Analysis of influencing factors of recurrence after administration of iodine 131 in patients with hyperthyroidism

Li Yubin; Zhang Qizhou; Xie Bin; Ba Ya; Li Xiaohong

doi:10.3969/j.issn.1671-6450.2025.01.012

Abstract：Objective To investigate the determinants of relapse among individuals with hyperthyroidism(GD)fol-lowing their initial iodine-131(131I)treatment.Methods A total of 211 patients diagnosed with GD who underwent 131I treatment at the Department of Nuclear Medicine,the First Affiliated Hospital of Xinjiang Medical University,between May 2022 and May 2023 were included in this study.Based on their post-treatment recurrence status,the patients were catego-rized into two groups:those without recurrence(189 cases)and those with recurrence(22 cases).Various thyroid hormone levels including free triiodothyronine(FT3),free thyroxine(FT4),thyroid-stimulating hormone(TSH),anti-thyroglobulin anti-body(TGAb),anti-thyroid peroxidase antibody(TPOAb),and thyroid-stimulating hormone receptor antibody(TRAb)were assessed.The correlation between these markers and the recurrence of GD following 131I treatment was examined using Spearman correlation analysis.Additionally,multivariate logistic regression analysis was performed to identify the factors in-fluencing the recurrence of GD post 131I treatment.Results The recurrence group exhibited elevated levels of serum FT3,FT4,and TRAb compared to the non-recurrence group,while displaying a lower serum TSH level(t/P=5.726/＜0.001,6.541/＜0.001,6.904/＜0.001,5.898/＜0.001).Similarly,the 24-hour uptake rate of 131 I and the cumulative total dose of 131I were higher in the recurrence group than in the non-recurrence group(t/P=4.668/＜0.001,5.724/＜0.001).According to Spearman correlation analysis,the recurrence following initial GD treatment with 131I was positively associated with disease duration,thyroid Ⅲ degree enlargement,family history of thyroid disease,elevated levels of FT3,FT4,TRAb,24-hour uptake rate of 131I,and cumulative total dose of 131I(r/P=0.221/0.001,0.137/0.046,0.135/0.05,0.312/＜0.001,0.322/＜0.001,0.313/＜0.001,0.306/＜0.001,0.333/＜0.001),and negatively correlated with TSH levels(r/P=-0.387/＜0.001).Additionally,the multivariate logistic regression analysis indicated that elevated FT3,increased FT4,higher TRAb levels,and greater 24-hour uptake rate of 131I were independent risk factors for recurrence post initial GD treatment with 131I[OR(95％CI)=1.193(1.069-1.636),1.586(1.121-2244),1.944(1.136-3.326),1.817(1.196-2.760)].Conclusion It is crucial to consider the pre-treatment levels of thyroid hormones and the sensitivity to 131I as significant elements influencing the likelihood of recurrence in patients re-ceiving initial thyroid treatment.Adjusting the treatment dosage promptly and closely monitoring fluctuations in thyroid hor-mone levels are essential for ensuring the enduring therapeutic efficacy of 131I in these patients.