Radioactive iodine ablation therapy: a viable option in the management of graves' disease in Nigeria

Abstract

Background: Graves' disease is an autoimmune disorder characterized by hyperthyroidism and associated features. Management of this disease condition for many decades has been largely by surgical and medical intervention. Usage of anti thyroid medication ameliorates the symptoms and effects of excessive production of thyroid hormones. Recently in Nigeria, Nuclear medicine facility became available with the option radioiodine ablative therapy for the management of Graves disease. This study highlights the benefits of radioiodine therapy against the background of equally viable medical and surgical practice. Patients material and method All the 36 patients seen from the inception of Nuclear Medicine facility at the University College Hospital from June 2006 to May 2010 were included in this study. Sources of referral were compiled. All the patients were on anti thyroid medication at presentation. Thyroid scan was performed by Siemens E- cam gamma camera 20 minutes after intravenous injection of 3-5mCi of Tc-99m Pertechnetate. The patients with "diffuse toxic goiter" on thyroid scan were given l0mCi of Iodine-131 orally and discharged home with radiosafety precautions. Most of the patients were treated 5 days post discontinuation of antithyroid medication. The patients were followed up monthly with thyroid function tests to determine commencement of replacement therapy. Result: Peak incidence of Graves' disease was at 6th decade (38.9%) of all patients studied. This disease was commoner in women with a ratio of 8 to 1. Ten (27.8%) patients became hypothyroid at the 3rd month post radioactive iodine -131 treatment, while the remaining 20(55.6%) patients became hypothyroid at the 5"' month. Six patients were lost to follow up. There was no recurrence of hyperthyroidism in all patients treated Twenty eight (93.3%) patients were maintained on l00mcg of levo-thyroxine daily, while 2(6.7%) patients had more than l00mcg of levo- thyroxine daily as maintenance dose. Conclusion: Radioactive iodine therapy presents a safe and effective alternative to the older conventional mode of management of Graves' disease