Thesis (MSc (Medical Imaging and Clinical Oncology. Nuclear Medicine))--University of Stellenbosch, 2009. / 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.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/4030 |
| Date | 03 1900 |
| Creators | Onimode, Yetunde Ajoke |
| Contributors | Ellmann, Annare, Korowlay, Nisaar, University of Stellenbosch. Faculty of Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine. |
| Publisher | Stellenbosch : University of Stellenbosch |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | 53 p. |
| Rights | University of Stellenbosch |
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