what happens if radioactive iodine treatment fails for graves disease

Patients were classified as having Graves’ disease if they either had positive TSH receptor stimulating antibodies or homogenous uptake on radioiodine uptake scan. Failure of RAI was defined as requiring treatment with an additional dose (s) of RAI and/or total thyroidectomy for treatment of hyperthyroidism

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Full Answer

What is life expectancy of Graves disease?

dE = – (ln 1.21)/0.098 for men, and - (ln 1.21)/0.10 for women. Thus the expected change in life expectancy for people with Graves’ disease in the UK, over 30 and under 45, is about -2 years, with the lower value of 1.1 giving -1 year, and the higher value of 1.5 gives -4 years.

Can Graves disease come back after radiation treatment?

Yes it can return . I was diagnosed with graves disease when I was 13 yrs old . At the age of 17 it went into remission . Then when I was 20 I got pregnant and 11 months after my son was born it came back in full . I ended up having to have the radiation iodine therapy to handle it . That was 7 yrs ago .

What are the long term effects of Graves disease?

• pre-eclampsia
• miscarriage
• premature labour and birth (before the 37th week of pregnancy)
• your baby having a low birthweight

What is the prognosis of Graves disease?

Graves Disease Prognosis – Understanding the Progression of this Autoimmune Thyroid Condition. A Graves Disease prognosis is considered to be highly positive; that is, if the right treatment is administered to the patient. Graves Disease is a type of autoimmune disorder that occurs when the thyroid is found to be overactive.

What happens if radioactive iodine does not work?

Thyroid cancer that no longer responds to radioactive iodine may become sensitive after starting anti-cancer drugs.

Can Graves disease return after radioactive iodine treatment?

Abstract. The use of radioactive iodine (131I) in the treatment of Graves' disease results frequently in hypothyroidism requiring thyroid hormone supplementation. Relapse of Graves' disease months after inadequate treatment with 131I is well-recognized.

What is the main drawback of radioactive iodine in treatment of Graves disease?

While it is generally safe to give RAI, patients may experience some side effects of therapy. The risk of eventual hypothyroidism is high, especially after treatment of GD. There can be transient exacerbation of hyperthyroid symptoms due to radiation thyroiditis.

How many times can you have radioactive iodine treatment?

You may only need to have this treatment once. But it can be repeated every 3 months if needed, until there is no sign of any thyroid cancer on your scans.

What is the life expectancy of someone with Graves disease?

Fluid in the lungs is another symptom that may occur. Patients who develop thyroid storm have a 20 to 50% chance of dying. In general, if your hyperthyroidism is caught early and you control it well with medication or other options, experts say your Graves' disease life expectancy and prognosis is favorable.

How long can you stay in remission from Graves disease?

Remission rates vary greatly, however, from 30% up to 70% in individual studies. Remission rates are only weakly related to the duration of ATD treatment: 12 to 18 months seems optimal, with slightly higher recurrence rates after 6 months and no apparent additional benefit by extending therapy beyond 18 months [21].

Does Graves disease get worse over time?

Hyperthyroidism caused by Graves disease usually gets worse over time. It has many complications, some of which are severe and affect quality of life.

Can Graves disease be cured with radiation?

Radioactive iodine (I131) is a common definitive treatment for Graves' Disease.

Does radioactive iodine shorten your life?

Quality of life is worse at 6-10 years after radioactive iodine therapy of Graves' disease compared with treatment with antithyroid drugs or surgery. Quality of life is worse at 6-10 years after radioactive iodine therapy of Graves' disease compared with treatment with antithyroid drugs or surgery.

What are the long term side effects of radioactive iodine?

Possible long term side effectsAbility to have children (fertility) Some women may have irregular periods after radioactive iodine treatment. ... Inflammation of the salivary glands (where spit is made) ... Tiredness. ... Dry or watery eyes. ... Lower levels of blood cells. ... Lung problems. ... Second cancers.

How long does radioactive iodine last?

The radioiodine from your treatment will temporarily remain in your body. Most of the radioiodine not taken up by your thyroid gland will be eliminated within the first (2) two days after treatment. Radioiodine leaves your body primarily by your urine. Very small amounts may leave in your saliva, sweat, or feces.

Which is better thyroid surgery or radioactive iodine?

Surgery for hyperthyroidism was associated with a lower risk of all-cause and cardiovascular death as compared to radioactive iodine therapy during long-term follow-up, particularly in men.

What is Graves disease?

Graves’ disease (GD) is an autoimmune condition characterised by elevated levels of thyroid stimulating (TSH) receptor antibodies with increased production of thyroid hormone. Among patients with hyperthyroidism, 60–80% have GD.

When does iodine cause birth defects?

There is no increase in birth defects or childhood malignancy in children born to mothers who had received radioactive iodine before the 10th week of gestation (49). Limited evidence suggests that RAI given after 10–12 weeks results in neonatal hypothyroidism or cretinism.

How is radiation exposure determined in utero?

Radiation exposure in utero is determined by the gestational age, foetal thyroid activity and maternal thyroid uptake (47) . Administration of a maximum dose of 15 mCi (550MBq) given up to 10 weeks of gestation does not severely affect foetal thyroid function and the low fetal exposure does not justify termination (48).

What is the primary treatment for thyrotoxicosis?

Carbimazole (CMZ), Methimazole (MTZ) and propylthiouracil (PTU) are used for the primary treatment of thyrotoxicosis due to GD or as a means of preparing the patient for definitive therapy with surgery or RAI (19).

What is the precursor of thyroxine?

Iodine is the precursor of thyroxine. The radioactive form of iodine is taken up by iodide transporter of the thyroid the same way as natural iodine and is similarly processed. The b particle destroys the follicular cell, gradually leading to volume reduction and control of the thyrotoxicosis.

Is hyperthyroidism a cause of CV?

A recent study (51) showed that chronic hyperthyroidism and not the treatment modality, is a cause of excess cardiovascular ( CV) mortality. This can be attributed to cerebrovascular disease and atrial fibrillation (AF). AF occurs in 5–15% of patients with hyperthyroidism (52).

Is RAI a treatment for GD?

RAI is the most widely used treatment for patients with GD in the United States (2) . Although therapy is well established for definitive treatment of GD, the approach to dosing remains controversial. This is due to differing goals of treatment (control of hyperthyroidism vs. avoidance of hypothyroidism).

What are Graves antibodies?

Second, you may still be dealing with Graves’ antibodies, which is a separate issue from not having any thyroid hormone production. The Graves’ antibodies are responsible for conditions like thyroid eye disease (TED) and disfiguring skin conditions (pretibial myxedema, acropachy).

What is Graves disease?

Graves’ disease is an autoimmune disease that leads to overactivity of the thyroid gland (hyperthyroidism). I have Hypothyroid Mom readers struggling with hypothyroidism now since treatment for their Graves’ with radioactive iodine (RAI) or thyroidectomy. I welcome Barbara Lougheed, author of the book Tired Thyroid: From Hyper to Hypo ...

How long does it take for antibodies to increase after RAI?

However, antibodies usually increase significantly during the first three months after RAI, then slowly decrease, but levels can still remain above the reference range even after five years. [3] . In some patients, as the antibodies regress, their Thyroid Stimulating Hormone (TSH) returns. [4] .

Who is the founder of Hypothyroid Mom?

Dana Trentini founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links including the Amazon Services LLC Associates Program.

Does RAI cause damage to the stomach?

Some who underwent RAI treatment suffer from some degree of damage to the stomach, salivary, [6] lacrimal (tear) glands [7] and other organs, because those organs also collect iodine. I did not suffer any severe side effects from the RAI, probably because of the low dose (8 mCi) given to me.

Does destroying the thyroid cause antibodies?

Destroying the thyroid gland may have no effect on the Graves’ antibodies, since white blood cells produce the antibodies, not the thyroid gland. In a few unfortunate patients, RAI may actually increase the antibodies and worsen or induce thyroid eye disease, which can be painful and disfiguring. [2] .

Abstract

To evaluate the success rate of therapeutic administration of a single calculated 131 I activity for eliminating hyperthyroidism due to Graves’ disease.

Introduction

Hyperthyroidism affects 0.5% of the population in the USA, with female preponderance (F5–10:M1) peaking between 40 and 60 years [ 1 ].

Methods and materials

We reviewed clinical records and collected data on consecutive hyperthyroid patients referred between 1990 and 1998 to the University of Michigan Nuclear Medicine Therapy Clinic for radioactive iodine (RAI) thyroid gland ablation procedure for definitive treatment of hyperthyroidism.

Results

Over a nine-year interval 316 patients (mean age 42.1 ± 16 y, range 4 to 94) were treated with RAI for hyperthyroidism due to Graves’ disease. The group was comprised of 238 (75.3%) women and 78 (24.6%) men, including 20 pediatric patients < 18 years old at diagnosis.

Discussion

Many endocrinologists prefer an ablative dose of radioactive iodine to treat Graves’ hyperthyroidism. Doses of 131 I in the range of 0.15–0.2 mCi per gram of thyroid tissue produce quicker resolution of hyperthyroidism than smaller dose therapies, lessening morbidity related to hyperthyroidism [ 7 ].

Conclusion

Using calculations of dose of RAI based upon thyroid gland size and correcting for radioiodine uptake, successful treatment with a single dose of RAI can be achieved with a 7% first therapy failure rate, with few patients requiring additional doses of RAI.

Author information

Nuclear Medicine/Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5028, USA

Why is iodine important for the thyroid gland?

Iodine is essential for proper function of the thyroid gland, which use s it to make the thyroid hormones. The thyroid is equipped with an active system or “pump” for moving iodine into its cells, where it is concentrated as iodide. The thyroid gland is the only tissue in the body that takes up and holds onto iodine.

What is iodine used for?

Iodine, in the form of iodide, is made into two radioactive forms of iodine that are commonly used in patients with thyroid diseases: I-123 ( harmless to thyroid cells) and I-131 ( destroys thyroid cells ). The radiation emitted by each of these forms of iodine can be detected from outside the patient to gain information about thyroid function ...

What is the I-123 isotope used for?

I-123 is the usual isotope used to take pictures and determine the activity of the intact thyroid gland ( Thyroid Scan and Radioactive Iodine Uptake, RAIU ), since it is harmless to thyroid cells. No special radiation precautions are necessary after a thyroid scan or RAIU using I-123. I-131 can also be used to take pictures of the thyroid gland, ...

What is the purpose of I-131?

THYROID CANCER – Large doses of I-131 are used to destroy thyroid cancer cells (see Thyroid Cancer brochure ). This is performed after the remaining thyroid cells ( including any cancer cells) are stimulated by raising TSH levels by either withdrawing the thyroid hormone pills or by treating with recombinant human TSH.

Is rai safe for X-rays?

RAI is safe to use in individuals who have had allergic reactions to seafood or X-ray contrast agents, since the reaction is to the compound containing io dine, not the iodine itself. RAI is given by mouth in pill or liquid form.

When can you stop breast feeding after I-131?

This protects the baby who would otherwise receive radioactive milk and the mother’s breasts which concentrate RAI. Breastfeeding must be stopped at least 6 weeks before administration of I-131 treatment and should not be restarted after administration of RAI, but can be safely done after future pregnancies.

Can RAI cause thyroid cancer?

Hypothyroidism is a common side effect of RAI for hyperthyroidism and always seen after RAI for thyroid cancer. This is usually easily treated with thyroid hormone replacement (see Hypothyroidism brochure ). Some studies suggest a slight increase in thyroid cancers may be seen after RAI treatment for hyperthyroidism.

How long can you live after iodine treatment?

You can expect to live a fairly normal life after radioactive iodine treatment but your life will probably not be exactly as it was before your procedure. For most people, this means that you can expect to live at 80-90% of your 'normal'.

What happens if you destroy your thyroid gland?

And, if you destroy your thyroid gland, it turns out that that may have consequences on your metabolism. Anectodally, you've probably already heard stories about people gaining weight after their procedure.

How long does radioactive iodine affect sperm count?

Important to men is the fact that radioactive iodine can cause short-term reductions in sperm count for up to 2 years after your procedure (8). This may or may not be important to you based on your age, your gender, and whether or not fertility is something you are interested in but, again, it's worth knowing about.

How to avoid weight gain after RAI?

Your best bet to AVOID weight gain after RAI is to go into your procedure with a normal weight and to maintain a healthy lifestyle both before and after. Just realize that you will always be in a 'sensitive' category and you will be more likely to gain weight compared to people with their thyroid intact. #3.

How long does it take for a RAI to fade?

The good news is that this radioactivity does fade over a short period of time (usually 5 to 7 days) but the bad news is that you need to stay under certain precautions during this time.

Can you survive after RAI?

You can obviously survive after RAI (otherwise they wouldn't do the procedure) but I want to teach you how to thrive afterward. And to key to getting there is to understand what happens to your body after this procedure and how it influences your thyroid function.

Can you take a thyroid pill every day?

There's no way for doctors to give you a pill once a day and for that pill to perform the exact same function that your thyroid gland does every minute of every day. Because of this, people may experience symptoms which may lead them to want to restore whatever thyroid function they can.