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Endocrine
Published in: Endocrine 3/2019

01-03-2019 | Thyroid Disease | Original Article

Thyroid stunning in radioiodine-131 therapy of benign thyroid diseases

Authors: Christian Happel, Wolfgang Tilman Kranert, Hanns Ackermann, Ina Binse, Benjamin Bockisch, Daniel Gröner, Ken Herrmann, Frank Grünwald

Published in: Endocrine | Issue 3/2019

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Abstract

Purpose

Existence and cause of thyroid stunning was controversially discussed for decades but the underlying mechanism remains unclear. Numerous studies describe thyroid stunning in radioiodine-131 therapy (RIT) of differentiated thyroid carcinoma. However, there are no studies evaluating thyroid stunning in benign thyroid diseases caused by the radioiodine uptake test (RIUT). Therefore, the influence of pre-therapeutic tracer radiation dose on therapeutic iodine-131 uptake was evaluated retrospectively.

Methods

A total of 914 RIT patients were included. Exclusion criteria were anti-thyroid drugs, pre- and/or intra-therapeutic effective half-lives (EHL) beyond 8.04 days and externally performed RIUT or 24 h RIUT. All patients received RIUT 1 week before RIT. Thyroid volume was estimated via ultrasound. Tracer radiation dose to the thyroid was calculated retrospectively. The dependence of changes in the pre-therapeutic to the therapeutic extrapolated-maximum-131I-uptake (EMU) from the dose in RIUT was evaluated statistically.

Results

EMU in RIUT ranged from 0.10 to 0.82 (median: 0.35) and EMU in RIT ranged from 0.10 to 0.74 (median: 0.33). Averaged over the whole cohort the therapeutic EMU decreased significantly (2.3% per Gray intra-thyroidal tracer radiation dose). A disease-specific evaluation showed dose-dependent thyroid stunning from 1.2% per Gray in solitary toxic nodules (n = 327) to 21% per Gray in goiters (n = 135) which was significant for the subgroups of disseminated autonomies (n = 114), multifocal autonomies (n = 178) and goiters (p < 0.05) but not for Graves’ diseases (n = 160) and solitary toxic nodules (p > 0.05).

Conclusions

The presented data indicate for the first time a significant dependence of pre-therapeutic radiation dose on thyroid stunning in goiter and disseminated and multifocal autonomy. To achieve the desired intra-thyroidal radiation dose, RIT activity should be adapted depending on the dose in RIUT.
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Metadata
Title
Thyroid stunning in radioiodine-131 therapy of benign thyroid diseases
Authors
Christian Happel
Wolfgang Tilman Kranert
Hanns Ackermann
Ina Binse
Benjamin Bockisch
Daniel Gröner
Ken Herrmann
Frank Grünwald
Publication date
01-03-2019
Publisher
Springer US
Published in
Endocrine / Issue 3/2019
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-018-01833-5

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