Efficacy of single fixed dose of radioiodine (I-131) therapy in patients with hyperthyroidism at Groote Schuur Hospital

 

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dc.contributor.advisor Kotze, Tessa
dc.contributor.author Isah, Ahmed Rufai
dc.date.accessioned 2020-03-13T14:35:30Z
dc.date.available 2020-03-13T14:35:30Z
dc.date.issued 2019
dc.identifier.citation Isah, A.R. 2019. Efficacy of single fixed dose of radioiodine (I-131) therapy in patients with hyperthyroidism at Groote Schuur Hospital. . ,Faculty of Health Sciences ,Department of Radiation Medicine. http://hdl.handle.net/11427/31591 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/31591
dc.description.abstract Aim: The aims of this audit were: To determine the proportion of hyperthyroid patients receiving I-131 therapy in whom treatment with a single fixed dose was successful, as defined by the achievement of euthyroidism or hypothyroidism 6-months after the therapy; To identify patients in whom treatment was not successful and a second dose needed; And, if possible, to establish the factors associated with treatment failure. Methods: A single observer reviewed the records of all patients who received I-131 therapy for hyperthyroidism between 23rd April 2010 and 23rd November 2017 in conjunction with their pre and post treatment thyroid function tests. Results of their thyroid ultrasound were retrieved and documented. The images of their Tc-99m sodium pertechnetate thyroid scans were also retrieved and reprocessed. Results: The records of 409 patients treated between April 2010 and November 2017 were retrieved. 223 (63%) patients were referred by the endocrine clinic at Groote Schuur hospital (GSH. Of the 409 patients, 56 (14%) patients that were excluded because their post therapy records were not available for analysis. Majority of our patients were females 310 (88%). Patients between the ages of 15 and 45 years are more likely to present with Grave’s disease while those aged more than 45 years presented with toxic multinodular gland (p=0.000). Patients that presented between the ages of 15 and 45 years are more likely to have moderately increased pretreatment FT4 (12-51 mmol/L) (p=0.002). We administered a radioiodine therapy dose of 456.6±54.8 MBq (Mean ± SD) to these 409 patients. Among the 353 patients, with complete records, 314(89%) achieved cure at some stage after receiving one dose of RAI; 239(76%) achieving cure ≤ 6 months of therapy and 75(24%) patients after 6 months. In our audit the patients who failed to achieve cure following the first RAI therapy appeared to be younger (median(interquartile range) age 39(16), p= 0.03), have severe hyperthyroidism as demonstrated by higher pre-treatment FT4 (median(interquartile range) 27 pmol/L(30.6), p= 0.05) and high pertechnetate uptake (median(interquartile range) uptake 9.9%(14), p= 0.002) on thyroid scintigraphy. CONCLUSION Our audit showed RAI therapy was found to be successful in 68% of patients at 6 month and 89% at a year. A second therapy with radioactive iodine would be indicated in 32% of patients, as these patients have not achieved cure at 6 months. Patients presenting with severe thyrotoxicity are likely to require more than one RAI therapy. Due to major deficiencies in referral, record keeping and follow up, other factors responsible for treatment were not be able to be evaluated. Based on these findings, suggested areas for further research are: should patients with severe hyperthyroidism be considered for pretreatment with antithyroid medication prior to RAI; would a one year follow up after radioiodine therapy be considered before second RAI. Now that the deficiencies in our current practice have been identified and suggestions put forward to address these deficiencies, a follow up audit would be needed.
dc.subject Hyperthyroidism
dc.subject I-131 (Radioiodine) therapy
dc.subject Effectiveness
dc.title Efficacy of single fixed dose of radioiodine (I-131) therapy in patients with hyperthyroidism at Groote Schuur Hospital
dc.type Master Thesis
dc.date.updated 2020-03-13T13:00:04Z
dc.language.rfc3066 eng
dc.publisher.faculty Faculty of Health Sciences
dc.publisher.department Department of Radiation Medicine
dc.type.qualificationlevel Masters
dc.type.qualificationname MMed
dc.identifier.apacitation Isah, A. R. (2019). <i>Efficacy of single fixed dose of radioiodine (I-131) therapy in patients with hyperthyroidism at Groote Schuur Hospital</i>. (). ,Faculty of Health Sciences ,Department of Radiation Medicine. Retrieved from http://hdl.handle.net/11427/31591 en_ZA
dc.identifier.chicagocitation Isah, Ahmed Rufai. <i>"Efficacy of single fixed dose of radioiodine (I-131) therapy in patients with hyperthyroidism at Groote Schuur Hospital."</i> ., ,Faculty of Health Sciences ,Department of Radiation Medicine, 2019. http://hdl.handle.net/11427/31591 en_ZA
dc.identifier.vancouvercitation Isah AR. Efficacy of single fixed dose of radioiodine (I-131) therapy in patients with hyperthyroidism at Groote Schuur Hospital. []. ,Faculty of Health Sciences ,Department of Radiation Medicine, 2019 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/31591 en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Isah, Ahmed Rufai AB - Aim: The aims of this audit were: To determine the proportion of hyperthyroid patients receiving I-131 therapy in whom treatment with a single fixed dose was successful, as defined by the achievement of euthyroidism or hypothyroidism 6-months after the therapy; To identify patients in whom treatment was not successful and a second dose needed; And, if possible, to establish the factors associated with treatment failure. Methods: A single observer reviewed the records of all patients who received I-131 therapy for hyperthyroidism between 23rd April 2010 and 23rd November 2017 in conjunction with their pre and post treatment thyroid function tests. Results of their thyroid ultrasound were retrieved and documented. The images of their Tc-99m sodium pertechnetate thyroid scans were also retrieved and reprocessed. Results: The records of 409 patients treated between April 2010 and November 2017 were retrieved. 223 (63%) patients were referred by the endocrine clinic at Groote Schuur hospital (GSH. Of the 409 patients, 56 (14%) patients that were excluded because their post therapy records were not available for analysis. Majority of our patients were females 310 (88%). Patients between the ages of 15 and 45 years are more likely to present with Grave’s disease while those aged more than 45 years presented with toxic multinodular gland (p=0.000). Patients that presented between the ages of 15 and 45 years are more likely to have moderately increased pretreatment FT4 (12-51 mmol/L) (p=0.002). We administered a radioiodine therapy dose of 456.6±54.8 MBq (Mean ± SD) to these 409 patients. Among the 353 patients, with complete records, 314(89%) achieved cure at some stage after receiving one dose of RAI; 239(76%) achieving cure ≤ 6 months of therapy and 75(24%) patients after 6 months. In our audit the patients who failed to achieve cure following the first RAI therapy appeared to be younger (median(interquartile range) age 39(16), p= 0.03), have severe hyperthyroidism as demonstrated by higher pre-treatment FT4 (median(interquartile range) 27 pmol/L(30.6), p= 0.05) and high pertechnetate uptake (median(interquartile range) uptake 9.9%(14), p= 0.002) on thyroid scintigraphy. CONCLUSION Our audit showed RAI therapy was found to be successful in 68% of patients at 6 month and 89% at a year. A second therapy with radioactive iodine would be indicated in 32% of patients, as these patients have not achieved cure at 6 months. Patients presenting with severe thyrotoxicity are likely to require more than one RAI therapy. Due to major deficiencies in referral, record keeping and follow up, other factors responsible for treatment were not be able to be evaluated. Based on these findings, suggested areas for further research are: should patients with severe hyperthyroidism be considered for pretreatment with antithyroid medication prior to RAI; would a one year follow up after radioiodine therapy be considered before second RAI. Now that the deficiencies in our current practice have been identified and suggestions put forward to address these deficiencies, a follow up audit would be needed. DA - 2019 DB - OpenUCT DP - University of Cape Town KW - Hyperthyroidism KW - I-131 (Radioiodine) therapy KW - Effectiveness LK - https://open.uct.ac.za PY - 2019 T1 - Efficacy of single fixed dose of radioiodine (I-131) therapy in patients with hyperthyroidism at Groote Schuur Hospital TI - Efficacy of single fixed dose of radioiodine (I-131) therapy in patients with hyperthyroidism at Groote Schuur Hospital UR - http://hdl.handle.net/11427/31591 ER - en_ZA


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