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Optimal Iodine-131 Dose for Eliminating Hyperthyroidism in Graves' Disease

Department of Nuclear Medicine, Straub Clinic & Hospital; and John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii

Correspondence: For reprints contact: Robert A. Nordyke, MD, Straub Clinic & Hospital, 888 So. King St., Honolulu, HI 96813.

ABSTRACT

Since hypothyroidism is commonplace after treatment of Graves' disease with radioiodine, the goal should be cure of hyperthyroidism rather than avoidance of hypothyroidism. To find the optimal dose to accomplish cure, we treated 605 patients with stepwise increasing doses of 3, 4, 5, 6, 8, and 10 mCi, analyzing the relationship of dose, age, sex, gland weight, and thyroidal uptake to cure. Estimates of cure at doses above 10 mCi were made from the literature. Cure was directly related to dose between 5 and 10 mCi. There was no significant relationship between cure and age (chi-square, p = 0.74), sex (chi-square, p = 0.12), and 24-hr uptake if over 30% (chi-square for slope, p > 0.10). Cure and gland weight had an inverse relationship (chi-square for slope, 0.01 < p < 0.02). We concluded that the optimal ¹³¹I dose for curing hyperthyroidism is approximated by starting with 10 mCi and increasing it for unusually large glands or for special patient circumstances.

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