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Identification of patients with Graves' disease who benefit from high-dose radioactive iodine therapy

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Title: Identification of patients with Graves' disease who benefit from high-dose radioactive iodine therapy
Authors: Watanabe, Shiro Browse this author →KAKEN DB
Okamoto, Shozo Browse this author →KAKEN DB
Akikawa, Kazumasa Browse this author
Miyamoto, Noriyuki Browse this author
Okamura-Kawasaki, Miyuki Browse this author
Uchiyama, Yuko Browse this author
Takenaka, Junki Browse this author
Toyonaga, Takuya Browse this author
Hirata, Kenji Browse this author →KAKEN DB
Kudo, Kohsuke Browse this author →KAKEN DB
Keywords: Graves' disease
Issue Date: 1-Nov-2022
Publisher: Springer
Journal Title: Annals of nuclear medicine
Volume: 36
Issue: 11
Start Page: 923
End Page: 930
Publisher DOI: 10.1007/s12149-022-01781-1
Abstract: Objective Radioactive iodine (RAI) therapy is a useful treatment for Graves' disease (GD). Most RAI sessions administer <= 500 MBq of iodine (I)-131. Sometimes patients require repeated RAI, often for longer periods of remission. We investigated the characteristics of patients for whom high dose (mostly 1110 MBq of I-131) RAI was effective as RAI therapy for GD. Methods We retrospectively analyzed the cases of 79 patients who underwent RAI for GD in a multicenter setting. We divided the patients into two groups based on the I-131 dose administered: the low dose (LD) group who received <= 500 MBq (n = 44) and the high dose (HD) group who received > 500 MBq (n = 35). The therapeutic effect was defined as achieving remission and reaching the point of participating in thyroid hormone replacement therapy within 1 year after RAI. We compared the LD and HD groups' remission rates and conducted a multivariate logistic regression analysis of predictive factors for remission. In a simulation, using the formula for predicting the probability of remission obtained from the analysis results, we estimated how much the remission rate would change if the I-131 dose is increased from 500 to 1110 MBq. Results The mean +/- standard deviation I-131 dose administered in the LD group was 480 +/- 6 MBq, and that of the HD group was 1054 +/- 265 MBq. Thirty-five patients (80%) in the LD group and 26 patients (74%) in the HD group achieved remission; this difference in the remission rate was not significant. The multivariate analysis results demonstrated that the absorbed dose and thyroid-stimulating antibody (TSAb) were independent predictors of remission. Seven patients (8.9%) showed an increased probability of remission from < 50% to > 50% when the higher RAI dose was applied (1110 MBq instead of 500 MBq). The thyroid volume and TSAb values in these patients were relatively large at 54.7 +/- 34.2 mL and 1378.4 +/- 586.3%, respectively. Conclusion Although the overall remission rate was not significantly different between the patients who received high- or low-dose I-131, treatment with high-dose RAI may improve the probability of remission in patients with a massive thyroid volume and/or high-TSAb Graves' disease.
Rights: This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at:
Type: article (author version)
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 渡邊 史郎

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