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Open Access Highly Accessed Research article

A mathematical model of optimized radioiodine-131 therapy of Graves' hyperthyroidism

Suhail AR Doi1*, Issa Loutfi2 and Kamal AS Al-Shoumer1

Author Affiliations

1 Endocrinology, Mubarak Al Kabeer Teaching Hospital & Faculty of Medicine, Kuwait University, Jabriya, Kuwait

2 Nuclear Medicine Divisions, Mubarak Al Kabeer Teaching Hospital & Faculty of Medicine, Kuwait University, Jabriya, Kuwait

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BMC Nuclear Medicine 2001, 1:1  doi:10.1186/1471-2385-1-1

Published: 28 August 2001

Abstract

Background

The current status of radioiodine-131 (RaI) dosimetry for Graves' hyperthyroidism is not clear. Recurrent hyperthyroidism and iatrogenic hypothyroidism are two problems which interact such that trying to solve one leads to exacerbation of the other. Optimized RaI therapy has therefore begun to be defined just in terms of early hypothyroidism (ablative therapy) as physicians have given up on reducing hypothyroidism.

Methods

Optimized therapy is evaluated both in terms of the greatest separation of cure rate from hypothyroidism rate (non-ablative therapy) or in terms of early hypothyroidism (ablative therapy) by mathematical modeling of outcome after radioiodine and critically discussing the three common methods of RaI dosing for Graves' disease.

Results

Cure follows a logarithmic relationship to activity administered or absorbed dose, while hypothyroidism follows a linear relationship. The effect of including or omitting factors in the calculation of the administered I–131 activity such as the measured thyroid uptake and effective half-life of RaI or giving extra compensation for gland size is discussed.

Conclusions

Very little benefit can be gained by employing complicated methods of RaI dose selection for non-ablative therapy since the standard activity model shows the best potential for cure and prolonged euthyroidism. For ablative therapy, a standard MBq/g dosing provides the best outcome in terms of cure and early hypothyroidism.