Abstract
Objective:Geriatric patient population has special importance due to particular challenges. In addition to the increase in incidence of toxic nodular goiter (TNG) with age, it has a high incidence in the regions of low-medium iodine intake such as in our country. The aim of this study was to evaluate the overall outcome of high fixed dose radioiodine (RAI) therapy, and investigate the particular differences in the geriatric patient population.Methods:One hundred and three TNG patients treated with high dose I-131 (370-740 MBq) were retrospectively reviewed. The baseline characteristics; age, gender, scintigraphic patterns and thyroid function tests before and after treatment, as well as follow-up, duration of antithyroid drug (ATD) medication and achievement of euthyroid or hypothyroid state were evaluated. The patient population was divided into two groups as those=>65 years and those who were younger, in order to assess the effect of age.Results:Treatment success was 90% with single dose RAI therapy. Hyperthyroidism was treated in 7±7, 2 months after RAI administration. At the end of the first year, overall hypothyroidism rate was 30% and euthyroid state was achieved in 70% of patients. Age was found to be the only statistically significant variable effecting outcome. A higher ratio of euthyroidism was achieved in the geriatric patient population.Conclusion:High fixed dose I-131 treatment should be preferred in geriatric TNG patients in order to treat persistent hyperthyroidism rapidly. The result of this study suggests that high fixed dose RAI therapy is a successful modality in treating TNG, and high rates of euthyroidism can be achieved in geriatric patients.
Highlights
Plummer’s disease usually affects individuals over 50 years of age [1]
Hyperthyroidism was treated in 7±7.2 months after RAI administration
Our treatment success was 90% with a single dose RAI therapy; only 10 patients required a second RAI dose, and hyperthyroidism was treated in all patients
Summary
Plummer’s disease usually affects individuals over 50 years of age [1]. On the other hand, 10-15% of hyperthyroid patients are over 60 years old [2]. High rates of euthyrodism are expected after treatment of TNG with radiodine due to the relatively radioresistant nature of the nodules and the probable existence of different amounts of underlying suppressed thyroid tissue [8,9]. Based on this fact and the need for rapid treatment of hyperthyroidism in geriatric patients, high fixed dose I-131 treatment regimen gained attraction. Iodine uptake of the thyroid gland decreases with aging, a high rate of euthyroidism can be achieved in geriatric patients with treatment In light of these data, the effectiveness and outcome of high dose RAI treatment of TNG patients and the possible difference in outcome in the geriatric group were evaluated in this study
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