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01-12-2014 | Endocrine Tumors

Failure of Radioactive Iodine in the Treatment of Hyperthyroidism

Authors: David F. Schneider, MD, MS, Philip E. Sonderman, BA, Michaela F. Jones, BS, Kristin A. Ojomo, MD, Herbert Chen, MD, Juan C. Jaume, MD, Diane F. Elson, MD, Scott B. Perlman, MD, Rebecca S. Sippel, MD

Published in: Annals of Surgical Oncology | Issue 13/2014

Abstract

Background

Persistent or recurrent hyperthyroidism after treatment with radioactive iodine (RAI) is common and many patiedlxnts require either additional doses or surgery before they are cured. The purpose of this study was to identify patterns and predictors of failure of RAI in patients with hyperthyroidism.

Methods

We conducted a retrospective review of patients treated with RAI from 2007 to 2010. Failure of RAI was defined as receipt of additional dose(s) and/or total thyroidectomy. Using a Cox proportional hazards model, we conducted univariate analysis to identify factors associated with failure of RAI. A final multivariate model was then constructed with significant (p < 0.05) variables from the univariate analysis.

Results

Of the 325 patients analyzed, 74 patients (22.8 %) failed initial RAI treatment, 53 (71.6 %) received additional RAI, 13 (17.6 %) received additional RAI followed by surgery, and the remaining 8 (10.8 %) were cured after thyroidectomy. The percentage of patients who failed decreased in a stepwise fashion as RAI dose increased. Similarly, the incidence of failure increased as the presenting T3 level increased. Sensitivity analysis revealed that RAI doses <12.5 mCi were associated with failure while initial T3 and free T4 levels of at least 4.5 pg/mL and 2.3 ng/dL, respectively, were associated with failure. In the final multivariate analysis, higher T4 (hazard ratio [HR] 1.13; 95 % confidence interval [CI] 1.02–1.26; p = 0.02) and methimazole treatment (HR 2.55; 95 % CI 1.22–5.33; p = 0.01) were associated with failure.

Conclusions

Laboratory values at presentation can predict which patients with hyperthyroidism are at risk for failing RAI treatment. Higher doses of RAI or surgical referral may prevent the need for repeat RAI in selected patients.

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Title: Failure of Radioactive Iodine in the Treatment of Hyperthyroidism
Authors: David F. Schneider, MD, MS
Philip E. Sonderman, BA
Michaela F. Jones, BS
Kristin A. Ojomo, MD
Herbert Chen, MD
Juan C. Jaume, MD
Diane F. Elson, MD
Scott B. Perlman, MD
Rebecca S. Sippel, MD
Publication date: 01-12-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 13/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3858-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Failure of Radioactive Iodine in the Treatment of Hyperthyroidism

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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