Radiotherapy with radioactive iodine-131 (RAI) has been used to treat benign thyroid diseases for over 50 years (1). Diseases of thyroid hyperfunction that can be treated with RAI include Graves' disease (GD), solitary hyperfunctioning nodule, and toxic multinodular goiter. RAI may also benefit patients with sub-clinical hyperthyroidism, particularly patients at risk for cardiac or systemic complications. RAI is used less frequently for the treatment of euthyroid goiters. The information in this chapter pertains only to the use of RAI in doses that are typical for the treatment of benign thyroid disease. Information regarding the use of RAI for malignant thyroid disease is available in Chapter 5.

The preferred method for treating hyperthyroidism varies in different countries. In a survey of American Thyroid Association (ATA), European Thyroid Association (ETA), and Japanese Thyroid Association (JTA) members,

69%, 22%, and 11% of respondents, respectively, chose RAI as the therapy of choice for an index patient with GD (2). In the same survey, antithyroid drugs were regarded as initial therapy in 30.5%, 77%, and 88% of ATA, ETA, and JTA respondents, respectively. Such variation likely stem from differences in perceived risks of prescribing radioactive treatments, differences in cost, local requirements for hospitalization during treatment, patient compliance, response to antithyroid medications, and natural history of autoimmune thyroid disease in different populations. Differences in dietary iodine content may also significantly affect treatment response in various populations (3).

Most jurisdictions have specific regulations for possession and use of iodine-131 and other radionuclides. Physicians who use radioisotopes must be knowledgeable and in compliance with all applicable laws. Therapeutic decisions should always be made with consideration for the population from which the patient originates and to local standards of practice.

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