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Objective <p>Surgery is recommended over radioactive iodine-131 therapy (RIT) for Graves’ hyperthyroidism (GH) with large goiter (LG, thyroid volume [TV] ≥ 80 mL). Historically, inaccurate volumetry and insufficient activity yielded low success rates. We aimed to evaluate the efficacy and safety of magnetic resonance imaging (MRI)-guided calculated-activity RIT in LG versus non-LG patients and to identify RIT failure risk factors.</p> Methods <p>GH patients receiving calculated-activity RIT (July 2017 to September 2024) were included, excluding those with prior RIT or incomplete data. TV was measured on MRI. Success included overt/subclinical hypothyroidism, euthyroidism, or subclinical hyperthyroidism. Failure included repeat RIT, surgery, or overt hyperthyroidism. Follow-ups ended at second RIT, surgery or March 2025. Risk factors for RIT failure were identified through Firth’s penalized logistic regression and least absolute shrinkage and selection operator.</p> Results <p>Among 181 patients with GH (mean age, 37.5 ± 13.7 years, 48 men), 33 had LG (mean TV, 146.6 mL). Minor adverse events were observed in LG patients (head-neck swelling [6.1%], exophthalmos progression [3.0%] and new-onset [3.0%]). Success rates were similar (LG 84.8% vs. non-LG 91.9%; <i>P</i> = .36), with universal goiter reduction. Planned activity-to-TV ratio (PA/TV) (odds ratio [OR], 0.68; 95% CI, 0.45–0.94; <i>P</i> = .02), and age (OR, 1.05; 95% CI, 1.01–1.10; <i>P</i> = .01) predicted RIT failure. Planned activity increased with TV in RIT success patients.</p> Conclusions <p>With mild adverse events, MRI-guided calculated-activity RIT achieved comparable success in LG and non-LG GH patients. Insufficient PA/TV, but not TV itself, was associated with RIT failure.</p>

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Outcome of MRI-Guided Single-Dose Iodine-131 for Graves’ Hyperthyroidism with Large Goiter

  • 期刊论文

  • 发表日期：

    2026年2月18日

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  • Shangcheng Yan,
  • Xiansheng Chen,
  • Bing Yan,
  • Xin Li,
  • Zhen Cao,
  • Pan Zhang,
  • Yajun Wang,
  • Wenmei Guo,
  • Ziwen Liu

摘要

Objective

Surgery is recommended over radioactive iodine-131 therapy (RIT) for Graves’ hyperthyroidism (GH) with large goiter (LG, thyroid volume [TV] ≥ 80 mL). Historically, inaccurate volumetry and insufficient activity yielded low success rates. We aimed to evaluate the efficacy and safety of magnetic resonance imaging (MRI)-guided calculated-activity RIT in LG versus non-LG patients and to identify RIT failure risk factors.

Methods

GH patients receiving calculated-activity RIT (July 2017 to September 2024) were included, excluding those with prior RIT or incomplete data. TV was measured on MRI. Success included overt/subclinical hypothyroidism, euthyroidism, or subclinical hyperthyroidism. Failure included repeat RIT, surgery, or overt hyperthyroidism. Follow-ups ended at second RIT, surgery or March 2025. Risk factors for RIT failure were identified through Firth’s penalized logistic regression and least absolute shrinkage and selection operator.

Results

Among 181 patients with GH (mean age, 37.5 ± 13.7 years, 48 men), 33 had LG (mean TV, 146.6 mL). Minor adverse events were observed in LG patients (head-neck swelling [6.1%], exophthalmos progression [3.0%] and new-onset [3.0%]). Success rates were similar (LG 84.8% vs. non-LG 91.9%; P = .36), with universal goiter reduction. Planned activity-to-TV ratio (PA/TV) (odds ratio [OR], 0.68; 95% CI, 0.45–0.94; P = .02), and age (OR, 1.05; 95% CI, 1.01–1.10; P = .01) predicted RIT failure. Planned activity increased with TV in RIT success patients.

Conclusions

With mild adverse events, MRI-guided calculated-activity RIT achieved comparable success in LG and non-LG GH patients. Insufficient PA/TV, but not TV itself, was associated with RIT failure.