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Success Rate of Radioiodine Therapy in Graves’ Disease: The Influence of Thyrostatic Medication

Departments of Nuclear Medicine and Neuropsychology (K.W.), Aachen University of Technology, Aachen, Germany

Address all correspondence and requests for reprints to: O. Sabri, Ph.D., M.D., Department of Nuclear Medicine, Aachen University of Technology, Pauwelsstrasse 30, D-52057 Aachen, Germany.

There is controversy whether simultaneous thyrostatic medication influences the outcome of radioiodine (¹³¹I) therapy in Graves’ disease by reducing the absorbed energy dose of ¹³¹I when delivering a standard dose. We therefore sought to ascertain whether the outcome of ablative ¹³¹I therapy is in any way affected by simultaneous thyrostasis (carbimazole) by aiming for a constant absorbed dose of 200–250 Gy. We prospectively studied 207 patients with Graves’ disease (106 with and 101 without simultaneous carbimazole at the time of ¹³¹I therapy). All patients were reexamined 3, 6, and 12 months after ¹³¹I therapy. The 101 nonthyrostatic patients showed a highly significantly greater success rate (93%) than the 106 thyrostatic patients (49%). Stepwise logistic regression demonstrated that failure was related to the administration of carbimazole during ¹³¹I therapy (P < 0.00005) and the absorbed dose (P < 0.025), but was not related to free T₃, free T₄, TSH receptor antibodies, or thyroid volume. The success rate was 100% in 93 nonthyrostatic patients with absorbed doses of 200 Gy or more, but was only 12.5% (1 of 8) for absorbed doses less than 200 Gy. Correlation between success and absorbed dose was significantly higher for nonthyrostatic than for thyrostatic patients (r = 0.93 vs. r = 0.24). Sixteen patients who discontinued thyrostasis 1–3 days before ¹³¹I therapy showed 94% successes.

Simultaneous thyrostasis is the decisive factor against a successful ¹³¹I therapy even if the significantly reduced ¹³¹I uptake/half-life values under thyrostasis are compensated with a higher delivered dose to ensure a comparable absorbed dose, possibly due to the additionally effective radioprotective properties of carbimazole. Therefore, if clinically feasible, we recommend discontinuing thyrostasis at least 1 day before beginning ¹³¹I therapy, because even in hyperthyroid nonthyrostatic patients the success rate was 100%.

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