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Panminerva Medica 2000 December;42(4):241-5


lingua: Inglese

One-year follow-up of Graves’ disease treatment by four different protocols of radioiodine administration

Calegaro J. U. M., De Freitas Gomes E., Bae S. H., Ulyssea R., Casulari L. A. *

From the Unit of Nuclear Medicine Hospital de Base do Distrito Federal
*Unit of Endocrinology, Brasilia University Hospital and Unit of Neurosurgery, Hospital de Base do Distrito Federal Brasília - DF, Brazil


Background. Studies ­have ­been per­formed in ­order to ­assess a treat­ment ­with 131I ­able to ­induce a con­sis­tent improve­ment in Graves’ hyper­thyr­oi­dism.
Methods. Experimental ­design: For ­this pur­pose, ­four dif­fer­ent pro­to­cols ­based on ­four dif­fer­ent dos­es of radio­io­dine ­have ­been test­ed in Graves’ dis­ease ­patients. Patients nev­er sub­mit­ted pre­vi­ous­ly to anti­thy­roid ­drug treat­ment ­were giv­en 1 mCi/ 10 gm of the esti­mat­ed thy­roid ­weight (­group I; n=50). Group II (n=48) includ­ed ­patients not pre­vi­ous­ly treat­ed ­with anti­thy­roid ­drugs and who ­were giv­en dos­es of ­iodine ­based on a for­mu­la tak­ing ­into ­account the ­rate of thy­roid ­iodine ­uptake, i.e. 131I ­dose = µCi/gm of the esti­mat­ed thy­roid ­weight × 100/24 hrs 131I ­uptake (%). Patients pre­vi­ous­ly sub­mit­ted to anti­thy­roid ­drug ther­a­py ­were treat­ed ­with radio­io­dine ­whose ­dose was cal­cu­lat­ed accord­ing to the for­mu­la report­ed ­above, but the ­dose was ­increased in ­order to over­come the pos­sible resis­tance of ­this ­kind of ­patients to the ­effect of 131I. One ­group (group III; n=24) ­received the cal­cu­lat­ed ­dose ­plus 1 µCi/gm of the esti­mat­ed thy­roid ­weight. Finally, ­group IV (n=27) ­received the cal­cu­lat­ed ­dose plus 0.25 µCi/gm of the esti­mat­ed thy­roid ­weight.
Results. The anal­y­sis of the ­patients one ­year lat­er dem­on­strat­ed ­that ­groups I and II pre­sent­ed the high­er per­cent of euthyr­oid ­patients (60% and 58%, respec­tive­ly) fol­lowed by ­group IV (37%) and ­group III (29.2%). The per­cent of ­patients ­still exhib­it­ing hyper­thyr­oi­dism was 28% in ­group I, 26% in ­group IV, 12.5% in ­group III and 8.3% in ­group II. The high­est num­ber of hypo­thy­roid ­patients was ­present in ­group III (58.3%) fol­lowed by ­group IV (37 %), ­group II (33.3%) and ­group I (12 %).
Conclusions. The ­data ­here pre­sent­ed sug­gest ­that pro­to­cols I and II ­based on rel­a­tive­ly low dos­es of radio­io­dine are rath­er effec­tive in reduc­ing Graves’ hyper­thyr­oi­dism in ­patients not sub­mit­ted pre­vi­ous­ly to anti­thy­roid ­drug ther­a­py. The ­most sat­is­fac­to­ry ther­a­py ­seems ­that uti­lized in pro­to­col II, ­that in ­front of a ­fair ­amount of euthyr­oid ­patients (58.3%) ­presents a ­very low num­ber of sub­jects ­still hyper­thyr­oid (8.3%). However, the num­ber of ­patients who ­became hypo­thy­roid (33.3%) as a con­se­quence of the ther­a­py was too ­high. Hopefully, a bet­ter ­design of the pro­to­col ­will ­reduce ­this fig­ure. The ­high inci­dence of hyper­thyr­oi­dism ­observed in ­groups III and IV sub­mit­ted to a ther­a­py ­with 131I dos­es con­sis­tent­ly high­er ­than ­those uti­lized in ­groups I and II ­seems to con­firm the hypoth­e­sis ­that hyper­thyr­oid sub­jects sub­mit­ted to a ther­a­py ­with anti­thy­roid ­drugs ­become rath­er resist­ant to a radio­io­dine treat­ment.

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