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Exp Clin Endocrinol Diabetes 2006; 114(5): 235-239
DOI: 10.1055/s-2006-924239
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Incidence of Radioiodine Induced Graves' Disease in Patients with Multinodular Toxic Goiter

J. Meller1 , U. Siefker1 , A. Hamann1 , M. Hüfner2
  • 1Department of Nuclear Medicine, University of Göttingen, Göttingen, Germany
  • 2Department of Internal Medicine, University of Göttingen, Göttingen, Germany
Further Information

Publication History

Received: September 1, 2005 First decision: October 24, 2005

Accepted: November 28, 2005

Publication Date:
28 June 2006 (online)

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Abstract

In this study, we assessed the incidence of Graves' disease (GD) following radioiodine therapy (RIT) in a large cohort of well characterized patients with autonomy in comparison to the clinical course of control patients with thyroidal autonomy not definitively treated with 131I or surgery. 622 consecutive patients were treated with 131I for autonomy (unifocal: n = 321; multifocal: n = 199; disseminated: n = 102) and followed up for at least 6 months post RIT. 108 consecutive patients with autonomy not definitively treated (unifocal: n = 49; multifocal: n = 42; disseminated: n = 11) followed up for at least 6 months served as controls. Initial evaluation and follow-up included determination of FT3, FT4, TSH, autoantibodies against the thyroid peroxidase (anti-TPO) and TSH-receptor antibodies (TRAb) by highly sensitive radio receptor-assay, quantitative thyroid scintigraphy and sonography. After 6 months, GD was newly diagnosed in 1/321 patients with unifocal autonomy, in 1/199 patients with multifocal autonomy and in 0/108 control patients. In patients with disseminated autonomy (group C), GD was diagnosed significantly more often compared to the other groups (5/102 patients; 4,1 %; p < 0.05). In conclusion, RIT may induce Graves' disease in a few cases with toxic multinodular goiter. The incidence in this population is small. Compared with patients suffering from uni- or multifocal autonomy, subjects with disseminated autonomy have a more than tenfold higher risk for the development of GD.

Key words

Radioiodine therapy (RIT) - toxic multinodular goiter - autoimmunity - disseminated autonomy - Graves' disease - TSH-receptor antibodies

References

  • 1 Bartalena L, Bogazzi F, Pecori F, Martino E. Graves' disease occurring after subacute thyroiditis: report of a case and review of the literature.  Thyroid. 1996;  6 345-348
    CrossrefPubMedGoogle Scholar
  • 2 Bähre M, Hilgers R, Lindemann C, Emrich D. Thyroid autonomy: sensitive detection and estimation of its functional relevance using quantified high-resolution scintigraphy.  Acta Endocrinol (Copenh). 1988;  117 145-153
    PubMedGoogle Scholar
  • 3 Becker W, Frank R, Börner W. Bedeutung einer quantitativen Grauwertanalyse des Sonogramms bei „diffusen“ Erkrankungen der Schilddrüse.  Fortschr Röntgenstr. 1989;  150 66-71
    PubMedGoogle Scholar
  • 4 Castagliola S, Morgenthaler N G, Hoermann R, Badenhoop K, Struck J, Freitag D, Poertl S, Weglöhner W, Hollidt J M, Quadbeck B, Dumont J E, Schumm-Draeger P M, Bergmann A, Mann K, Vassart G, Usadel K H. Second generation assay for thyrotropin receptor antibodies has superior sensitivity for Graves' disease.  J Clin Endocrinol Metab. 1999;  84 90-97
    CrossrefPubMedGoogle Scholar
  • 5 DeGroot L J. Radioiodine and the immune system.  Thyroid. 1997;  7 259-264
    PubMedGoogle Scholar
  • 6 Dunkelmann S, Endlicher D, Prillwitz A, Rudolph F, Groth P, Schuemichen C. Results of TcTUs-optimized radioiodine therapy of multifocal and disseminated functional thyroid autonomy.  Nuklearmedizin. 1999;  38 131-139
    PubMedGoogle Scholar
  • 7 Dunkelmann S, Wolf R, Koch A, Kittner C, Groth P, Schuemichen C. Incidence of radiation-induced Graves' disease in patients treated with radioiodine for thyroid autonomy before and after introduction of a high-sensitivity TSH receptor antibody assay.  Eur J Nucl Med Mol Imaging. 2004;  31 1428-1434
    PubMedGoogle Scholar
  • 8 Emrich D, Erlenmaier U, Pohl M, Luig H. Determination of the autonomously functioning volume of the thyroid.  Eur J Nucl Med. 1993;  20 410-414
    PubMedGoogle Scholar
  • 9 Freeman J S, Ertel N H, McA'Nulty J A, Khan M Y. Graves' disease following resection of an autonomous solitary thyroid adenoma.  J Med Soc NY. 1983;  80 444-446
    PubMedGoogle Scholar
  • 10 Kraiem Z, Glaser B, Yigla M, Pauker J, Sadeh O, Sheinfeld M. Toxic multinodular goiter: a variant of autoimmune hyperthyroidism.  Clin Endocrinol Metab. 1987;  65 659-664
    CrossrefPubMedGoogle Scholar
  • 11 Meller J, Jauho A, Hüfner M, Gratz S, Becker W. Disseminated thyroid autonomy versus graves disease: reevaluation by a second generation TSH-receptor-antibody assay.  Thyroid. 2000 a;  10 1085-1091
    PubMedGoogle Scholar
  • 12 Meller J, Schreivogel I, Bergmann A, Morgenthaler N, Hüfner M, Becker W. Klinische Implikationen eines neuen TSH-Rezeptor-Antikörper-Assays (DYNOtest® TRAKhuman) bei autoimmunen Schilddrüsenerkrankungen.  Nuklearmedizin. 2000 b;  39 14-18
    PubMedGoogle Scholar
  • 13 Meller J, Hüfner M, Krohn K, Paschke R, Becker W. Disseminierte Autonomie (DISA): Eine TRAk-negative Autoimmunhyperthyreose?. Mann K, Weinheimer B, Janssen OE Schilddrüse 2001. Berlin; de Gruyter 2002 a: 139-148
    Google Scholar
  • 14 Meller J, Sahlmann C O, Becker W. Radioidine treatment of functional thyroidal autonomy.  Nucl Med Rev Cent East Eur. 2002 b;  5 1-10
    PubMedGoogle Scholar
  • 15 Meller J, Becker W. The continuing importance of thyroid scintigraphy in the era of high resolution ultrasound.  Eur J Nucl Med. 2002;  29 S425-S438
    CrossrefPubMedGoogle Scholar
  • 16 Nygaard B, Knudsen J H, Hegedues L, Veje A, Hansen J EM. Thyrotropin receptor antibodies and Graves' disease, a side effect of131I treatment in patients with non-toxic goiter.  J Clin Endocrinol Metab. 1997;  82 2926-2930
    CrossrefPubMedGoogle Scholar
  • 17 Nygaard B, Metcalfe R A, Phipps J, Weetman A P, Hegedus L. Graves' disease and thyroid associated ophthalmopathy triggered by 131I treatment of non-toxic goiter.  J Endocrinol Invest. 1999 a;  22 481-485
    PubMedGoogle Scholar
  • 18 Nygaard B, Faber J, Veje A, Hegedus L, Hansen J M. Transition of nodular toxic goiter to autoimmune hyperthyroidism triggered by 131I therapy.  Thyroid. 1999 b;  9 477-481
    CrossrefPubMedGoogle Scholar
  • 19 Orsolon P, Lupi A, De Antoni Migliorati G, Vianello Dri A. Appearance of Graves' disease following regression of autonomously functioning thyroid nodules. Two case reports.  Minerva Endocrinol. 1998;  23 53-56
    PubMedGoogle Scholar
  • 20 Pohl M, Emrich D. Immunogene und nicht immunogene Hyperthyreose - Ein Vergleich.  Nuklearmedizin. 1993;  32 200-205
    PubMedGoogle Scholar
  • 21 Scherbaum W A, Paschke R. Bedeutung der Schilddrüsenantikörper für Diagnostik und Verlaufsbeurteilung von Schilddrüsenerkrankungen.  Internist. 1995;  36 303-309
    PubMedGoogle Scholar
  • 22 Schumm-Draeger P M, Wenisch H JC. Methoden zum Nachweis von Schildddrüsenantikörpern.  Akt Endokr Stoffw. 1989;  10 90-102
    PubMedGoogle Scholar
  • 23 Senekowitsch-Schmidtke R, Schwaiger M. Zum Auftreten einer Immunhyperthyreose nach Radioiodtherapie von Schilddrüsenautonomien.  Med Klin. 1997;  92 130-137
    PubMedGoogle Scholar
  • 24 Soule J, Mayfield R. Graves' disease after 131I therapy for toxic nodule.  Thyroid. 2001;  10 91-92
    PubMedGoogle Scholar
  • 25 Studer H, Peter H J, Gerber H. Morphologic and functional changes in developing goiters. Studer H Thyroid Disorders Associated with Iodine Deficiency and Excess. 1st ed. New York; Raven Press 1985: 227-240
    Google Scholar
  • 26 Vitti P, Rago T, Mazzeo S, Brogioni S, Lampis M, De Liperi A, Bartolozzi C. Thyroid blood flow by color-flow doppler sonography distinguishes Graves' disease from Hashimoto's thyroiditis.  J Endocrinol Invest. 1995;  18 857-861
    CrossrefPubMedGoogle Scholar
  • 27 Wallaschofski H, Orda C, Georgi P, Miehle K, Paschke R. Distinction between autoimmune and non-autoimmune hyperthyroidism by determination of TSH-receptor antibodies in patients with the initial diagnosis of toxic multinodular goiter.  Horm Metab Res. 2001;  33 504-507
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Wallaschofski H, Müller D, Georgi P, Paschke R. Induction of TSH-receptor antibodies in patients with toxic multinodular goitre by radioiodine treatment.  Horm Metab Res. 2002;  34 36-39
    Article in Thieme ConnectPubMedGoogle Scholar

MD Johannes Meller

Department of Nuclear Medicine
Georg August University

Robert-Koch-Str. 40

37075 Göttingen

Germany

Phone: + 49551398510

Fax: + 49 551 39 85 26

Email: jmeller@med.uni-goettingen.de

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