Response to radioiodine in male hyperthyroid patients at Tygerberg Hospital

Onimode, Yetunde Ajoke (Stellenbosch : University of Stellenbosch, 2009-03)

Thesis (MSc (Medical Imaging and Clinical Oncology. Nuclear Medicine))--University of Stellenbosch, 2009.

Thesis

ENGLISH ABSTRACT: Radioiodine therapy is reputed to yield poorer results in male patients than in females. We retrospectively reviewed the records of 308 patients treated with radioiodine-131 (RAI) for Graves’ disease (n=266, 86.4%), toxic multinodular goitres (n=35, 11.4%) and toxic solitary nodules (n=7, 2.3%). The mean age of the men was 44 ±13.6 years (range 14-77 years). Patients with GD were predominantly in the younger age groups, while those with toxic nodular goitres were in the older range. Two hundred and fifty-nine patients (84.1%) were treated with a single dose of RAI, while 49 (15.9%) required further doses. A second dose had to be administered to 38 patients, while 8 received 3 doses, 2 got 4 doses and 1 patient had 5 doses in all (these included a first dose received prior to referral to our Thyroid Clinic). Cure was determined as euthyroidism or hypothyroidism at the 3-month follow-up visit. The average pre-treatment T4 value was 68.9 ± 31.8 pmol/L (range 5.7 – 155 pmol/L); while the mean Tc-99m pertechnetate uptake value was 15.8 ± 10.9% (range 0.88 - 62.9). Patients with GD presented with more severe hyperthyroidism than the other patients; mean free T4 of 71.9 ± 31.1 pmol/L compared to 51.4 ± 29.9 pmol/L for the TMG group of patients, and 39.6 ± 26.8 pmol/L for the TSN group (ANOVA p<0.0001, confirmed by the Kruskal-Wallis test). Patients with TMG and TSN were treated with higher doses than patients with GD; mean first doses of 349.3 ± 88.5 MBq and 428.1 ± 28.6 MBq respectively, compared to a mean dose of 325.1 ± 69.3 MBq for patients with GD. Treatment with multiple doses of RAI correlated with higher values of T4 and T3 at presentation (p<0.0001). However, none of the baseline variables of age, T4 and T3, and first dose of RAI was significant predictors of free T4 outcome at 3 months. A consistently higher dose was administered to the male patients, compared to female patients of similar age, diagnosis and level of thyrotoxicosis (Tc-99m pertechnetate uptake). Despite this, male patients had similar outcomes as the female patients 3 months after therapy. Our findings lend weight to the theory that male patients are more difficult to treat than their female counterparts, seeing that the former had similar outcomes despite the significantly higher doses of RAI administered to the males.

AFRIKAANSE OPSOMMING: Radiojodium terapie lewer na bewering swakker resultate in mans as in vroulike pasiënte. Die inligting van 308 pasiënte met Grave se siekte (n=266, 86.4%), toksiese multinodulêre tiroïed (n=35, 11.4%) en enkel toksiese nodules (n=7, 2.3%) wat met radiojodium (I-131) behandel is, is retrospektief nagegaan. Die gemiddelde ouderdom van die mans was 44 ±13.6 jaar (reikwydte 14-77 jaar). Die meeste pasiënte met Grave se siekte was in die jonger ouderdomsgroep, terwyl dié met toksiese multinodulêre tiroïed, ouer was. Tweehonderd nege-en-vyftig pasiënte (84.1%) is met ‘n enkel dosis radiojodium behandel, terwyl 49 (15.9%) meer as een dosis benodig het. ‘n Tweede dosis is aan 38 pasiënte gegee, terwyl agt 3 dosisse, twee 4 dosisse en 1 pasiënt 5 dosisse in totaal ontvang het (wat ‘n eerste dosis voor verwysing na die tiroïedkliniek, ingesluit het). Herstel is gedefinieer as eutiroïdisme of hipotiroidisme tydens die drie maande opvolgbesoek. Die gemiddelde T4-waarde voor behandeling was 68.9 ± 31.8 pmol/L (reikwydte 5.7–155 pmol/L); terwyl die gemiddelde Tc-99m pertegnetaatopname 15.8 ± 10.9% (reikwydte 0.88–62.9) was. Pasiënte met Grave se siekte het met erger hipertiroidisme as die ander pasiënte gepresenteer; met ‘n gemiddelde vry T4 van 71.9 ± 31.1 pmol/L vergeleke met 51.4 ± 29.9 pmol/L vir die toksiese multinodulêre tiroïedgroep en 39.6 ± 26.8 pmol/L vir die enkel toksiese nodule groep (ANOVA p<0.0001, bevestig met die Kruskal-Wallistoets). Pasiënte met toksiese multinodulêre tiroïed en enkel toksiese nodule, is met hoër dosisse as dié met Grave se siekte behandel; met ‘n gemiddelde eerste dosis van 349.3 ± 88.5 MBq en 428.1 ± 28.6 MBq onderskeidelik, vergeleke met ‘n gemiddelde dosis van 325.1 ± 69.3 MBq vir pasiënte met Grave se siekte. Behandeling met meer as een dosis radiojodium het gekorreleer met hoër T4- en T3- waardes by (p<0.0001). Geen van die basislyn veranderlikes (ouderdom, T4 en T3, en die eerste dosis radiojodium) was egter ‘n betekenisvolle voorspeller van die vry T4 uitkoms op 3 maande nie. Die dosis wat aan manlike pasiënte toegedien is, was konstant hoër, vergeleke met die vroulike pasiënte van dieselfde ouderdom, diagnose en vlak van tirotoksikose. (Tc-99m pertegnetaatopname). Ongeag hiervan, was die uitkoms by manlike en vroulike pasiënte 3 maande na terapie dieselfde. Ons bevindinge dra by tot die teorie dat manlike pasiënte moeiliker is om te behandel as hul vroulike eweknieë, aangesien mans soortgelyke uitkomste gehad het ten spyte van betekenisvol hoër dosisse radiojodium.

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