SFEBES2018 Poster Presentations Thyroid (27 abstracts)
Low Dose Radioiodine Therapy for Graves’ disease: comparison of outcomes following administration of different doses across two centres
Natasha Sawhney 1 , Carmen Diaz-Ortega 1 , Sam Philip 1 , Fraser Gibb 2 , Prakash Abraham 1 & Alex Graveling 1
1NHS Grampian, Aberdeen, UK; 2NHS Lothian, Edinburgh, UK.
Introduction: Low dose radioiodine (LDRAI) has been used to treat benign thyroid disease for over 70 years (1). However, controversies remain about the optimal dosage to administer. The Royal College of Physicians guidelines recommend a dosage of 400–600 MBq for uncomplicated Graves’ disease (2); the dose administered varies between centres.
Methods: Outcome data at Edinburgh Royal Infirmary were collected retrospectively for patients who received an average of 400 MBq (Range 364-467 MBq) LDRAI between January 2010 and October 2015. Outcome data at Aberdeen Royal Infirmary were collected retrospectively for patients who received 550 MBq between January 2012 and June 2017. Only people with a diagnosis of Graves’ disease receiving their first dose of radioiodine were included.
Results:
| Demographics | 400 MBq | 550 MBq |
| Total number | 348 | 169 |
| Mean age±SD | 51.07±15.58 | 50.4±15.77 |
| Female (%) | 72.1 | 76.3 |
| TSH receptor antibody positive* | 96.8% | 91.5% |
| *A clinical diagnosis of Graves’ was made in the remaining small percentage of patients. | ||
| Outcomes at 12 months following LDRAI | 400 MBq | 550 MBq |
| Hypothyroid or receiving levothyroxine (%) | 74.1 | 84.0 |
| Euthyroid (%) | 6.6 | 6.5 |
| Hyperthryoid (%) | 18.4 | 8.3 |
| Deceased (%) | 0.9 | 0.6 |
| Unknown (%) | 0 | 0.6 |
| Demographics | 400 MBq | 550 MBq |
| Total number | 348 | 169 |
| Mean age±SD | 51.07±15.58 | 50.4±15.77 |
| Female (%) | 72.1 | 76.3 |
| TSH receptor antibody positive* | 96.8% | 91.5% |
| *A clinical diagnosis of Graves’ was made in the remaining small percentage of patients. | ||
| Outcomes at 12 months following LDRAI | 400 MBq | 550 MBq |
| Hypothyroid or receiving levothyroxine (%) | 74.1 | 84.0 |
| Euthyroid (%) | 6.6 | 6.5 |
| Hyperthryoid (%) | 18.4 | 8.3 |
| Deceased (%) | 0.9 | 0.6 |
| Unknown (%) | 0 | 0.6 |
Discussion: Administration of 550 MBq LDRAI resulted in a significantly higher cure rate at 12 months (90.5%) compared to 400 MBq (80.8%) (P=0.0024), albeit with an increased number of patients requiring levothyroxine replacement. These results suggest that if our aim is to cure hyperthyroidism then we should be administering the higher dose of 550 MBq to our patients with Graves’ disease.
References
1. Hertz S, Roberts A (1946) Radioactive iodine in the study of thyroid physiology VII. The use of radioactive iodine therapy in hyperthyroidism. JAMA 131:81.
2. Report of a working party (2007) Radioiodine in the management of benign thyroid disease. Royal College of Physicians.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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