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A Randomized Comparison of Radioiodine Doses in Graves’ Hyperthyroidism

Section of Nuclear Medicine, University of Manitoba (W.D.L.); Department of Nuclear Medicine, St. Boniface General Hospital (W.D.L., L.W.); and Section of Endocrinology and Metabolism, University of Manitoba and St. Boniface General Hospital (W.D.L., E.A.S., S.L., R.C.R., E.A.C.), Winnipeg, Canada R2H 2A6

Address all correspondence and requests for reprints to: Dr. William D. Leslie, Department of Medicine (C5121), 409 Tache Avenue, Winnipeg, Canada R2H 2A6. E-mail: bleslie{at}sbgh.mb.ca.

The optimal method for determining iodine-131 treatment doses for Graves’ hyperthyroidism is unknown, and techniques have varied from a fixed dose to more elaborate calculations based upon gland size, iodine uptake, and iodine turnover. Patients with Graves’ hyperthyroidism (n = 88) who had not been previously treated with radioactive iodine were randomized to one of four dose calculation methods: low-fixed, 235 MBq; high-fixed, 350 MBq; low-adjusted, 2.96 MBq (80 µCi)/g thyroid adjusted for 24 h radioiodine uptake; and high-adjusted, 4.44 MBq (120 µCi)/g thyroid adjusted for 24 h radioiodine uptake. Subjects were followed for mean of 63 months (range, 10–94 months) for the following clinical outcomes: euthyroid without medication, hyperthyroid requiring further radioiodine, and hypothyroid requiring life-long L-T₄. Mean treatment doses were similar in the different outcome groups. We could not demonstrate any advantage to using an adjusted dose method. Survival analysis did not demonstrate any difference in the time to outcome between the fixed and adjusted dose methods. The use of a fixed dose method simplifies the approach to treatment with potential cost savings.

Abbreviations: RAIU, Radioiodine uptake.

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