Treatment of thyrotoxicosis with radioiodine (аnalytical review of literature and own clinical data)

Abstract

Background. Thyrotoxicosis syndrome is a severe disease of the thyroid that adversely affects functioning of almost all organs and body systems and can result in serious complications like ciliary arrhythmia, cardiovascular inefficiency, thyroid eye disease with visual deterioration, multi-organ failure. The choice of treatment strategy, its sequence and radioiodine therapy effectiveness in thyrotoxicosis and other non-oncological diseases of the thyroid gland is still a challenging issue in endocrinology and radiology. Purpose. To analyze the literature data regarding radionuclide treatment in patients with thyrotoxicosis and to present own experience-outcomes of radioiodine treatment administered to 146 patients with thyrotoxicosis symptoms and 9 patients with other non-oncological thyroid pathology at SO «Grigoriev Institute for Medical Radiology and Oncology» during 2010–2019. Materials and methods. The literature analysis involved 34 sources of information in the form of scientific articles, research papers, monographies, etc. Among them, 4 sources were domestic, 3 sources were Russian, the other 27 were taken from the foreign scientific journals. The evidence level of researching varies from І А to ІІІ С. The analysis of own findings has been carried out for the period from 2010 to the first half of 2020. Treatment with 131I-sodium iodide was provided in liquid or capsule form, per os; 155 patients in total underewnt treatment. Radioiodine activity per a course ranged from 185 MBq to 1110 MBq, the number of courses was chosen individually. Results and discussion. The analytical review of modern domestic and foreign literature has made it possible to define that radioiodine treatment still plays an important role in treatment of thyrotoxicosis, especially for patients with recurrent and resistant to thyrostatics disease form. Our own data showed that the treatment was reasonable to be administered via high radioiodine doses (600–1000 MBq), that resulted in curing the disease in 98 % (113 patients with Graves’ disease and 33 patients with toxic multinodular goiter). The effectiveness of radioiodine therapy for patients with AIT (2 cases) and in case of the retrosternal location of the thyroid gland (7 patients) has been proven. Conclusions. Radioiodine treatment remains a modern and effective way to overcome such conditions as Graves’ disease, TMNG (toxic multinodular goiter), retrosternal location of hyperplastic thyroid gland, AIT.