Physical and radiobiological bases of the use of125I in the management of thyrotoxicosis

Increasing interest is recently shown in the use of¹²⁵I as an alternative isotope to¹³¹I for the management of thyrotoxicosis based on the postulate that there is a relative sparing of the reproductive integrity of the thyroid follicular cell and a consequent possibility of smaller incidence of hypothyroidism after therapy. A review of the dosimetric, radiobiological and clinical aspects of the use of¹²⁵I are presented here.For the same activity though¹²⁵I gives smaller mean glanddose than¹³¹I, the dose computations at microscopic level have revealed that there is a preferential irradiation of the apical membrane compared to the nucleus of the follicular cell. The ratio of the dose to the apical membrane and that to the nucleus increases with the decrease of the percentage colloid mass of the gland. Radiobiological significance of this non-uniform dose distribution across a follicular cell, with¹²⁵I, is brought out using rat thyroid as the biological system. For the same mean gland dose the follicular cell survival is larger with¹²⁵I than with¹³¹I. 24 h radioiodine uptake is reduced in case of¹²⁵I treatment whereas it is not affected with¹²⁵I. Pilot clinical trials using¹²⁵I for the management of thyrotoxicosis are underway in some centres. Preliminary results from centres using doses 3–4 times that of the conventional¹³¹I dose are not very different from those with conventional¹³¹I therapy. Centres that used doses same as or less than the conventional¹³¹I doses, reported smaller incidence of hypothyroidism.Alexander von Humboldt Fellow in Klinikum Steglitz, Berlin