Optimized radioiodine therapy of Graves' disease: analysis of the delivered dose and of other possible factors affecting outcome

The best approach to radioiodine dose selection in the treatment of Graves' hyperthyroidism remains highly controversial. The formula to calculate the individual dose of I-131 to be delivered has been used for half a century and takes into account the thyroid mass, the effective half-life and the ma ximum uptake of I-131. The objective of the present study was to evaluate t he accuracy of this formula by determining the relationship between the adm inistered dose of I-131 calculated to deliver a target dose of 50 Gy to the thyroid and the actual exact organ dose. We further analyzed if therapeuti c success, defined by euthyroidism following the individually calculated do se, can be predicted by different pretreatment parameters and particularly by organ dose. One hundred patients with a first episode of Graves' disease and who had re ceived optimal thyroid irradiation after precise dosimetry were retrospecti vely reviewed. The patients were categorized according to their thyroid fun ction (plasma free thyroxine (T-4) serum concentration) as eu-, hyper or hy pothyroid during and 1 year after treatment. The relationship between the a dministered dose and organ dose was assessed by simple regression. We compa red free T-4, free tri-iodothyronine, thyroid weight, the number of patient s with antithyroperoxidase antibodies and TSH receptor autoantibodies. 24h urinary iodine excretion, I-131 uptake. and the exact dose of I-131 deliver ed to the thyroid as pretreatment variables, Although we found a correlatio n between administered dose (mCi) and organ dose (Gy) (r = 0.3, P = 0.003), the mean coefficient of variation for organ dose was 45%, Individualized r adioiodine therapy enabled euthyroidism in 26% of patients and failed in 74 % of patients (33% had persistent or recurrent hyperthyroidism and 41%; per manent hypothyroidism). I-131 uptake was significantly higher in the hypert hyroidism group in comparison with the euthyroid group. However, organ dose and other pretreatment variables did not differ among the three groups. In conclusion, these results confirm the low performance of individual dosi metry using what are established ratios, since the delivered dose to the gl and, although correlated to the intended dose, is highly variable. The find ing that other usual pretreatment variables are not different between group s, gives little hope for improving the way of calculating the ideal dose of radioiodine, We suggest to those not yet ready to give a standard or an ab lative dose for Graves' hyperthyroidism that they abandon this way to calcu late the I-131 dose.