When and How to Use Higher131I Doses for Hyperthyroidism

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Abstract
Of 356 131I-treated hyperthyroid patients, 54 were selected for higher doses (20 to 100 mCi) because of heart disease, toxic nodular goiter or massive toxic diffuse goiter. Two euthyroid patients with progressive infiltrative ophthalmopathy and nonsuppressible function after previous surgery were also treated. Measures to protect heart patients from 131I-induced thyroxine discharge included adjustment of cardiac medications, reserpine, antithyroid drug pretreatment and hospitalization. Hypothyroidism was anticipated in patients with toxic diffuse goiter, and substitution therapy administered promptly. No adverse reactions occurred. Hyperthyroidism was controlled with one 131I dose in all but two patients, who required two. Hypothyroidism occurred in two of 36 patients with toxic nodular goiter, and 17 of 19 with toxic diffuse goiter. The euthroid state was achieved in one to three months in 51 patients and within six months in two. With proper pretherapy large doses of 131I may safely be administered to hyperthyroid patients, even with complicating heart disease.

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