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Original Article
Pak J Nucl Med. 2020; 10(1): 4-12

Effectiveness of the selection of administered 131I-iodide activity based on the thyroid "volume algorithm" approach for the therapy of Graves' disease

Authors: Federica Guidoccio, Antonio Claudio Traino, Federica Orsini, Duccio Volterrani, Giuliano Mariani, Mariano Grosso.

View PDF HTML FullText DOI: 10.24911/PJNMed.175-1577458976

Abstract

Background: In the current clinical practice, radiometabolic therapy of Graves' disease is based on the administration of an amount of 131I-iodide defined according to two different modalities: administration of a fixed activity (up to a maximum of 555 MBq allowed by many national legislations on an outpatient basis) or an 131I-iodide activity individually defined so as to reach the certain fixed values of target thyroid-absorbed dose. The aim of this study was to prove the effectiveness of a personalized approach to cure Graves' disease based on the administration of a 131I activity defined according to the desired "optimal final thyroid mass." According to this model, one can predict the thyroid-absorbed dose following the administration of an activity as a function of the desired reduction of the baseline, pre-treatment mass of the gland. Methods: A total of 217 patients with Graves' disease were included in this study. They were randomly divided into five groups, of which four groups were divided based on fixed thyroid-absorbed dose value of 100 (Group A, n = 29), 200 (Group B, n = 25), 300 (Group C, n = 51), and 400 (Group D, n = 25), respectively, whereas patients of the final thyroid mass (mf) (Group V, n = 87) received a 131I activity calculated based on the desired "optimal" final thyroid mass according to the so-called "volume algorithm" approach. Results: At the 1-year follow-up, therapeutic success (i.e., a state of either hypothyroidism or euthyroidism) was achieved in 48% of patients in Group A (100 Gy), 64% in Group B (200 Gy), 78% in Group C (300 Gy), 96% in Group D (400 Gy), and 92% in Group V (mf). A significantly higher proportion of patients were was cured in Groups D and V (mf) than in Groups A, B, and C (P < 0.01). There was no statistical difference in cure rates between Groups D and V (mf). The median thyroid-absorbed dose was 407 Gy for Group D (400 Gy), significantly higher than 296 Gy for Group V (mf) (P < 0.001) and also significantly greater than the administered 131I activity (494 vs. 345 MBq, P < 0.001). Conclusions: This study indicates that the most effective thyroid-absorbed dose to be delivered for the radiometabolic therapy of patients with Graves' disease should not be based on a fixed dose but rather should be personalized. The new method based on thyroid mass reduction allows the optimization of 131I-iodide therapy for Graves' disease on an individual basis, achieving a high therapeutic efficacy while at the same time avoiding the administration of unjustified greater activities of 131I.

Keywords:   Graves' disease, hyperthyroidism, radioiodine; 131I-iodide, dosimetry in Graves' disease, "Volume algorithm" approach


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Effectiveness of the selection of administered 131I-iodide activity based on the thyroid "volume algorithm" approach for the therapy of Graves' disease


Authors
Federica Guidoccio
Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
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Antonio Claudio Traino
Health Physics Unit, University Hospital of Pisa, Pisa, Italy
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Federica Orsini
Nuclear Medicine Service, “Maggiore Della Carità” University Hospital, Novara, Italy
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Duccio Volterrani
Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
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Giuliano Mariani
Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
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Mariano Grosso
Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
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Correspondence to:
. Mariano Grosso, Regional Center of Nuclear Medicine, University Pisa, Pisa, Italy.; marianogrosso@yahoo.it

Publication history
Received 30 Dec 2019
Revised 11 Mar 2020
Accepted 21 Apr 2020
Published online 26 Jun 2020
Published in print 11 Sep 2020
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How to cite this article

Pubmed Style

Guidoccio F, Traino AC, Orsini F, Volterrani D, Mariani G, Grosso M. Effectiveness of the selection of administered 131I-iodide activity based on the thyroid "volume algorithm" approach for the therapy of Graves' disease. Pak J Nucl Med. 2020; 10(1): 4-12. doi:10.24911/PJNMed.175-1577458976


Web Style

Guidoccio F, Traino AC, Orsini F, Volterrani D, Mariani G, Grosso M. Effectiveness of the selection of administered 131I-iodide activity based on the thyroid "volume algorithm" approach for the therapy of Graves' disease. http://www.pjnmed.com/?mno=79616 [Access: September 19, 2021]. doi:10.24911/PJNMed.175-1577458976


AMA (American Medical Association) Style

Guidoccio F, Traino AC, Orsini F, Volterrani D, Mariani G, Grosso M. Effectiveness of the selection of administered 131I-iodide activity based on the thyroid "volume algorithm" approach for the therapy of Graves' disease. Pak J Nucl Med. 2020; 10(1): 4-12. doi:10.24911/PJNMed.175-1577458976


Vancouver/ICMJE Style

Guidoccio F, Traino AC, Orsini F, Volterrani D, Mariani G, Grosso M. Effectiveness of the selection of administered 131I-iodide activity based on the thyroid "volume algorithm" approach for the therapy of Graves' disease. Pak J Nucl Med. (2020), [cited September 19, 2021]; 10(1): 4-12. doi:10.24911/PJNMed.175-1577458976


Harvard Style

Guidoccio, F., Traino, . A. C., Orsini, . F., Volterrani, . D., Mariani, . G. & Grosso, . M. (2020) Effectiveness of the selection of administered 131I-iodide activity based on the thyroid "volume algorithm" approach for the therapy of Graves' disease. Pak J Nucl Med, 10 (1), 4-12. doi:10.24911/PJNMed.175-1577458976


Turabian Style

Guidoccio, Federica, Antonio Claudio Traino, Federica Orsini, Duccio Volterrani, Giuliano Mariani, and Mariano Grosso. 2020. Effectiveness of the selection of administered 131I-iodide activity based on the thyroid "volume algorithm" approach for the therapy of Graves' disease. Pakistan Journal of Nuclear Medicine, 10 (1), 4-12. doi:10.24911/PJNMed.175-1577458976


Chicago Style

Guidoccio, Federica, Antonio Claudio Traino, Federica Orsini, Duccio Volterrani, Giuliano Mariani, and Mariano Grosso. "Effectiveness of the selection of administered 131I-iodide activity based on the thyroid "volume algorithm" approach for the therapy of Graves' disease." Pakistan Journal of Nuclear Medicine 10 (2020), 4-12. doi:10.24911/PJNMed.175-1577458976


MLA (The Modern Language Association) Style

Guidoccio, Federica, Antonio Claudio Traino, Federica Orsini, Duccio Volterrani, Giuliano Mariani, and Mariano Grosso. "Effectiveness of the selection of administered 131I-iodide activity based on the thyroid "volume algorithm" approach for the therapy of Graves' disease." Pakistan Journal of Nuclear Medicine 10.1 (2020), 4-12. Print. doi:10.24911/PJNMed.175-1577458976


APA (American Psychological Association) Style

Guidoccio, F., Traino, . A. C., Orsini, . F., Volterrani, . D., Mariani, . G. & Grosso, . M. (2020) Effectiveness of the selection of administered 131I-iodide activity based on the thyroid "volume algorithm" approach for the therapy of Graves' disease. Pakistan Journal of Nuclear Medicine, 10 (1), 4-12. doi:10.24911/PJNMed.175-1577458976


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