title: The relationship between 24 h/4 h radioiodine-131 uptake ratio and outcome after radioiodine therapy in 1402 patients with solitary autonomously functioning thyroid nodules.
abstract: OBJECTIVE
  To evaluate the role of 24 h/4 h uptake ratio (UR) in response to radioiodine-131 ((131)I) therapy in patients with autonomously functioning thyroid nodules (AFTN).
  
  
  METHODS
  A total of 1402 consecutive hyperthyroid patients were treated with (131)I, between 1958 and 2005. Therapeutic doses (D) were calculated according to the formula: D = weight of nodule x dose per gram of nodular tissue (q)/24 h (131)I uptake. The ratios of the 24 and 4 h uptake were retrospectively calculated and the patients were grouped according to outcome and q into three groups of UR (< or =1.25; 1.26-1.68; > or =1.69) by means of terziles.
  
  
  RESULTS
  Of the 1402 patients, 95 did not respond to (131)I treatment while 93/1307 developed hypothyroidism. Most non-responders (55.8%) had UR < or =1.25, while many hypothyroid patients (66.7%) had UR > or =1.69 (chi (2): P < 0.001). As q increased, the proportion of successfully treated patients increased (level of significance) only in the group with UR < or =1.25; while in the other two terziles, with increasing dose per gram of nodular tissue, the number of successfully treated patients did not increase (level of significance). The cumulative incidence of hypothyroidism was 2.2% at the 1st year after (131)I treatment, increasing to 13.9% at 5 years and 26.2% at 10 years.
  
  
  CONCLUSIONS
  The (131)I UR can predict the outcome of (131)I treatment in AFTN and may have utility in modifying treatment in some patients to limit post-radioiodine induced hypothyroidism and treatment failures in order to achieve euthyroidism.
authors.affiliation: Department of Clinical Sciences, Nuclear Medicine, Policlinico Umberto I, 'La Sapienza' University, Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Filesi
authors.forename: Laura
authors.initials: L
authors.lastname: Travascio
authors.forename: Teresa
authors.initials: T
authors.lastname: Montesano
authors.forename: Angelo D
authors.initials: AD
authors.lastname: Di Nicola
authors.forename: Marzia
authors.initials: M
authors.lastname: Colandrea
authors.forename: Fabio
authors.initials: F
authors.lastname: Ugolini
authors.forename: Rocco
authors.initials: R
authors.lastname: Bruno
authors.forename: Milton D
authors.initials: MD
authors.lastname: Gross
authors.forename: Annarita
authors.initials: A
authors.lastname: Vestri
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ronga