4-7 d before RIT.
Collapse
Affiliation(s)
- Jinyan Chai
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, People's Republic of China
| | - Ruiguo Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, People's Republic of China
| | - Wei Zheng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, People's Republic of China
| | - Guizhi Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, People's Republic of China
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, People's Republic of China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, People's Republic of China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Anshan Road No. 154, Heping District, Tianjin, 300052, People's Republic of China.
| | - Renfei Wang
- Department of Nuclear Medicine, Tongji University Tenth People's Hospital, Shanghai, 200000, People's Republic of China.
| |
Collapse
|
4
|
Pamnani H, Jindal R, Khare J, Sharma M, Siddiqui A, Wangnoo SK. Observational Study on Outcomes after Radioiodine Ablation in Hyperthyroid Patients. Indian J Endocrinol Metab 2022; 26:149-153. [PMID: 35873945 PMCID: PMC9302425 DOI: 10.4103/ijem.ijem_29_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/12/2022] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Radio-active Iodine (RAI) is a safe, definitive, and cost-effective modality of treatment that is used as the first line of treatment for Graves' hyperthyroidism by most endocrinologists. Very few reports are available from India, observational follow-up data is needed to determine the meaningful prognostic outcomes of RAI ablation in the Indian population. AIMS To study the outcomes in hyperthyroid patients undergoing RAI ablation. MATERIALS AND METHODS This observational cohort study was conducted at Department of Endocrinology at Indraprastha Apollo Hospital, New Delhi. A total of 82 hyperthyroid patients who underwent RAI ablation between June 2014 to June 2018 were enrolled. RAI dose was calculated arbitrarily in most cases; often by an empirical fixed dose based on the goiter size and RAIU. The patients were reviewed at 1, 3 and 6 months post-RAI ablation. During follow-up, along with a detailed clinical examination, free T4, free T3 and TSH were checked. RESULTS The dose of I-131 varied from 6 mCi to 14 mCi. Most of the patients were given RAI in the dose of 7.1-10 mci. About 63.4% of patients achieved hypothyroidism in 6 months, 6.1% in 1 month, 37.8% in 3 months, and 19.5% in 6 months. Gender, age, etiology of hyperthyroidism, baseline thyroid function, goiter, and ophthalmopathy did not affect outcomes after RAI ablation. Those who were not treated with antithyroid drugs prior to RAI therapy were found to have higher rates of conversion to a hypothyroid state. CONCLUSION RAI can be given safely as the first line of treatment in Graves' disease and antithyroid drug naïve patients respond better to therapy.
Collapse
Affiliation(s)
- Harsha Pamnani
- Department of Endocrinology, Peoples College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Radhika Jindal
- Department of Endocrinology, Safdarjung Hospital, New Delhi, India
| | - Jaideep Khare
- Department of Endocrinology, Peoples College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Monika Sharma
- Consultant Endocrinologist, Venkateshwar Hospital, New Delhi, India
| | - Asim Siddiqui
- Senior Consultant Endocrinologist, Indraprastha Apollo Hospital, New Delhi, India
| | - Subhash K. Wangnoo
- Senior Consultant Endocrinologist, Indraprastha Apollo Hospital, New Delhi, India
| |
Collapse
|
5
|
Das D, Banerjee A, Jena AB, Duttaroy AK, Pathak S. Essentiality, relevance, and efficacy of adjuvant/combinational therapy in the management of thyroid dysfunctions. Biomed Pharmacother 2022; 146:112613. [PMID: 35062076 DOI: 10.1016/j.biopha.2022.112613] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/14/2021] [Accepted: 01/02/2022] [Indexed: 11/02/2022] Open
Abstract
Thyroid dysfunction is the most prevalent endocrine disorder worldwide having an epidemiology of 11% in Indians, 4.6% in the United Kingdom, and 2% in the United States of America among the overall population. The common thyroid disorders include hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, and thyroid cancer. This review briefly elaborates the molecular regulation and mechanism of thyroid hormone, and its associated thyroid disorders. The thyroid hormones regulate critical biochemical functions in brain development and function. Hypothyroidism is mainly associated with dysregulation of cytokines, increased ROS production, and altered signal transduction in major regions of the brain. In addition, it is associated with reduced antioxidant capacity and increased oxidative stress in humans. Though 70% of thyroid disorders are caused by heredity, environmental factors have a significant influence in developing autoimmune thyroid disorders in people who are predisposed to them. This drives us to understand the relationship between environmental factors and thyroid dysregulated disorders. The treatment option for the thyroid disorder includes antithyroid medications, receiving radioactive iodine therapy, or surgery at a critical stage. However, antithyroid drugs are not typically used long-term in thyroid disease due to the high recurrence rate. Adjuvant treatment of antioxidants can produce better outcomes with anti-thyroid drug treatment. Thus, Adjuvant therapy has been proven as an effective strategy for managing thyroid dysfunction, herbal remedies can be used to treat thyroid dysfunction in the future, which in turn can reduce the prevalence of thyroid disorders.
Collapse
Affiliation(s)
- Diptimayee Das
- Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai 603103, India
| | - Antara Banerjee
- Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai, India
| | | | - Asim K Duttaroy
- Department of Nutrition, Institute of Medical Sciences, Faculty of Medicine, University of Oslo, Norway.
| | - Surajit Pathak
- Department of Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai, India.
| |
Collapse
|
6
|
Corvilain B, Hamy A, Brunaud L, Borson-Chazot F, Orgiazzi J, Bensalem Hachmi L, Semrouni M, Rodien P, Lussey-Lepoutre C. Treatment of adult Graves' disease. ANNALES D'ENDOCRINOLOGIE 2018; 79:618-635. [PMID: 30193753 DOI: 10.1016/j.ando.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Treatment strategy in Graves' disease firstly requires recovery of euthyroid status by antithyroid therapy. Treatment modalities, precautions, advantages and side-effects are to be discussed with the patient. No particular treatment modality has demonstrated superiority. Pregnancy or pregnancy project affects choice of treatment and monitoring. Graves' orbitopathy is liable to be aggravated by iodine-131 treatment and requires pre-treatment assessment. Iodine-131 treatment aims at achieving hypothyroidism. Thyroid surgery for Graves' disease should preferably be performed by an expert team. In case of recurrence of hyperthyroidism, the various treatment options should be discussed with the patient. Empiric treatment of thyroid dermopathy uses local corticosteroids in occlusive dressing.
Collapse
Affiliation(s)
- Bernard Corvilain
- Department of Endocrinology, Erasme University Hospital, université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Hamy
- Service de chirurgie viscérale et endocrine, CHU d'Angers, 49000 Angers, France
| | - Laurent Brunaud
- Service de chirurgie, unité de chirurgie endocrinienne, thyroïdienne et métabolique, unité multidisciplinaire de chirurgie de l'obésité, université de Lorraine, CHU Nancy, hôpital Brabois adultes, 11, allée du Morvan, 54511 Vandœuvre-les-Nancy, France
| | - Françoise Borson-Chazot
- HESPER EA 7425, hospices civils de Lyon, fédération d'endocrinologie, université Claude-Bernard Lyon 1, 69008 Lyon, France
| | - Jacques Orgiazzi
- CERMEP-imagerie du vivant, université Claude-Bernard Lyon 1, Lyon, France
| | - Leila Bensalem Hachmi
- Service d'endocrinologie à l'Institut national de nutrition de Tunis, faculté de médecine de Tunis, Tunisia
| | | | - Patrice Rodien
- Service EDN, centre de référence des maladies rares de la thyroïde et des récepteurs hormonaux, CHU d'Angers, 49000 Angers, France.
| | - Charlotte Lussey-Lepoutre
- Service de médecine nucléaire, Inserm U970, Sorbonne université, groupe hospitalier Pitié-Salpétrière, 75013 Paris, France
| |
Collapse
|
7
|
Investigation of factors influencing radioiodine (131I) biokinetics in patients with benign thyroid disease using nonlinear mixed effects approach. Eur J Clin Pharmacol 2018; 74:1037-1045. [DOI: 10.1007/s00228-018-2459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/04/2018] [Indexed: 10/16/2022]
|
8
|
Zakavi SR, Khazaei G, Sadeghi R, Ayati N, Davachi B, Bonakdaran S, Jabbari Nooghabi M, Moosavi Z. Methimazole discontinuation before radioiodine therapy in patients with Graves' disease. Nucl Med Commun 2015; 36:1202-7. [PMID: 26426965 DOI: 10.1097/mnm.0000000000000384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although radioiodine therapy (RIT) has been used for the treatment of hyperthyroidism for many decades, there is no consensus on the optimal time of methimazole (MMI) discontinuation before RIT. The aim of this clinical trial is to study the effect of three different time points of MMI discontinuation on response to RIT. METHOD AND PATIENTS Overall, 151 patients (18-65 years old), with Graves' disease who were taking MMI and referred to I-131 therapy, were consecutively assigned to one of three groups, and MMI was discontinued for 24-48, 48.1-72, and 72.1-168 h in group, 1, 2, and 3, respectively. Radioiodine uptake was measured in all patients and the radioiodine dose was calculated according to the Quimby formula to deliver 7.4 MBq of I-131 per gram of thyroid weight. Response to RIT was assessed at 1, 3, 6, and 12 months after RIT. RESULTS A total of 102 women and 49 men were included in the study. The mean administered dose of I-131 was 362.9±188.7 MBq (9.8±5.1 mCi) and the mean time to response for radioiodine was 4.1±3.6 months. There was no significant difference between the three groups in age, thyroid weight, anti-TPO level, radioactive iodine uptake level, and radioiodine dose (P>0.1). Response to RIT at 1, 3, 6, and 12 months after administration was also not different between the three groups (P>0.57). CONCLUSION No difference was found in the response to treatment between patients with MMI discontinuation for 24-48, 48.1-72, and 72.1-96 h before RIT. Shorter discontinuation of MMI before RIT may be preferable in most patients. Video Abstract: http://links.lww.com/NMC/A39.
Collapse
Affiliation(s)
- Seyed R Zakavi
- aNuclear Medicine Research Center bEndocrine Research Center cRadiology Department, Ghaem Hospital dSurgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences eDepartment of Statistics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Karyampudi A, Hamide A, Halanaik D, Sahoo JP, Kamalanathan S. Radioiodine therapy in patients with Graves' disease and the effects of prior carbimazole therapy. Indian J Endocrinol Metab 2014; 18:688-693. [PMID: 25285287 PMCID: PMC4171893 DOI: 10.4103/2230-8210.139234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED The use of radioiodine as the first line of treatment in Graves' disease is restricted in India because of its limited availability and an unrealistic risk perception associated with it. Additionally, the effectiveness of radioiodine ablation in Graves' disease is influenced by many factors. Prior medical antithyroid therapy is one such important factor. AIMS To analyze the efficacy of low dose radioiodine therapy (5 mCi) in treatment of naive patients of Graves' disease in comparison to that in which it was already primed with an antithyroid drug, carbimazole. SETTINGS AND DESIGN A non-randomized, interventional study conducted in the Department of Medicine and Endocrinology of a tertiary care institute in South India. MATERIALS AND METHODS The study had two groups; Group A (36 treatment naive, uncomplicated Graves' disease patients) and B (34 Graves' disease patients on carbimazole prior to radioiodine therapy). Both groups had baseline clinical, biochemical evaluation and were reassessed at 3 and 6 months for evaluating the clinical status for possible documentation of cure. RESULTS The cure rate was 61.1% in drug naive group and 58.8% in pretreated group at 6 months following radioiodine (P = 0.845). Higher baseline 999m technicium (99m Tc) uptake, male gender, BMI and higher baseline free thyroxine (fT4) level predicted treatment failure following radioiodine therapy. CONCLUSIONS Administration of carbimazole prior to low dose radioiodine therapy does not alter the efficacy of radioiodine. Low fixed dose (5 mCi) of radioactive iodine may be a safe and effective primary therapeutic option in Graves' disease patients pretreated with antithyroid drugs.
Collapse
Affiliation(s)
- Arun Karyampudi
- Department of Medicine, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India
| | - Abdoul Hamide
- Department of Medicine, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India
| | - Dhanapathi Halanaik
- Department of Nuclear Medicine, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India
| | - Jaya Prakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India
| | - Sadishkumar Kamalanathan
- Department of Endocrinology, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India
| |
Collapse
|
10
|
Perona M, Dagrosa MA, Pagotto R, Casal M, Pignataro O, Pisarev MA, Juvenal GJ. Protective effect of an antithyroid compound against γ-radiation-induced damage in human colon cancer cells. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2014; 53:611-619. [PMID: 24811726 DOI: 10.1007/s00411-014-0542-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 04/13/2014] [Indexed: 06/03/2023]
Abstract
We have previously reported the radioprotective effect of propylthiouracil (PTU) on thyroid cells. The aim of the present study was to analyze whether tumor cells and normal cells demonstrate the same response to PTU. Human colon carcinoma cells were irradiated with γ-irradiation with or without PTU. We evaluated the clonogenic survival, intracellular reactive oxygen species levels, catalase, superoxide dismutase and glutathione peroxidase activities, and apoptosis by nuclear cell morphology and caspase-3 activity assays. Cyclic AMP (cAMP) levels were measured by radioimmunoassay. PTU treatment increased surviving cell fraction at 2 Gy (SF2) from 56.9 ± 3.6 in controls to 75.0 ± 3.5 (p < 0.05) and diminished radiation-induced apoptosis. In addition, we observed that the level of antioxidant enzymes' activity was increased in cells treated with PTU. Moreover, pretreatment with PTU increased intracellular levels of cAMP. Forskolin (p < 0.01) and dibutyryl cAMP (p < 0.05) mimicked the effect of PTU on SF2. Co-treatment with H89, an inhibitor of protein kinase A, abolished the radioprotective effect of PTU. PTU reduces the toxicity of ionizing radiation by increasing cAMP levels and also possibly through a reduction in apoptosis levels and in radiation-induced oxidative stress damage. We therefore conclude that PTU protects both normal and cancer cells during exposure to radiation in conditions mimicking the radiotherapy.
Collapse
Affiliation(s)
- Marina Perona
- Department of Radiobiology (CAC), National Atomic Energy Commission (CNEA), San Martín, Buenos Aires, Argentina
| | | | | | | | | | | | | |
Collapse
|
11
|
Gibb FW, Zammitt NN, Beckett GJ, Strachan MWJ. Predictors of treatment failure, incipient hypothyroidism, and weight gain following radioiodine therapy for Graves' thyrotoxicosis. J Endocrinol Invest 2013; 36:764-9. [PMID: 23633646 DOI: 10.3275/8949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Following radioiodine ((131)I) therapy, both late recognition of hypothyroidism and treatment failure may result in adverse outcomes. AIM We sought to assess indicators of both incipient hypothyroidism and treatment failure following (131)I and determine factors predictive of weight gain. SUBJECTS AND METHODS Retrospective study of 288 patients receiving (131)I for treatment of Graves' thyrotoxicosis. Primary outcome measures were thyroid status and weight change at 1 yr following (131)I. RESULTS The treatment failure rate at 1 yr was 13.5%. Hypothyroidism developed in 80.9%, with 58.5% of patients having levels of free T4 (fT4) <6 pmol/l at diagnosis. Patients receiving thionamides before and after (131)I had significantly higher levels of treatment failure (23.3%) than those with no thionamide exposure (6.3%, p=0.003), but also had more active Graves' disease. Following (131)I, development of a detectable TSH or low-normal fT4 levels was not associated with recurrent thyrotoxicosis. Median weight gain was 5.3 kg, although patients with nadir fT4 levels <6 pmol/l gained an average 2 kg more than those with levels >6 pmol/l (p=0.05). The main predictor of weight gain was fT4 level immediately prior to treatment; those in the lowest tertile gained a median 3.1 kg whilst those in the highest tertile gained 7.4 kg (median difference 4.3 kg; 95% confidence interval: 2.5-6.2). CONCLUSIONS Marked hypothyroidism following (131)I is common and often occurs early. Simple biochemical parameters may help identify incipient hypothyroidism and potentially limit excess weight gain. Treatment failure is common in patients with severe thyrotoxicosis and in such cases larger doses of (131)I may be warranted.
Collapse
Affiliation(s)
- F W Gibb
- Edinburgh Centre for Endocrinology, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK.
| | | | | | | |
Collapse
|
12
|
Lima JGD, Souza ABCD, Mendonça RPD, Nóbrega LHC, Moura FADA, Queiroz ZJD. Embolização de artérias tireoidianas como opção terapêutica para o hipertireoidismo: série de casos. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a resposta da embolização arterial tireoidiana como terapêutica para o hipertireoidismo primário. MATERIAIS E MÉTODOS: Cinco mulheres com falha ao tratamento farmacológico com tionamida foram submetidas a vaso-oclusão em três artérias dominantes tireoidianas (avaliadas por ultrassonografia Doppler e arteriografia) e acompanhadas até 8 semanas após o procedimento (três acompanhadas até 16 semanas) com ultrassonografia Doppler, calcemia, função tireoidiana e controle clínico. RESULTADOS: Nenhuma alcançou remissão permanente de doença após 8 semanas. Houve recidiva de hipertireoidismo em 24 semanas, mesmo com redução do volume tireoidiano de 49,5 ± 15,2% em 16 semanas. Não encontramos complicações, mas radioiodo foi necessário após 24 semanas em três das pacientes acompanhadas. CONCLUSÃO: Nas pacientes que concluíram o protocolo, a vaso-oclusão arterial com polivinil álcool nas três artérias dominantes permitiu redução volumétrica do bócio, entretanto, foi ineficiente em controlar o hipertireoidismo.
Collapse
|
13
|
Perona M, Dagrosa MA, Pagotto R, Casal M, Pignataro OP, Pisarev MA, Juvenal GJ. Protection against radiation-induced damage of 6-propyl-2-thiouracil (PTU) in thyroid cells. Radiat Res 2013; 179:352-60. [PMID: 23398355 DOI: 10.1667/rr2658.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Many epidemiologic studies have shown that the exposure to high external radiation doses increases thyroid neoplastic frequency, especially when given during childhood or adolescence. The use of radioprotective drugs may decrease the damage caused by radiation therapy and therefore could be useful to prevent the development of thyroid tumors. The aim of this study was to investigate the possible application of 6-propyl-2-thiouracil (PTU) as a radioprotector in the thyroid gland. Rat thyroid epithelial cells (FRTL-5) were exposed to different doses of γ irradiation with or without the addition of PTU, methimazole (MMI), reduced glutathione (GSH) and perchlorate (KClO4). Radiation response was analyzed by clonogenic survival assay. Cyclic AMP (cAMP) levels were measured by radioimmunoassay (RIA). Apoptosis was quantified by nuclear cell morphology and caspase 3 activity assays. Intracellular reactive oxygen species (ROS) levels were measured using the fluorescent dye 2',7'-dichlorofluorescein-diacetate. Catalase, superoxide dismutase and glutathione peroxidase activities were also determined. Pretreatment with PTU, MMI and GSH prior to irradiation significantly increased the surviving cell fraction (SF) at 2 Gy (P < 0.05), while no effect was observed with KClO4. An increase in extracellular levels of cAMP was found only in PTU treated cells in a dose and time-dependent manner. Cells incubated with agents that stimulate cAMP (forskolin and dibutyril cAMP) mimicked the effect of PTU on SF. Moreover, pretreatment with the inhibitor of protein kinase A, H-89, abolished the radioprotective effect of PTU. PTU treatment diminished radiation-induced apoptosis and protected cells against radiation-induced ROS elevation and suppression of the antioxidant enzyme's activity. PTU was found to radioprotect normal thyroid cells through cAMP elevation and reduction in both apoptosis and radiation-induced oxidative stress damage.
Collapse
Affiliation(s)
- Marina Perona
- Department of Radiobiology, National Atomic Energy Commission, University of Buenos Aires, Department of Human Biochemistry, School of Medicine, Argentina
| | | | | | | | | | | | | |
Collapse
|
14
|
Bonnema SJ, Hegedüs L. Radioiodine therapy in benign thyroid diseases: effects, side effects, and factors affecting therapeutic outcome. Endocr Rev 2012; 33:920-80. [PMID: 22961916 DOI: 10.1210/er.2012-1030] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Radioiodine ((131)I) therapy of benign thyroid diseases was introduced 70 yr ago, and the patients treated since then are probably numbered in the millions. Fifty to 90% of hyperthyroid patients are cured within 1 yr after (131)I therapy. With longer follow-up, permanent hypothyroidism seems inevitable in Graves' disease, whereas this risk is much lower when treating toxic nodular goiter. The side effect causing most concern is the potential induction of ophthalmopathy in predisposed individuals. The response to (131)I therapy is to some extent related to the radiation dose. However, calculation of an exact thyroid dose is error-prone due to imprecise measurement of the (131)I biokinetics, and the importance of internal dosimetric factors, such as the thyroid follicle size, is probably underestimated. Besides these obstacles, several potential confounders interfere with the efficacy of (131)I therapy, and they may even interact mutually and counteract each other. Numerous studies have evaluated the effect of (131)I therapy, but results have been conflicting due to differences in design, sample size, patient selection, and dose calculation. It seems clear that no single factor reliably predicts the outcome from (131)I therapy. The individual radiosensitivity, still poorly defined and impossible to quantify, may be a major determinant of the outcome from (131)I therapy. Above all, the impact of (131)I therapy relies on the iodine-concentrating ability of the thyroid gland. The thyroid (131)I uptake (or retention) can be stimulated in several ways, including dietary iodine restriction and use of lithium. In particular, recombinant human thyrotropin has gained interest because this compound significantly amplifies the effect of (131)I therapy in patients with nontoxic nodular goiter.
Collapse
Affiliation(s)
- Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, DK-5000 Odense C, Denmark.
| | | |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW Review of the management decisions that must be made by the endocrinologist during the use of radioactive iodine (RAI) therapy of hyperthyroidism and differentiated thyroid cancer. RECENT FINDINGS Since the 1940s radioactive (131)I (RAI) therapy has been a major component of the treatment of hyperthyroidism and differentiated thyroid cancer. RAI is the most common definitive treatment of hyperthyroidism. Pretherapy decisions including use of antithyroid medication and low-iodine diet will be discussed with the relevant supportive literature. The method of semi-quantitative calculation used for RAI treatment of hyperthyroidism will be described. Evidence-based guideline for the management of differentiated thyroid cancer by the American Thyroid Association, new drug development and recent randomized controlled trials have changed current practice of how RAI is used for remnant ablation and adjuvant therapy of differentiated thyroid cancer. SUMMARY RAI is a common tool for the endocrinologist in the management of hyperthyroidism and differentiated thyroid cancer. Review of the management decisions and practice of RAI therapy will educate the endocrinologist of the literature supporting current RAI use in hyperthyroidism and new developments in limiting the radiation exposure to the patients with differentiated thyroid cancer.
Collapse
Affiliation(s)
- Stephanie L Lee
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
| |
Collapse
|
16
|
Abstract
Thyrotoxicosis is a common disorder, especially in women. The most frequent cause is Graves' disease (autoimmune hyperthyroidism). Other important causes include toxic nodular hyperthyroidism, due to the presence of one or more autonomously functioning thyroid nodules, and thyroiditis caused by inflammation, which results in release of stored hormones. Antithyroid drugs are the usual initial treatment (thionamides such as carbimazole or its active metabolite methimazole are the drugs of choice). A prolonged course leads to remission of Graves' hyperthyroidism in about a third of cases. Because of the low remission rate in Graves' disease and the inability to cure toxic nodular hyperthyroidism with antithyroid drugs alone, radioiodine is increasingly used as first line therapy, and is the preferred choice for relapsed Graves' hyperthyroidism. Total thyroidectomy is an option in selected cases. Future efforts are likely to concentrate on novel and safe ways to modulate the underlying disease process rather than stopping excess thyroid hormone production.
Collapse
Affiliation(s)
- Jayne A Franklyn
- Centre for Diabetes, Endocrinology and Metabolism, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | | |
Collapse
|
17
|
Bonnema SJ, Grupe P, Boel-Jørgensen H, Brix TH, Hegedüs L. A randomized trial evaluating a block-replacement regimen during radioiodine therapy. Eur J Clin Invest 2011; 41:693-702. [PMID: 21175612 DOI: 10.1111/j.1365-2362.2010.02452.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lack of consensus regarding the antithyroid drug regimen in relation to radioiodine ((131) I) therapy of hyperthyroidism prompted this randomized trial comparing two strategies. DESIGN Patients with Graves' disease (GD, n = 51) or toxic nodular goitre (TNG, n = 49) were randomized to (131) I either 8 days following discontinuation of methimazole (-BRT, n = 52, median dose: 5 mg) or while on a continuous block-replacement regimen (+BRT, n = 48, median dose 15 mg methimazole and 100 μg levothyroxine). results: Patients in the +BRT group required more radioactivity. In this group, thyroid function did not change in the early post (131) I period, while serum-free T3 index was higher in the -BRT group (P < 0·05). One year posttherapy, the fraction of cured patients (euthyroid or hypothyroid) was 48% and 61% in the +BRT and -BRT group, respectively (P = 0·014 unadjusted; P = 0·004 adjusted), but the outcome depended on the type of disease. In GD, treatment failure in the +BRT group correlated positively with the 24-h thyroid (131) I uptake (P = 0·017), while no correlations existed in the -BRT group. In addition to +BRT allocation, patients with TNG were at higher risk of treatment failure with lower thyroid radiation doses (P = 0·048), higher doses of methimazole (P = 0·026) and lower levels of serum TSH (P = 0·009). CONCLUSIONS A continuous block-replacement regimen results in a stable thyroid function during (131) I therapy but is hampered by the higher amounts of radioactivity required. The study demonstrates that the outcome in GD is highly unpredictable, while treatment failure in patients with TNG is correlated with a number of factors.
Collapse
Affiliation(s)
- Steen J Bonnema
- Department of Endocrinology, Odense University Hospital, Denmark.
| | | | | | | | | |
Collapse
|
18
|
Abstract
Graves' disease is the most common cause of hyperthyroidism in the developed world. It is caused by an immune defect in genetically susceptible individuals in whom the production of unique antibodies results in thyroid hormone excess and glandular hyperplasia. When unrecognized, Graves' disease impacts negatively on quality of life and poses serious risks of psychosis, tachyarrhythmia and cardiac failure. Beyond the thyroid, Graves' disease has diverse soft-tissue effects that reflect its systemic autoimmune nature. Thyroid eye disease is the most common of these manifestations and is important to recognise given its risk to vision and potential to deteriorate in response to radioactive iodine ablation. In this review we discuss the investigation and management of Graves' disease, the recent controversy regarding the hepatotoxicity of propylthiouracil and the emergence of novel small-molecule thyroid-stimulating hormone (TSH) receptor ligands as potential targets in the treatment of Graves' disease.
Collapse
Affiliation(s)
| | | | - Jack R. Wall
- Department of Medicine, University of Sydney, Sydney, Australia
| |
Collapse
|
19
|
Bonnema SJ, Fast S, Nielsen VE, Boel-Jørgensen H, Grupe P, Andersen PB, Hegedüs L. Serum thyroxine and age--rather than thyroid volume and serum TSH--are determinants of the thyroid radioiodine uptake in patients with nodular goiter. J Endocrinol Invest 2011; 34:e52-7. [PMID: 20834199 DOI: 10.1007/bf03347076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radioiodine (131I) therapy is widely used for treatment of non-toxic goiters. A limitation for this treatment is a low thyroid radioiodine uptake (RAIU), often encountered in these patients. AIM To estimate the impact of various factors on the thyroid RAIU. METHODS We examined prospectively 170 patients (146 females; age range: 22-87 yrs) with nodular goiter (median 64 ml, range: 20-464 ml) selected for 131I therapy. Serum TSH was sub-normal in 42.4%. None were treated with anti-thyroid drugs. The thyroid RAIU was determined at 24h and 96 h. The goiter volume was measured by ultrasound (no.=127), or by magnetic resonance imaging (no.=43). RESULTS The 24h and the 96 h RAIU were 34.2 ± 9.8(SD)% (range: 11.4-66.0%) and 34.0 ± 10.0% (range: 10.5-60.9%), respectively. Sixty-one patients had a 24h RAIU <30% and these individuals were older than patients with a 24h RAIU ≥ 30% (median 58 vs 51 yrs, p=0.02). These two subgroups did not differ significantly in other variables. Overall, the 24h RAIU was positively correlated to the serum (s) free T4-index (r=0.20, p=0.01), and negatively to age (r=-0.18, p=0.02), but not significantly related to serum TSH or thyroid volume. Age correlated positively with thyroid volume (r=0.31, p < 0.001). In a regression analysis, s-free T4-index and age remained as the only determinants of the 24h and the 96 h RAIU. CONCLUSIONS In patients with a symptomatic nodular goiter, serum T4 and age are the major determinants of the thyroid RAIU. A sub-normal serum TSH is not a marker of a compromised thyroid RAIU but reflects that the iodine is confined to a few 'hot spots'.
Collapse
Affiliation(s)
- S J Bonnema
- Department of Endocrinology, Odense University Hospital, DK-5000 Odense C, Denmark.
| | | | | | | | | | | | | |
Collapse
|
20
|
Kahmann C, Wunderlich G, Freudenberg R, Zöphel K, Oehme L, Kotzerke J. Radioprotection of thyroid cells mediated by methimazole. Int J Radiat Biol 2010; 86:811-6. [PMID: 20608812 DOI: 10.3109/09553002.2010.488276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The radioprotective effect of antithyroid drugs on radioiodine treatment is a controversial issue. However, it is of clinical relevance whether antithyroid medication has to be interrupted for therapy and when antithyroid medication can be continued after radioiodine treatment. We investigated DNA damage caused by internal or external radiation using thyroid cells (sodium iodine symporter [NIS] positive). MATERIALS AND METHODS Adherent thyroid cells were irradiated following incubation with the mediators methimazole and perchlorate using either X-ray tube or Re-188-perrhenate. DNA damage was quantified by OTM (Olive's tail moment) of the alkaline comet assay. RESULTS Following external irradiation of 15 Gy OTM was 4.3 ± 4.2 compared to 0.5 ± 1.4 in controls. DNA damage was reduced by methimazole to 70%. Incubation with Re-188 showed effects depending on presence of the mediators. Non-irradiated controls had a mean OTM < 1, internal irradiation increased OTM to 25.5 ± 9.1 in cells without mediators. OTM decreased to 60% after pre-incubation with methimazole and to 15% with perchlorate. Re-188 uptake was modified by both perchlorate and, to a lesser extent, methimazole. CONCLUSIONS Methimazole was shown to have a radioprotective effect not only by its scavenger capacity but also by interaction with NIS. Perchlorate acted by competitive inhibition of NIS mediated Re-188 uptake.
Collapse
Affiliation(s)
- Cindy Kahmann
- Department of Nuclear Medicine, University Hospital, Technische Universität Dresden, Germany
| | | | | | | | | | | |
Collapse
|
21
|
Oszukowska L, Knapska-Kucharska M, Lewiński A. Effects of drugs on the efficacy of radioiodine (|) therapy in hyperthyroid patients. Arch Med Sci 2010; 6:4-10. [PMID: 22371713 PMCID: PMC3278936 DOI: 10.5114/aoms.2010.13499] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 01/08/2009] [Accepted: 02/08/2009] [Indexed: 11/30/2022] Open
Abstract
The treatment of hyperthyroidism is targeted at reducing the production of thyroid hormones by inhibiting their synthesis or suppressing their release, as well as by controlling their influence on peripheral tissue (conservative therapy, medical treatment). Radical treatment includes surgical intervention to reduce the volume of thyroid tissue or damage of the mechanisms of thyroid hormone synthesis by radioiodine ((131)|) administration. Radioiodine ((131)|) is a reactor radionuclide, produced as a result of uranium decomposition and emission of β and γ radiation. The therapeutic effects of the isotope are obtained by the emission of β radiation. In the paper, the effects of administered drugs (antithyroid, glucocorticosteroids, lithium carbonate, inorganic iodine, β-blockers) on the final outcome of radioiodine therapy in patients with hyperthyroidism are discussed.
Collapse
Affiliation(s)
- Lidia Oszukowska
- Department of Nuclear Medicine and Oncological Endocrinology, Medical University of Lodz, Poland
| | | | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Poland
- Polish Mother's Memorial Hospital – Research Institute, Lodz, Poland
| |
Collapse
|
22
|
Hegedüs L. Treatment of Graves' hyperthyroidism: evidence-based and emerging modalities. Endocrinol Metab Clin North Am 2009; 38:355-71, ix. [PMID: 19328416 DOI: 10.1016/j.ecl.2009.01.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Currently there are three well-established treatment options for hyperthyroid Graves' disease (GD): antithyroid drug therapy with thionamides (ATD), radioactive iodine treatment with (131)I, and thyroid surgery. This article reviews the current evidence so the reader can evaluate advantages and disadvantages of these treatment modalities. Surgery is rarely used, except for patients who have a large goiter or ophthalmopathy. Fewer than 50% of patients treated with ATD remain in long-term remission. Therefore, radioactive iodine is used increasingly. No data as yet support the routine use of biologic therapies (eg, rituximab). Prospective, randomized studies comparing available and any novel therapeutic options for GD are needed. The focus of these studies should include, but not be limited to, cost and quality of life.
Collapse
Affiliation(s)
- Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
| |
Collapse
|
23
|
Shi GM, Xu Q, Zhu CY, Yang YL. Influence of Propylthiouracil and Methimazole Pre-treatment on the Outcome of Iodine-131 Therapy in Hyperthyroid Patients with Graves' Disease. J Int Med Res 2009; 37:576-82. [PMID: 19383254 DOI: 10.1177/147323000903700235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
There is ongoing controversy about potential differences in the influence of the anti-thyroid drugs propylthiouracil (PTU) and methimazole (MMI) on radioiodine treatment of Graves' hyperthyroidism. This retrospective study investigated the influence of PTU and MMI pre-treatment, individually or sequentially, on the outcome of iodine-131 (131I) therapy in 199 patients with Graves' disease who had been treated with 131I for the first time and followed up at 3 and 6 months after treatment. Pre-treatment with PTU, or sequential PTU and MMI pre-treatment, increased the failure rate of 131I therapy and reduced the rate of hypothyroidism. MMI pre-treatment alone had no significant influence on the results of 131I therapy. Logistic regression analyses indicated that PTU pre-treatment and having a thyroid gland of > 60 g were both significantly related to 131I therapy failure.
Collapse
Affiliation(s)
- G-M Shi
- Department of Chemotherapy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
| | - Q Xu
- Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
| | - C-Y Zhu
- Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
| | - Y-L Yang
- Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
| |
Collapse
|
24
|
Walter MA, Schindler C, Christ-Crain M, Müller-Brand J, Müller B. Different strategies to overcome the effect of carbimazole on high- and low-dose radioiodine therapy: results from continuous dose-effect models. Eur J Clin Invest 2009; 39:51-7. [PMID: 19087129 DOI: 10.1111/j.1365-2362.2008.02061.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Until now, it remains elusive which strategy - antithyroid drug withdrawal or increased radioiodine target doses - should be preferred to avoid the detrimental effect of antithyroid drugs in high- and low-dose radioiodine therapy, respectively. METHODS We explored the effects of carbimazole on the 1-year post-radioiodine success and hypothyroidism rates by continuous dose-effect models, whereas success was defined as elimination of hyperthyroidism. Euthyroidism rates with and without carbimazole were calculated by numerical integration of the area between success and hypothyroidism curves. Target dose amplification factors for equal chance of success with and without carbimazole were calculated using logistic regression. RESULTS Two hundred and twenty-eight patients were included in this study. Radioiodine target doses between 33 and 839 Gy were applied. Overall, the euthyroidism rates were 16.5% and 64.8%, while the hypothyroidism rates were 37.6% and 14.8% in Graves' disease and toxic nodular goitre, respectively. The success rate with simultaneous carbimazole (median dose 15 mg day(-1); range 2.5-60 mg day(-1)) was reduced over the entire target dose range in Graves' disease and toxic nodular goitre. The areas between curves for euthyroidism without and with simultaneous carbimazole were 127 and 43 Gy in Graves' disease and 178 and 128 Gy in toxic nodular goitre. The estimated radioiodine target dose amplification factor was 5.5 for Graves' disease and 3.0 for toxic nodular goitre. CONCLUSIONS Simultaneous carbimazole reduces the euthyroidism rate, the aim of low-dose radioiodine therapy, over the entire target dose range in both Graves' disease and toxic nodular goitre. Therefore, antithyroid drug discontinuation should be preferred in low-dose radioiodine therapy. Conversely, escalation of the target dose should be preferred in high-dose radioiodine therapy.
Collapse
Affiliation(s)
- M A Walter
- Institute of Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
| | | | | | | | | |
Collapse
|
25
|
Abstract
Thyrotoxicosis is a condition resulting from elevated levels of thyroid hormone. In this article, the authors review the presentation, diagnosis, and management of various causes of thyrotoxicosis.
Collapse
Affiliation(s)
- Bindu Nayak
- Division of Endocrinology and Metabolism, Georgetown University Hospital, 4000 Reservoir Road, Building D, Suite 232, Washington, DC 20007, USA.
| | | |
Collapse
|
26
|
Patel AJ, Collins JS, Patel JR, Mehta RH. High-speed heart. Am J Med 2007; 120:503-5. [PMID: 17524749 DOI: 10.1016/j.amjmed.2007.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2006] [Revised: 02/14/2007] [Accepted: 02/14/2007] [Indexed: 11/26/2022]
|