RAI THERAPY DURING KIDNEY DIALYSIS

RAI THERAPY DURING KIDNEY DIALYSIS

QUESTION-- I wanted to know your recommendations regarding dosing a patient with hyperthyroidism with radioactive iodine who has ESRD on hemodialysis 3 days a week. How much would you give and when should it be given in timing with dialysis? Should patient be dialyzed more frequently following treatment?
Gay M. Story, M.D., FACE
RESPONSE-There is only one report on radioiodine treatment for hyperfunctioning nodular goiter in a patient on dialysis. Larger experience is with thyroid cancer. In this context, RAI activity in the order of 100 mCi are safe. The dose must be administered soon after HD and the HD is repeated after  24, 48, 72 and 96 hours. In a patient with hyperthyroidism I would reduce the dose of RAI by 50% because the retention time will be longer and the renal clearance is of course reduced. Thus, if you use standard doses of 15 mCi (as in Italy), I would give 7-8 mCi. There should be no toic effects from radioiodine. Sincerely, Furio  Pacini MD