Treatment of Thyrotoxicosis Using Radioactive Iodine 131

Throtoxicosis is common in the Sudan, and its management constitute a significant health problem in terms of expenses, in addition to dilemma of best therapy between the physician's choice and the patients' reference. As the role of Radioactive lodine is becoming more acceptable. It is wise to evaluate our experience and compare it to the current literature, aiming to use the treatment more effectively in our setting. The objective is to evaluate the effectively of radioiodine and factors affecting them, and to find out the possible complications, and compare the cost of treatment to that of surgery and antithyroid drugs, as well as to find out the patient attitude and knowledge towards the treatment. 103 thyrotoxic patients referred to Radioisotope center and received Radioiodine therapy in the period between 1986-1997 were considered in the study. Those who received the treatment in 1997 were followed up prospectively for minimum of 12 months. Clinical feature, severity of the disease, size and type of goitre and complications were considered. Patients were treated as out patients and followed up in the referred clinic. 115 patients (88.5%) were female and 15(11.5%) were male. The mean age was (49±)10.7), the majority (43.9%) were fluocortolonum state and the least (1.5%) from Southern states. Most of the patients (58%) were referred from medical units in the hospitals, their mean thyroxine level (212.285±36.753) and mean weight (58.031±8.724)kg. (54.6%) had diffused goitre and 36% multinodular goitre and 9.2% had solitary nodule. 48.5% of the patients had moderate size goitre, 32.3% large size and 19.2% small size goitre. The main indication was replace after medical treatment (40%). Out of the 59 patients interviewed (77.9%) have no knowledge about the therapy, and (48.4%) accepted the treatment without difficulty. 22 patients presented with complications, and most of the complications were cardiac, heart failure with arrhythmia (50%) 15 patients had ophthalmopathy and they had variable response to treatment. (80.7%) of the patients showed clinical response within 6 months. 113 patients gained weight and all had reduction of thyroid size with (100%) disappearance among patients with solitary, and (91.7%) among those with diffused goitre. (23%) of the patients developed early complications. (50%) was transient worsening of the symptoms and (20%) was transient hypothyroidism. Recurrence was mainly seen among patients with diffused gotire (7.04%) and hypothyroidism was in (16.6%) among patients with diffused goitre, which from the highest percentage of hypothyroidism. There was no significant differences in treatment response in relation to initial thyroxine level and size of goitre, but the response was better among diffuse goitre and solitary nodule. Carcinoma of the thyroid and Leukaemia were not seen in our series, genetic effect and infertility were not considered in our study. Radioactive lodine is cheap, effective and safe with exception of hypothyroidism, there was not other significant complication. Excluding children and pregnant women, it can be used in all patients and as a first line in elderly and patients with complications.(Author)