Abstract
The results of radioactive iodine (RAI) treatment for Graves' disease (GD) are related to the choice of diagnostic and dosimetry protocols, the steroid protection used, and the subsequent 131I dose. The effect of a high tissue-absorbed dose on the level of anti-thyroid antibodies (ATA) has been rarely considered. To estimate the effect of the first RAI therapy with a dose of 250 Gy on anti-thyreoperoxidase (anti-TPO) and anti-thyroid-stimulating hormone (TSH) receptor thyrotropin receptor antibody - TRAb levels in GD patients. The analysis encompassed 46 consecutive patients with clinical presentation of GD. We examined the serum levels of TSH, free thyroxine (FT4), anti-TPO, TRAb, thyroid volume (ThV), 131I effective half-life (EHL), introduction of steroid protection, levothyroxine dose used in thyroid replacement therapy - TRT, and effectiveness of treatment. As a result of RAI treatment, hypothyroidism was found in 35 patients (76.1%), euthyroidism in 7 patients (15.2%) and hyperthyroidism in 4 patients (8.7%). After RAI, we observed ThV reduction and increased anti-TPO (p = 0.001 and p = 0.001, respectively). It was found that a shorter EHL correlated with a higher baseline TRAb concentration and lower final anti-TPO serum concentration (p = 0.03 and p = 0.01, respectively). Lower final TRAb was found in patients with steroid protection (p = 0.049). Intergroup comparison of patients without steroid protection showed significantly higher final anti-TPO concentation (p = 0.02). Intergroup comparison of patients with TRT revealed significantly higher final anti-TPO concentration (p = 0.04). The application of a high absorbed dose of 250 Gy in GD resulted in high efficacy of RAI therapy at 1-year follow-up. An increased ATA level and its relationships with EHL and ThV reduction were observed at 1-year follow-up. There is a possible relationship between steroid protection and anti-TPO concentration.
Highlights
The results of radioactive iodine (RAI) treatment for Graves’ disease (GD) are related to the choice of diagnostic and dosimetry protocols, the steroid protection used, and the subsequent 131I dose
We examined the serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), anti-TPO, thyrotropin receptor antibody (TRAb), thyroid volume (ThV), 131I effective half-life (EHL), introduction of steroid protection, levothyroxine dose used in thyroid replacement therapy – TRT, and effectiveness of treatment
The application of a high absorbed dose of 250 Gy in GD resulted in high efficacy of RAI therapy at 1-year follow-up
Summary
The results of radioactive iodine (RAI) treatment for Graves’ disease (GD) are related to the choice of diagnostic and dosimetry protocols, the steroid protection used, and the subsequent 131I dose. While numerous aspects of radioactive iodine (RAI) treatment, such as its efficacy, its relation to a high absorbed dose, and its impact on clinical outcome and the shrinkage of thyroid volume (ThV) have been described in the literature, there are still some issues to be addressed.[1] In view of a significant reduction of ThV after RAI therapy, one question worth considering is the influence of the therapy on the final level of anti-thyroid antibodies (ATA).[2,3] Another issue to examine is the possible relationship between the level of ATA and radioiodine turnover, the tracer uptake, radioactive iodine uptake – RAIU and thyroidal 131I effective half-life (EHL).[4] The connection of these factors with the use of steroid protection and the potential subsequent dose of thyroid replacement therapy (TRT) due to post-therapeutic hypothyroidism is another issue to be explored.[5]. We aim to explore these factors as potentially clinically valuable information
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