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Special Features: Scott A. Rivkees and Catherine Dinauer An Optimal Treatment for Pediatric Graves’ Disease Is Radioiodine J Clin Endocrinol Metab 2007; 92: 797-800 [Abstract] [Full text] [PDF]

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RAI Therapy in Childhood and Cancer Risk

Leslie J De Groot   (24 April 2007)

RAI Therapy in Childhood and Cancer Risk 24 April 2007
Leslie J De Groot, Professor of Medicine Brown University Send letter to journal: Re: RAI Therapy in Childhood and Cancer Risk ldegroot{at}earthlink.net Leslie J De Groot	Since the possibility of induction of cancer deaths by 131I is of central concern, it is interesting to calculate the risk using the data presented by Rivkees and Dinauer (1). The risk of cancer death following radiation exposure is noted to be 0.16%/rem for children, and the whole body radiation exposure from RAI treatment at age 10 is noted to be 1.45 rem/mCi administered. Rivkees and Dinauer advise treatment with doses of RAI greater then 160 μCi/gram thyroid, to achieve a thyroidal radiation dose of at least 150 Gy. Assuming a reasonable RAIU of 50% and gland size of 40 gm, the administered dose would thus be 40(gm) x 160 μCi/gm x 2 (to account for 50% uptake) = 12.8 mCi. Thus the long term cancer death risk would be 12.8 (mCi) x 1.45 rem (per mCi) x 0.16% (death/rem) = 2.15%. Whether or not accepting the rather surprisingly high 2% risk of cancer death from this treatment is, of course, a matter of judgment by the physician and family. However, this would seem to many persons to constitute a significant risk that should be avoided, in sharp contrast to the view presented by the authors. Reference 1. Rivkees SA, Dinauer C. 2007. An Optimal Treatment for Pediatric Graves’ Disease Is Radioiodine J Clin Endocrinol Metab 92:797-800