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

J. Meller; U. Siefker; A. Hamann; M. Hüfner

doi:10.1055/s-2006-924239

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

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

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

Full Text

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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