COMPARISON OF RADIOACTIVE IODINATED SERUM ALBUMIN (RISA) AND RADIOACTIVE MERCURY-203 FOR BRAIN SCANNING.
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We compared the 24-hour uptake of radioactive iodine (RAIU) in hyperthyroid patients diagnosed from 1970 to 1972 (Group A) and from 1975 to 1976 (Group B). Mean RAIU values in Group B decreased from those in Group A. In 1969 we lowered the normal range for the RAIU test to 0% to 24%, and used the new range for the diagnosis of hyperthyroidism in both groups of patients. The RAIU in Group B is within normal limits in 14% of the patients with Graves' disease and 80% of the patients with toxic nodular goiter (TNG). This study demonstrates that in our geographic area, the 24-hour RAIU has become a poor test for the diagnosis of hyperthyroidism, particularly TNG. However, the test should be performed before radioactive iodine therapy because it is necessary in calculating the therapeutic dose.
Amiodarone use in the United States is increasing including a role in advanced cardiac life support protocols. There has been a significant increase in hypothyroidism, destructive thyroiditis (type II), and iodine-induced thyrotoxicosis (type I) with amiodarone. Preexisting thyroid disease and status of iodine intake can determine the nature of iodine-induced thyroid disease. Treating amiodarone-induced thyrotoxicosis (AIT) may include traditional antithyroid agents, glucocorticoids, and surgery. Usually, it is assumed the radioactive iodine uptake (RAIU) will be low, and this choice as a treatment modality is excluded at the initial visit. We report a satisfactory outcome in a patient with AIT using radioactive iodine. The role of radioactive iodine in treating AIT is reviewed
Graves' disease is the most common form of hyperthyroidism in childhood. Current treatment options include antithyroid medications, surgery, and radioactive iodine. Medical therapy is generally associated with long-term remission rates of less than 25% and a small risk of serious adverse reactions that include hepatic failure and bone marrow suppression. Total thyroidectomy is associated with very high cure rates and a small risk of hypoparathyroidism and recurrent laryngeal nerve damage. When radioactive iodine is used at appropriate doses, there is a very high cure rate without increased risks of thyroid cancer or genetic damage. Because of the theoretical risk of thyroid cancer after thyroid irradiation in individuals less than 20 years of age, relatively high doses of radioactive iodine should be administered to minimize residual thyroid tissue.
Two patients had hyperthyroidism secondary to functioning metastatic follicular thyroid carcinoma. Failure to control the thyrotoxic state with antithyroid drugs in one patient prior to treatment with radioactive iodine led to exacerbation of the thyrotoxicosis with thyroid storm and death. A second patient, in whom a euthyroid state was induced before radioactive iodine therapy, had a benign posttreatment course. Radioactive iodine therapy of functioning metastatic thyroid carcinoma should be administered with caution and only after adequate preparation of the elderly patient with cardiovascular disease.
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