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Radioiodine Therapy of Benign Thyroid Diseases: Graves’ Disease, Plummer’s Disease, Non-toxic Goiter and Nodules

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Abstract

Thyroid diseases are common in all parts of the world. Hormonal disorders of thyroid gland negatively affect whole metabolism, and cause various health problems while goiter and nodules can cause local, compressive symptoms. Once a correct diagnosis is made, a definitive treatment protocol should be initiated. Medications, surgery, and radioactive iodine are currently the most widely available options. Each treatment option has its own advantages, disadvantages, and limitations. This chapter focuses on the role of radioiodine therapy of benign thyroid diseases. Pertinent information is also provided on the basics of thyroid diseases, thyroid medication, and surgery.

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Acknowledgement

The authors would like to acknowledge the technical assistance of Arda Dora Aktolun in improving the quality of images and preparing them for publication using his excellent computer skills.

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Authors and Affiliations

  1. Tirocenter Nuclear Medicine Center, Istanbul, Turkey

    Cumali Aktolun M.D., M.Sc.

  2. Nuclear Medicine Service, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey

    Muammer Urhan M.D.

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  1. Cumali Aktolun M.D., M.Sc.
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Correspondence to Cumali Aktolun M.D., M.Sc. .

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Editors and Affiliations

  1. Tirocenter Nuclear Medicine Center, Adnan Saygun Cad. 3, Istanbul, 34340, Turkey

    Cumali Aktolun

  2. & Molecular Imaging, New York-Presbyterian Hospital, Division of Nuclear Medicine, East 68th Street 525, New York, 10065, New York, USA

    Stanley J. Goldsmith

Appendix: Dosimetry

Appendix: Dosimetry

To avoid unnecessarily high irradiation of thyroid and the whole body by circulating radioiodine before being taken up by the thyroid gland, individualized calculation of activity necessary for optimal radiation dose to be absorbed by thyroid tissue to be ablated has always been an attractive approach [36, 73, 74]. This can be achieved through individualized dosimetric calculations, which mainly depend on target dose, 24-h radioiodine uptake (activity time interval), and amount of thyroid tissue to be ablated.

Amount of thyroid tissue and the volume to be ablated can be best calculated by ultrasonography. For thyroid glands with multiple autonomy (multiple toxic nodules), scintigraphic volume calculations can be used.

I-131 is the logistically ideal radionuclide for 24-h radioiodine uptake using a collimated probe (thyroid uptake device). I-123 can also be preferred if γ camera is used for counting. For Graves’ disease, a 5-h uptake can be helpful for keeping to the fast kinetics of I-131, since iodine turnover is faster and time-to-reach peak is shorter in this disease than in any other thyroid diseases. Alternatively, 20-min Tc-99m uptake can be used on logistical grounds, but the information obtained from this method is not exactly the same with that obtained from a 24-h iodine uptake study. Anti-thyroid drugs should be withdrawn at least 1 day before the uptake studies.

Two main approaches are commonly used: the Marinelli formula (Marinelli–Quimby formula) and MIRD algorithm [36, 40, 73, 74], the latter differing from the former by about 10 %.

The Marinelli formula [75]:

$$ \rm{I - }131\rm\rm{activity}\rm{(MBq)}=\frac{\rm{Target}\rm\rm{dose}(\rm{Gy})\times \rm{target}\rm\rm{weight}(\rm{g})\times 24.67}{\rm{Maximal}\rm\rm{uptake}(\%)\times \rm{effective}\rm\rm{half - life}\rm{(days)}}.$$

Modified Marinelli–Quimby–Hine formula:

$$ \rm{I - }131\rm\rm{activity}\rm{(mCi) = }\frac{\rm{Target}\rm\rm{dose}\rm{(cGy)}\times \rm{thyroid}\rm\rm{weight}\rm{(g)}\times 6.67}{{t}_{1/2}\rm{effective}\rm\rm{half - life}\rm{(days)}\times 24\rm{ - h}\rm\rm{uptake}(\%)}.$$

Target dose is the desired radiation absorbed dose. Dosimetric calculations take into consideration the effective half-life of radioiodine in the gland and the time-integrated activity. Many physicians choose to calculate the target activity individually by performing multiple tracer dose activity measurements at various times. Some prefer to use four “target variables”: time-integrated activity coefficient, time of maximum activity, effective half-life in the gland, and maximum activity. This approach increased accuracy only slightly [40].

Using a parameter k, thyroid absorbed dose and thyroid mass reduction as early as 1 month after RAIT month after therapy can be predicted before RAIT administration [76]. Dosimetric ­calculations were, however, found to be not ­useful in rendering the patient euthyroid and the performance of dosimetric calculations be low in this respect [77–79].

Dosimetry-based therapy of Graves’ disease is still associated with significant controversies and challenges. Most of the formulas, models, and proposed modifications aim to calculate the individual activity in Graves’ disease only. It is difficult to draw a reliable conclusion about the use of dosimetric calculations for Plummer’s disease with the limited data published in the literature on this topic.

A simpler formula requires three variables: 24-h radioiodine uptake, gland weight, fixed activity in microgram per gram of thyroid tissue [32].

$$ \rm{Activity}\rm{(mCi)}=\frac{\rm{Gland}\rm\rm{weight}(\rm{g})\times \rm{Microgram}\rm\rm{per}\rm\rm{each}\rm\rm{gram}\rm\rm{of}\rm\rm{thyroid}\rm\rm{tissue}\times 100}{24\rm{ - h}\rm\rm{uptake}\rm{(percent)}}.$$

Currently, in clinical practice, most of the patients are eligible for a fixed activity-based treatment, but some patients still require elaborative dosimetric calculations. Although fixed activity method gives satisfactory results to achieve the targeted irradiation of thyroid gland in 80 % of the patients with Graves’ disease, there is an obvious need to develop a reasonably fast, simple, and cost-effective method to measure the intra-thyroidal radioiodine kinetics for the routine calculation of optimal radioiodine activity.

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Aktolun, C., Urhan, M. (2013). Radioiodine Therapy of Benign Thyroid Diseases: Graves’ Disease, Plummer’s Disease, Non-toxic Goiter and Nodules. In: Aktolun, C., Goldsmith, S. (eds) Nuclear Medicine Therapy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4021-5_17

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