Download PDF
Nuklearmedizin 2002; 41(04): 178-183
DOI: 10.1055/s-0038-1623893
Original Article
Schattauer GmbH

Early change of thyroid hormone concentration after 131I treatment in patients with solitary toxic adenoma

Frühe Veränderungen der Schilddrüsenhormonkonzentration nach Radioiodtherapie von Patienten mit solitärem toxischen Adenom
E. Pirnat
1   University Medical Centre Ljubljana, Department of Nuclear Medicine (Head: Sergej Hojker), Slovenia
,
V. Fidler
1   University Medical Centre Ljubljana, Department of Nuclear Medicine (Head: Sergej Hojker), Slovenia
,
K. Zaletel
1   University Medical Centre Ljubljana, Department of Nuclear Medicine (Head: Sergej Hojker), Slovenia
,
S. Gaberšček
1   University Medical Centre Ljubljana, Department of Nuclear Medicine (Head: Sergej Hojker), Slovenia
,
S. Hojker
1   University Medical Centre Ljubljana, Department of Nuclear Medicine (Head: Sergej Hojker), Slovenia
› Author Affiliations
Further Information

Publication History

Received: 18 February 2002

15 May 2002

Publication Date:
11 January 2018 (online)

    Permissions and Reprints

Summary

Aim: In spite of extensive use of 131I for treatment of hyperthyroidism, the results of early outcome are variable. In our prospective clinical study we tested whether 131I induced necrosis causing clinical aggravation of hyperthyroidism and increasing the free thyroid hormone concentration in the serum of patients with solitary toxic adenoma not pretreated with antithyroid drugs. Patients and methods: 30 consecutive patients were treated with 925 MBq 131I. Serum concentration of thyrotropin (TSH), free thyroxine (fT4), free triiodothyronine (fT3), thyroglobulin (Tg), and interleukin-6 (IL-6) were measured before and after application of 131I. Results: After application of 131I no clinical worsening was observed. FT4 and fT3 concentration did not change significantly within the first five days, whereas both of them significantly decreased after 12 days (p <0.0001). Slight and clinically irrelevant increase in the level of the two thyroid hormones was observed in 9 patients. Furthermore, we observed a prolonged increase in Tg concentration and a transient increase in IL-6 concentration. Conclusion: Neither evidence of any clinical aggravation of hyperthyroidism nor any significant increase in thyroid hormone concentration by 131I induced necrosis of thyroid cells was found. Therefore, the application of 131I may be considered as a safe and effective treatment for patients with hyperthyroidism due to toxic adenoma.

Zusammenfassung

Ziel: Trotz der häufigen Anwendung von Radioiod zur Behandlung der Hyperthyreose, variieren die Ergebnisse in der frühen Phase. In unserer prospektiven klinischen Studie testeten wir, ob 131I bei nicht mit Thyreostatika vorbehandelten Patienten mit solitärem toxischen Adenom Nekrosen induziert, zur klinischen Verschlimmerung der Hyperthyreose führt und zu erhöhter Konzentration an freien Schilddrüsenhormonen. Patienten und Methoden: 30 konsekutive Patienten wurden mit 925 MBq 131I therapiert. Die Serumkonzentrationen von TSH, freiem Thyroxin (fT4), freiem Triiodthyronin (fT3), Thyreoglobulin (Tg) und Interleukin-6 (IL-6) wurden vor und nach der Radioiodapplikation bestimmt. Ergebnisse: Nach Radioiodgabe wurden keine klinische Verschlimmerung beobachtet. Die fT3- und fT3-Konzentrationen veränderten sich in den ersten fünf Tagen nicht signifikant. Doch beide verringerten sich nach 12 Tagen signifikant (p <0,0001). Ein leichter, klinisch unbedeutender Anstieg der beiden Schilddrüsenhormone wurde bei 9 Patienten beobachtet. Außerdem wurde ein lang dauernder Anstieg der Tg-Konzentration und ein zeitlich begrenzter Anstieg der IL-6-Konzentration festgestellt. Schlussfolgerung: Da weder ein Hinweis auf die Induktion von Schilddrüsenzellnekrose durch 131I einschl. Verschlimmerung der Hyperthyreose noch eine signifikant erhöhte Schilddrüsenhormonkonzentration gefunden wurden, darf die Radioiodtherapie als sichere und effektive Behandlung der Hyperthyreose infolge eines toxischen Adenoms gelten.

Keywords

Toxic adenoma - hyperthyroidism - 131I treatment - necrosis

Schlüsselwörter

Toxisches Adenom - Hyperthyreose - Radioiodtherapie - Nekrose
 

  • References

  • 1 Andrade VA, Gross JL, Maia AL. Effects of methimazole pretreatment on serum thyroid hormone levels after radioactive treatment in Graves’ hyperthyroidism. J Clin Endocrinol Metab 1999; 84: 4012-6.
    PubMedGoogle Scholar
  • 2 Bartalena L, Brogioni S, Grasso L. et al. Inter-leukin-6 and the thyroid. Eur J Endocrinol 1995; 132: 386-93.
    CrossrefPubMedGoogle Scholar
  • 3 Bartalena L, Brogioni S, Grasso L. et al. Inter-leukin-6: a marker of thyroid-destructive processes?. J Clin Endocrinol Metab 1994; 79: 1424-7.
    CrossrefPubMedGoogle Scholar
  • 4 Brix K, Herzog V. Extrathyroidal release of thyroid hormones from thyroglobulin by J774 mouse macrophages. J Clin Invest 1994; 93: 1388-96.
    CrossrefPubMedGoogle Scholar
  • 5 Brunn J, Block U, Ruf G. et al. Volumetrie der Schilddrüsenlappen mittels real-time Sonographie. Dtsch Med Wschr 1981; 106: 1338-40.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Burch HB, Solomon B, Wartofsky L. et al. Discontinuing antithyroid drug therapy before ablation with radioiodine in Graves’ disease. Ann Intern Med 1994; 121: 553-9.
    CrossrefPubMedGoogle Scholar
  • 7 Creutzig H, Kallfelz J, Haindl J. et al. Thyroid storm and iodine-131 treatment. Lancet 1976; 2: 145-6.
    PubMedGoogle Scholar
  • 8 Date J, Blichert-Toft M, Feldt-Rasmussen U. et al. Lacking evidence for release of thyroid hormones from circulating thyroglobulin during subtotal thyroidectomy. Acta Endocrinol 1988; 117: 219-24.
    Google Scholar
  • 9 Dobyns BM, Vickery AL, Maloof F. et al. Functional and histologic effects of therapeutic doses of radioactive iodine on the thyroid of man. J Clin Endocrinol Metab 1953; 13: 548-67.
    CrossrefPubMedGoogle Scholar
  • 10 Fidler V, Prepadnik M, Fettich J. et al. Nuclear Medicine IBM-GAMMA-PF Computer System. Radiol Oncol 1997; 31: 27-32.
    Google Scholar
  • 11 Gardner DF, Rothman J, Utiger RD. Serum thyroglobulin in normal subjects and patients with hyperthyroidism due to Graves’ disease: effects of T3, iodine 131I and antithyroid drugs. Clin Endocrinol 1979; 11: 585-94.
    CrossrefPubMedGoogle Scholar
  • 12 Grubeck-Loebenstein B, Buchan G, Chantry D. et al. Analysis of intrathyroidal cytokine production in thyroid autoimmune disease: thyroid follicular cells produce interleukin-1 and interleukin-6. Clin Exp Immunol 1989; 77: 324-30.
    PubMedGoogle Scholar
  • 13 Johns HE, Cunningham JR. The physics of radiology. Springfield: Charles C Thomas Publisher; 1971: 107-9.
    Google Scholar
  • 14 Kreisig T, Abenhard W, Mann K. et al. Frühveränderungen der Schilddrüsenhormone nach Radiojodtherapie der Hyperthyreose unter Berücksichtigung von Ätiologie und begleitender Medikation. Klin Wochensch 1989; 67: 386-92.
    CrossrefPubMedGoogle Scholar
  • 15 Maxon HR, Thomas SR, Saenger EL. et al. Ionising irradiation and the induction of clinically significant disease in human thyroid gland. Am J Med 1977; 63: 967-78.
    CrossrefPubMedGoogle Scholar
  • 16 McDermott MT, Kidd GS, Dodson LE. et al. Radioiodine-induced thyroid storm. Case report and literature review. Am J Med 1983; 75: 353-9.
    CrossrefPubMedGoogle Scholar
  • 17 Parma J, Duprez L, Van Sande J. et al. Somatic mutations in the thyrotropin receptor gene cause hyperfunctioning thyroid adenomas. Nature 1993; 365: 649-51.
    CrossrefPubMedGoogle Scholar
  • 18 Rousset B, Selmi S, Alquier C. et al. In vitro studies of the thyroglobulin degradation pathway: endocytosis and delivery of thyroglobulin to lysosomes, release of thyroglobulin cleavage products – iodotyrosines and iodothyronines. Biochimie 1989; 71: 247-62.
    CrossrefPubMedGoogle Scholar
  • 19 Sawin CT, Becker DV. Radioiodine and the treatment of hyperthyroidism: The early history. Thyroid 1997; 7: 163-72.
    CrossrefPubMedGoogle Scholar
  • 20 Schimmel M, Utiger RD. Acute effect of inorganic iodine after 131-J therapy for hyperthyroidism. Clin Endocrinol 1977; 6: 635-7.
    Google Scholar
  • 21 Shafer RB, Nuttal FQ. Acute changes in thyroid function in patients treated with radioactive iodine. Lancet 1975; 2: 653-7.
    PubMedGoogle Scholar
  • 22 Shafer RB, Nuttal FQ. Thyroid crisis induced by radioactive iodine. J Nucl Med 1971; 12: 262-4.
    PubMedGoogle Scholar
  • 23 Tamaga EJ, Levine GA, Hershman JM. Thyroid hormone concentrations after radioiodine therapy for hyperthyroidism. J Nucl Med 1979; 20: 387-91.
    PubMedGoogle Scholar
  • 24 Uller RP, van Herle AJ. Effect of therapy on serum thyroglobulin levels in patients with Graves’ disease. J Clin Endocrinol Metab 1978; 46: 747-55.
    CrossrefPubMedGoogle Scholar
  • 25 Van Sande J, Parma J, Tonacchera M. et al. Genetic basis of thyroid disease, somatic and germline mutations of the TSH receptor gene in thyroid diseases. J Clin Endocrinol Metab 1995; 80: 2577-85.
    PubMedGoogle Scholar
  • 26 Wise PH, Burnet RB, Almad A. et al. Intentional radioiodine ablation in Graves’ disease. Lancet 1975; 2: 1231-3.
    PubMedGoogle Scholar