Outcome and incidence of hypothyroidism in low-dose radioactive iodine treatment for hyperthyroidism | Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)

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Hyperuptake of [18F]F-FDG in lower mid-apical segments and apex of LV which is thickened on CMR (A), with active focus on the anterior wall of the right ventricle, with slight thickening on CMR (B) and hyperuptake of the tracer in the left appendage, without practical translation in CMR (C). Axial PET/MR fusion images and axial CMR black blood sequences. Hyperuptake of [18F]F-FDG in lower mid-apical segments and apex of LV wich is thickened on CMR (A), with active focus on the anterior wall of the right ventricle, with slight thickening on CMR (B) and hyperuptake of the tracer in the left appendage, without practical translation in CMR (C)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.R. Garcia, R. Olivero, M. Panelo, L. Mont, L. Pinilla, M.E. Riera, A. Maceira" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J.R." "apellidos" => "Garcia" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Olivero" ] 2 => array:2 [ "nombre" => "M." 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For the 47 patients who eventually developed hypothyroidism, 47% experienced it within six months, and 60% within twelve months. The cumulative incidence over time exhibited a slowly rising curve with a high starting percentage." ] ] ] "textoCompleto" => "IntroductionRadioactive iodine (RAI) has been used to treat hyperthyroidism for decades. Despite its widespread use, standardization of dosimetry remains elusive, leading to variations in the determination of administered activity, whether through calculated or fixed dosing approaches.<a class="elsevierStyleCrossRefs" href="#bib0005">1–5</a> The calculated method involves intricate considerations such as thyroid volume, desired radiation dosage, radioiodine uptake measurement, and the biological half-life of radioiodine within the thyroid gland, all of which can exhibit considerable variability. Conversely, the fixed dose approach is simple and relies on empirical evidence, with some studies suggesting comparable or superior efficacy to the calculated method.<a class="elsevierStyleCrossRefs" href="#bib0030">6–8</a> However, even with fixed dosing, there exists no universally optimal dose for individual patients. While higher doses may increase hyperthyroidism cure rates, they also elevate the risk of hypothyroidism. Long-term follow-up studies have revealed significant incidences of hypothyroidism up to 82% post-RAI treatment.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> In our institution, a preference for low doses (<370 Mbq) aims to mitigate hypothyroidism risks, yet limited statistical data and disparities in available information persist regarding hypothyroidism incidence post-RAI. This study aims to determine the response rates and hypothyroidism incidences following low-dose RAI, as well as associated potential risk factors and onset time of hypothyroidism.Materials and methodsPatientsA retrospective review was conducted on clinical records of patients receiving RAI with doses less than 370 Mbq for hyperthyroidism at the Department of Nuclear Medicine, Mackay Memorial Hospital, between May 2008 and November 2016. According to literatures, RAI below 370 Mbq was defined as low-dose in our study. Patients for first time RAI with a follow-up period of at least two years unless hyperthyroidism or permanent hypothyroidism developed were included in the study. There were 210 person-time treatments during the study period and after excluding 47 patients not for first time RAI and five patients who had not enough follow-up time period, a total of 158 patients were enrolled in this study. Among them, 45 (28.5%) were male and 113 (71.5%) were female. The doses received ranged from 111 Mbq to 296 Mbq (216.1 ± 40.3 Mbq), and the age ranged from 21 to 74 years old. Patient characteristics were shown is <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>MethodsIn order to compare treatment outcome and incidence of hypothyroidism, patients were further grouped based on sex, age and doses. The higher age group consists of 77 (45%) patients 45 years old or above while the lower age group consists of 81 (55%) patients under 45 years old. Thirty-nine patients who received 222 Mbq or more RAI (239.4 ± 30.3 Mbq) were classified into high dose group and 119 patients who received less than 222 Mbq (160.2 ± 33.3 Mbq) RAI were classified into low dose group. Treatment outcome and incidence of hypothyroidism were compared between different gender, age and dose groups. In those becoming hypothyroid, time to develop hypothyroidism was calculated for the cumulative incidences over time, presented by cumulative percentage for every six months interval from treatment.Radioiodine treatmentThe doses delivered to the patients were determined by the referring physician or nuclear medicine doctor, using empirical fixed dose method. The dose chosen was based on the patient’s status of hyperthyroidism, radiation safety issue and personal preference after thorough discussion with the patient. Patients were asked to discontinue use of iodide-containing preparations and medications, including antithyroid medications, multivitamins containing iodide and amiodarone, that could potentially affect the ability of the thyroid tissue to accumulate iodide. Patients were also asked to take low-iodine diet for seven days before therapy. Iodine-containing radiographic contrast agents were strictly prohibited within one month before therapy.Outcomes assessmentTreatment outcomes were categorized into post-treatment hypothyroidism, treatment failure (persistent hyperthyroidism), and euthyroidism. Hypothyroidism and euthyroidism post-treatment were considered treatment responses. Onset of hypothyroidism was determined by the earliest recorded elevated abnormal TSH level or initiation of levothyroxine treatment, combined with a diagnosis at least six months post-treatment to exclude transient hypothyroidism.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Patients with persistent hyperthyroidism or normal TSH levels without levothyroxine supplementation were deemed treatment failures or euthyroid, respectively.Ethical statementThe ethical, methodological, and protocol aspects of this investigation were approved by the MacKay Memorial Hospital Institutional Review Board (IRB Number: 23MMHIS405e).Statistical analysisQuantitative data (age, dose, time) were presented as mean ± SD. The chi-square test assessed differences between categorical variables (e.g., gender, dose, age). P-values <0.05 were considered statistically significant. Statistical analysis was performed using Libraoffice software (The document Foundation, version 7.3.4.2, Berlin, Germany) and IBM SPSS software (IBM Corp., version 21, Armonk, New York, USA).ResultsAmong the 158 patients, 47 (29.7%) developed hypothyroidism, 101 (63.9%) experienced treatment failure, and 10 (6.3%) remained euthyroid post-treatment. In the higher dose group, 22 (56.4%) had treatment failure and 15 (38.5%) became hypothyroidism, while in the lower dose group, 79 patients (66.4%) had treatment failure and 32 (26.9%) became hypothyroidism. The differences between the two groups were not significant, either in response rate (33.6% vs. 43.5%, p = 0.260) or incidence of hypothyroidism (26.9% vs. 38.5%, p = 0.170).Similarly, age subgroups (≥45 vs. < 45 years) showed no significant differences in response rates (37.7% vs. 34.6%, p = 0.69) or hypothyroidism incidence (28.6% vs. 30.9%, p = 0.75). Females exhibited higher response rates (42.5% vs. 20.0%, p = 0.008) and hypothyroidism incidence (46.3% vs. 13.3%, p = 0.004) compared to males (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Among patients developing hypothyroidism, onset occurred at a mean of 24.0 ± 29.2 months, with a median of 8 months. Cumulative incidences over time in six and twelve months post-treatment were 47% and 60%, respectively (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionThe fixed doses of radioactive iodine (RAI) utilized in various studies have ranged from as low as 111 Mbq<a class="elsevierStyleCrossRef" href="#bib0025">5</a> to as high as 1480 Mbq,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> with Iagraru recommending an appropriate dosage of 370–555 Mbq.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> It's evident from studies that higher doses correlate with higher response rates for hyperthyroidism. For instance, Allahabadia et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> and Esfahani et al.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> studies respectively showed response rates of 66.6% versus 84.6% and 48.5% versus 88.5% when comparing 185 Mbq to 370 Mbq doses. Pusuwan et al. study<a class="elsevierStyleCrossRef" href="#bib0075">15</a> demonstrated rates of 52% versus 70% with 296 Mbq versus 377 Mbq, while Boelaert et al. study<a class="elsevierStyleCrossRef" href="#bib0080">16</a> showed rates of 63% versus 74.9% versus 84.1% with 185 Mbq, 370 Mbq, and 555 Mbq, respectively. Similarly, Husseni et al. study<a class="elsevierStyleCrossRef" href="#bib0085">17</a> exhibited rates of 41.6% versus 68.0% with 370 Mbq versus 555 Mbq. A systematic review and meta-analysis highlighted that patients treated with a fixed high dose had an 18.1% higher cure rate (risk ratio = 1.2) compared to those treated with fixed low dose protocols.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> In our study, a mean dose of 214.6 Mbq was used, with an overall response rate of 36.1%, encompassing 29.7% hypothyroidism and 6.3% euthyroidism. Notably, the higher dose group exhibited a higher 43.5% response rate compared to a 33.6% response rate in the lower dose group, although this difference was not statistically significant, likely due to an insufficient dose separation (240.5 Mbq and 159.1 Mbq) between the two groups.Our observed response rate of 36.1% was notably lower than similar doses used in some previous studies. Several factors could influence the efficacy of RAI, including antithyroid medications, thyroid gland volume or weight, iodine uptake ratio, and the severity of hyperthyroidism. While we followed the Society of Nuclear Medicine and Molecular Imaging practice guideline<a class="elsevierStyleCrossRef" href="#bib0095">19</a> regarding dietary restrictions and medication cessation before RAI administration, patient compliance was not monitored closely. Moreover, although it’s been suggested that propylthiouracil may need to be discontinued for more than 55 days<a class="elsevierStyleCrossRef" href="#bib0100">20</a> while antithyroid medications should not restart within seven days,<a class="elsevierStyleCrossRef" href="#bib0105">21</a> we only asked the patients to discontinue antithyroid medications for seven days and resume them three days after RAI. Therefore, the treatment efficacy may not be optimal or as expected, resulting in the lower response rate.Regarding demographic factors, we found that females had a significantly higher response rate compared to males (42.5% vs. 13.3%, p < 0.01). This observation aligns with some previous studies indicating gender-based differences in response rates,<a class="elsevierStyleCrossRefs" href="#bib0065">13,22</a> though other studies opposed the differences.<a class="elsevierStyleCrossRefs" href="#bib0070">14,23–25</a> Similarly, some papers reported that age was not a predicting factor for treatment outcome,<a class="elsevierStyleCrossRefs" href="#bib0070">14,23–25</a> but some reported that younger people were more likely to present persistent hyperthyroidism after RAI therapy.<a class="elsevierStyleCrossRefs" href="#bib0065">13,22,26,27</a> We did not find a difference between our lower (<45 years old) and higher (≥45 years old) age groups, but when we moved the dividing age down to 30 years old, the difference became significant (p = 0.018). A greater resistance to radiation of younger thyroid tissue had been suggested by Ceccarelli et al.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> though Allahabadia considered that the difference between ages was attributed to a strong association with goiter and severity of hyperthyroidism.<a class="elsevierStyleCrossRefs" href="#bib0065">13,22</a>In terms of hypothyroidism incidence post-RAI, studies have shown a clear correlation with both the time elapsed post-RAI and the dosage administered. In Franklyn et al. study,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> the cumulative incidences of hypothyroidism were 18% at 5 years and 42% at 20 years after RAI. Similarly, in Ceccarelli et al. study,<a class="elsevierStyleCrossRef" href="#bib0140">28</a> 7.6%, 28%, 46%, and 60% of patients developed hypothyroidism at 1, 5, 10, and 20 years post-treatment. Metso et al.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> reported incidences of 24%, 59%, and 82% in Graves’ disease patients and 4%, 15%, and 32% in toxic multinodular goiter patients at 1, 10, and 25 years, respectively.In our study, the incidence of hypothyroidism was 29.7%. In those becoming hypothyroid, almost half of them (47%) occured within six months with the majority (60%) within one year after treatment. Though the cumulative incidence was expected to increase steadily over time, surprisingly, instead of a slow rise to the end, the curve showed a high percentage from the beginning (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). This finding suggested that hypothyroidism could manifest early after treatment even with low-dose RAI, and to our best knowledge, the finding was not found in the literature.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Higher doses of RAI have been associated with both a higher response rate and an increased incidence of hypothyroidism. Boelaert et al.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> reported incidences of hypothyroidism at 60.4%, 49.2%, and 38.1% when using doses of 600 MBq, 370 MBq, and 185 MBq of RAI, respectively. Similarly, Esfahani et al. study<a class="elsevierStyleCrossRef" href="#bib0070">14</a> showed incidences of 50.0% and 18.2% with doses of 370 Mbq and 185 Mbq, respectively. Husseni et al.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> and Rokni et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> reported similar findings, with an odds ratio of 2.95 for hypothyroidism with higher doses and a higher risk ratio for permanent hypothyroidism with fixed high doses, respectively. A study utilizing very low doses of RAI reported a hypothyroidism rate of 25% with a mean dose of 103.6 Mbq and a rate of 29% with a mean dose of 218.3 Mbq, with no significant difference between the two groups.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> Similarly, we did not find a significant difference between our higher dose group (mean: 240.5 Mbq) and the lower dose group (mean: 159.1 Mbq), likely due to an insufficient dose separation between the two groups.Besides the timing and dosage, several other factors may contribute to the development of hypothyroidism after RAI. As mentioned earlier, there was a higher cumulative incidence of hypothyroidism in Graves’ disease patients compared to those with toxic multinodular goiter, as shown in Metso et al. study.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Allahabadia also reported a higher incidence of hypothyroidism in Graves' disease patients compared to those with toxic nodular goiter (54.5% vs. 31.7%, P < 0.0001).<a class="elsevierStyleCrossRef" href="#bib0065">13</a> In addition, our study revealed a higher incidence of hypothyroidism in females than in males (46.3% vs. 13.3%, p < 0.001), as suggested by Boelaert et al. study,<a class="elsevierStyleCrossRef" href="#bib0080">16</a> which showed an adjusted odds ratio of 1.46 for females. The lower incidence of hypothyroidism in toxic nodular goiter patients after RAI might be attributed to the radiation being predominantly delivered to the toxic nodule, thereby sparing the normal thyroid tissues and preserving some thyroid function. However, the reason why females had a higher incidence of hypothyroidism after RAI remains unclear. The association between age and the incidence of hypothyroidism after RAI is controversial. No correlation was found between the development of hypothyroidism and age in Husseni et al. study<a class="elsevierStyleCrossRef" href="#bib0085">17</a> and ours, but a slightly increased incidence of hypothyroidism in younger age groups (adjusted odds ratio: 1.03) was reported in Boelaert et al. study,<a class="elsevierStyleCrossRef" href="#bib0080">16</a> while a higher incidence of hypothyroidism in individuals over 45 years old was reported in Ceccarelli et al. study.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>There were several limitations in our study. First, in our institution, only six patients were treated with 370 Mbq or higher RAI during the study period. Therefore, even the higher dose group in our study generally had lower doses than in other studies, and hence the difference between the higher and lower dose groups might not be distinguishable as both were in the low dose domain. Second, the etiology of hyperthyroidism, such as Graves’ disease or toxic nodule goiter, the volume of the thyroid gland, radioactive iodine uptake values, and the severity of hyperthyroidism, all of which may affect the response rate or incidence of hypothyroidism, could not be obtained from our database. Third, the duration of discontinuing propylthiouracil before RAI and the restart of antithyroid medications after RAI may not be long enough. Despite these limitations, we found that the response rate was lower in males and young people, as reported in some other studies, suggesting that the dose of RAI may need to be adjusted in these groups. Additionally, even with low doses, there was a significant incidence of hypothyroidism, and onset could occur early after treatment.In conclusion, while low-dose RAI treatment for hyperthyroidism aims to mitigate hypothyroidism risks, it concurrently diminishes treatment response rates and may not effectively prevent early onset of hypothyroidism. Gender and age also play significant roles in influencing treatment outcomes. Patients should be thoroughly informed about the potential risks of hypothyroidism and the likelihood of lower response rates associated with low-dose RAI. Physicians must engage in comprehensive discussions with patients to tailor treatment strategies, consider individual factors, and optimize dosage selection to achieve a better balance between therapeutic outcomes and adverse effects.Ethical statementThe ethical, methodological, and protocol aspects of this investigation were approved by the MacKay Memorial Hospital Institutional Review Board (IRB Number: 23MMHIS405e) on 2023/12/22." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2246542" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1878964" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2246541" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1878965" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Radioiodine treatment" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Outcomes assessment" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Ethical statement" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Ethical statement" ] 10 => array:2 [ "identificador" => "xack775110" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-04-29" "fechaAceptado" => "2024-08-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1878964" "palabras" => array:5 [ 0 => "Low-dose" 1 => "Radioactive iodine" 2 => "Outcome" 3 => "Hypothyroidism" 4 => "Hyperthyroidism" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1878965" "palabras" => array:5 [ 0 => "Baja dosis" 1 => "Yodo radioactivo" 2 => "Resultado" 3 => "Hipotiroidismo" 4 => "Hipertiroidismo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveThe study aimed to analyze the outcome of low-dose radioactive iodine (RAI) treatment for hyperthyroidism, disclose whether age and gender influence the outcome and determine the incidence and onset time of hypothyroidism following low-dose RAI. Material and methodsA total of 158 patients who received doses less than 370 Mbq RAI were enrolled in the study. Treatment outcome and incidence of hypothyroidism were compared between different gender (45 male vs.113 female), age (77 patients ≥45 years old vs. 81 patients <45 years old) and dose (39 patients receiving higher doses RAI vs. 119 receiving lower dose with a cutoff of 222 MBq) groups. Treatment outcomes were categorized into post-treatment hypothyroidism, treatment failure (persistent hyperthyroidism), and euthyroidism. In those becoming hypothyroid, time to develop hypothyroidism was calculated for cumulative incidences over time. ResultsOut of 158 patients, 47 (29.7%) developed hypothyroidism, 101 (63.9%) had treatment failure, and 10 (6.3%) remained euthyroid after treatment. Response rates (33.6% vs. 43.5%, p = 0.260) and hypothyroidism incidences (26.9% vs. 38.5%, p = 0.170) did not differ significantly between lower and higher dose groups, neither between lower and higher age groups (p = 0.69 in response rates and p = 0.75 in hypothyroidism incidence). Females exhibited higher response rates (42.5% vs. 20.0%, p = 0.008) and hypothyroidism incidence (46.3% vs. 13.3%, p = 0.004) compared to males. Hypothyroidism onset occurred at a mean of 24.0 ± 29.2 months, and the cumulative incidences over time were 47% and 60% in six and twelve months, respectively. ConclusionsLow-dose RAI has a low response rate for treating hyperthyroidism. Although there may be a lower incidence of hypothyroidism following low-dose RAI compared to high-dose RAI, hypothyroidism may occur early after treatment. Besides, females have higher response rates but more incidence of hypothyroidism. The balance between the risks and benefits of using low-dose RAI should be taken into deliberate consideration." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoEl estudio tuvo como objetivo analizar el resultado del tratamiento con yodo radioactivo de baja dosis (RAI) para el hipertiroidismo, revelar si la edad y el género influyen en el resultado, y determinar la incidencia y el tiempo de inicio del hipotiroidismo después del RAI de baja dosis. Material y métodosUn total de 158 pacientes que recibieron dosis menores de 370 Mbq de RAI fueron incluidos en el estudio. Los resultados del tratamiento y la incidencia de hipotiroidismo se compararon entre diferentes grupos de género (45 hombres vs. 113 mujeres), edad (77 pacientes ≥45 años vs. 81 pacientes <45 años) y dosis (39 pacientes que recibieron dosis más altas de RAI vs. 119 que recibieron dosis más bajas con un límite de 222 MBq). Los resultados del tratamiento se categorizaron en hipotiroidismo post-tratamiento, fracaso del tratamiento (hipertiroidismo persistente) y eutiroidismo. En aquellos que desarrollaron hipotiroidismo, se calculó el tiempo para desarrollar hipotiroidismo para las incidencias acumulativas a lo largo del tiempo. ResultadosDe los 158 pacientes, 47 (29.7%) desarrollaron hipotiroidismo, 101 (63.9%) tuvieron fracaso del tratamiento y 10 (6.3%) permanecieron eutiroideos después del tratamiento. Las tasas de respuesta (33.6% vs. 43.5%, p = 0.260) y las incidencias de hipotiroidismo (26.9% vs. 38.5%, p = 0.170) no difirieron significativamente entre los grupos de dosis más baja y más alta, ni entre los grupos de edad más baja y más alta (p = 0.69 en tasas de respuesta y p = 0.75 en incidencia de hipotiroidismo). Las mujeres exhibieron tasas de respuesta más altas (42.5% vs. 20.0%, p = 0.008) e incidencia de hipotiroidismo (46.3% vs. 13.3%, p = 0.004) en comparación con los hombres. El inicio del hipotiroidismo ocurrió a una media de 24.0 ± 29.2 meses, y las incidencias acumulativas a lo largo del tiempo fueron del 47% y 60% a los seis y doce meses, respectivamente. ConclusionesEl RAI de baja dosis tiene una baja tasa de respuesta para tratar el hipertiroidismo. Aunque puede haber una menor incidencia de hipotiroidismo después del RAI de baja dosis en comparación con el RAI de alta dosis, el hipotiroidismo puede ocurrir tempranamente después del tratamiento. Además, las mujeres tienen tasas de respuesta más altas pero mayor incidencia de hipotiroidismo. El equilibrio entre los riesgos y beneficios de utilizar RAI de baja dosis debe ser considerado cuidadosamente." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 906 "Ancho" => 1675 "Tamanyo" => 72124 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Cumulative incidence of hypothyroidism with time after RAI. For the 47 patients who eventually developed hypothyroidism, 47% experienced it within six months, and 60% within twelve months. The cumulative incidence over time exhibited a slowly rising curve with a high starting percentage." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Numbers (percentages) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (28.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">113 (71.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years old)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20∼29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (13.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30∼39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (27.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40∼49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (27.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50∼59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (19.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60∼69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (7.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70∼79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (3.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dose (Mbq)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">111 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (7.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">148 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (2.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">185 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (15.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">222 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">851 (53.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">240.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">259 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (17.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">296 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (3.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3660794.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patients characteristics." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hypothyroidism Numbers (percentages) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment failure Numbers (percentages) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Euthyroidism Numbers (percentages) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Overall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (29.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">101 (63.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (13.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (80%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (6.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (36.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 (57.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (6.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years old)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20∼29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (13.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (86.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30∼39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (38.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (56.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (4.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40∼49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (25.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (63.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (11.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50∼59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (25.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (67.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (6.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60∼69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (45.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (45.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (9.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70∼79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (50.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (50.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lower age group (<45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (30.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 (65.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3(3.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Higher age group (≥45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (28.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 (62.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (9.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dose</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lower dose group (111∼185 Mbq) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (26.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 (66.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (6.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Higher dose group (222∼296 Mbq) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (38.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (56.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (5.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3660792.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Treatment outcomes in different groups." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time (months) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Numbers (cumulative percentages) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lower dose group numbers (cumulative percentages) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Higher dose group numbers (cumulative percentages) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0∼6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (46.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (26.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (56.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6∼12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (59.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (53.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (62.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12∼18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (61.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (60.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (62.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18∼24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (63.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (62.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24∼30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (72.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (73.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (71.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30∼36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (74.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (73.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (75.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36∼42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (74.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (73.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (75.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42∼48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (80.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (80.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (81.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48∼54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (83.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (80.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (84.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54∼60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (85.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (80.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (87.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60∼66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (87.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (80.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (90.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66∼72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (91.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (86.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (93.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72∼78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (93.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (86.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (96.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78∼84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (93.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (86.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (96.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84∼90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (93.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (86.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (96.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90∼96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (97.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (93.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3660793.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Time to hypothyroidism developed." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "State of the art in nuclear medicine dose assessment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.G. 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Original Article

Outcome and incidence of hypothyroidism in low-dose radioactive iodine treatment for hyperthyroidism

Resultado e incidencia del hipotiroidismo en el tratamiento con yodo radioactivo de baja dosis para el hipertiroidismo

Ku-Hung Lina,

Corresponding author

b8401046@gmail.com

Corresponding author.

, Jiun-Chang Wub, Ming-Che Wua

a Department of Nuclear Medicine, Mackay Memorial Hospital, Taipei, Taiwan

b Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan

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        "titulo" => "Resultado e incidencia del hipotiroidismo en el tratamiento con yodo radioactivo de baja dosis para el hipertiroidismo"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cumulative incidence of hypothyroidism with time after RAI&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">For the 47 patients who eventually developed hypothyroidism&#44; 47&#37; experienced it within six months&#44; and 60&#37; within twelve months&#46; The cumulative incidence over time exhibited a slowly rising curve with a high starting percentage&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Radioactive iodine &#40;RAI&#41; has been used to treat hyperthyroidism for decades&#46; Despite its widespread use&#44; standardization of dosimetry remains elusive&#44; leading to variations in the determination of administered activity&#44; whether through calculated or fixed dosing approaches&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;5</span></a> The calculated method involves intricate considerations such as thyroid volume&#44; desired radiation dosage&#44; radioiodine uptake measurement&#44; and the biological half-life of radioiodine within the thyroid gland&#44; all of which can exhibit considerable variability&#46; Conversely&#44; the fixed dose approach is simple and relies on empirical evidence&#44; with some studies suggesting comparable or superior efficacy to the calculated method&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a> However&#44; even with fixed dosing&#44; there exists no universally optimal dose for individual patients&#46; While higher doses may increase hyperthyroidism cure rates&#44; they also elevate the risk of hypothyroidism&#46; Long-term follow-up studies have revealed significant incidences of hypothyroidism up to 82&#37; post-RAI treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> In our institution&#44; a preference for low doses &#40;&#60;370 Mbq&#41; aims to mitigate hypothyroidism risks&#44; yet limited statistical data and disparities in available information persist regarding hypothyroidism incidence post-RAI&#46; This study aims to determine the response rates and hypothyroidism incidences following low-dose RAI&#44; as well as associated potential risk factors and onset time of hypothyroidism&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0010" class="elsevierStylePara elsevierViewall">A retrospective review was conducted on clinical records of patients receiving RAI with doses less than 370 Mbq for hyperthyroidism at the Department of Nuclear Medicine&#44; Mackay Memorial Hospital&#44; between May 2008 and November 2016&#46; According to literatures&#44; RAI below 370 Mbq was defined as low-dose in our study&#46; Patients for first time RAI with a follow-up period of at least two years unless hyperthyroidism or permanent hypothyroidism developed were included in the study&#46; There were 210 person-time treatments during the study period and after excluding 47 patients not for first time RAI and five patients who had not enough follow-up time period&#44; a total of 158 patients were enrolled in this study&#46; Among them&#44; 45 &#40;28&#46;5&#37;&#41; were male and 113 &#40;71&#46;5&#37;&#41; were female&#46; The doses received ranged from 111 Mbq to 296 Mbq &#40;216&#46;1&#8239;&#177;&#8239;40&#46;3 Mbq&#41;&#44; and the age ranged from 21 to 74 years old&#46; Patient characteristics were shown is <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">In order to compare treatment outcome and incidence of hypothyroidism&#44; patients were further grouped based on sex&#44; age and doses&#46; The higher age group consists of 77 &#40;45&#37;&#41; patients 45 years old or above while the lower age group consists of 81 &#40;55&#37;&#41; patients under 45 years old&#46; Thirty-nine patients who received 222 Mbq or more RAI &#40;239&#46;4&#8239;&#177;&#8239;30&#46;3 Mbq&#41; were classified into high dose group and 119 patients who received less than 222 Mbq &#40;160&#46;2&#8239;&#177;&#8239;33&#46;3 Mbq&#41; RAI were classified into low dose group&#46; Treatment outcome and incidence of hypothyroidism were compared between different gender&#44; age and dose groups&#46; In those becoming hypothyroid&#44; time to develop hypothyroidism was calculated for the cumulative incidences over time&#44; presented by cumulative percentage for every six months interval from treatment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Radioiodine treatment</span><p id="par0020" class="elsevierStylePara elsevierViewall">The doses delivered to the patients were determined by the referring physician or nuclear medicine doctor&#44; using empirical fixed dose method&#46; The dose chosen was based on the patient&#8217;s status of hyperthyroidism&#44; radiation safety issue and personal preference after thorough discussion with the patient&#46; Patients were asked to discontinue use of iodide-containing preparations and medications&#44; including antithyroid medications&#44; multivitamins containing iodide and amiodarone&#44; that could potentially affect the ability of the thyroid tissue to accumulate iodide&#46; Patients were also asked to take low-iodine diet for seven days before therapy&#46; Iodine-containing radiographic contrast agents were strictly prohibited within one month before therapy&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Outcomes assessment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Treatment outcomes were categorized into post-treatment hypothyroidism&#44; treatment failure &#40;persistent hyperthyroidism&#41;&#44; and euthyroidism&#46; Hypothyroidism and euthyroidism post-treatment were considered treatment responses&#46; Onset of hypothyroidism was determined by the earliest recorded elevated abnormal TSH level or initiation of levothyroxine treatment&#44; combined with a diagnosis at least six months post-treatment to exclude transient hypothyroidism&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Patients with persistent hyperthyroidism or normal TSH levels without levothyroxine supplementation were deemed treatment failures or euthyroid&#44; respectively&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical statement</span><p id="par0030" class="elsevierStylePara elsevierViewall">The ethical&#44; methodological&#44; and protocol aspects of this investigation were approved by the MacKay Memorial Hospital Institutional Review Board &#40;IRB Number&#58; 23MMHIS405e&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Quantitative data &#40;age&#44; dose&#44; time&#41; were presented as mean&#8239;&#177;&#8239;SD&#46; The chi-square test assessed differences between categorical variables &#40;e&#46;g&#46;&#44; gender&#44; dose&#44; age&#41;&#46; P-values &#60;0&#46;05 were considered statistically significant&#46; Statistical analysis was performed using Libraoffice software &#40;The document Foundation&#44; version 7&#46;3&#46;4&#46;2&#44; Berlin&#44; Germany&#41; and IBM SPSS software &#40;IBM Corp&#46;&#44; version 21&#44; Armonk&#44; New York&#44; USA&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Among the 158 patients&#44; 47 &#40;29&#46;7&#37;&#41; developed hypothyroidism&#44; 101 &#40;63&#46;9&#37;&#41; experienced treatment failure&#44; and 10 &#40;6&#46;3&#37;&#41; remained euthyroid post-treatment&#46; In the higher dose group&#44; 22 &#40;56&#46;4&#37;&#41; had treatment failure and 15 &#40;38&#46;5&#37;&#41; became hypothyroidism&#44; while in the lower dose group&#44; 79 patients &#40;66&#46;4&#37;&#41; had treatment failure and 32 &#40;26&#46;9&#37;&#41; became hypothyroidism&#46; The differences between the two groups were not significant&#44; either in response rate &#40;33&#46;6&#37; vs&#46; 43&#46;5&#37;&#44; p&#8239;&#61;&#8239;0&#46;260&#41; or incidence of hypothyroidism &#40;26&#46;9&#37; vs&#46; 38&#46;5&#37;&#44; p&#8239;&#61;&#8239;0&#46;170&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Similarly&#44; age subgroups &#40;&#8805;45 vs&#46;&#8239;&#60;&#8239;45 years&#41; showed no significant differences in response rates &#40;37&#46;7&#37; vs&#46; 34&#46;6&#37;&#44; p&#8239;&#61;&#8239;0&#46;69&#41; or hypothyroidism incidence &#40;28&#46;6&#37; vs&#46; 30&#46;9&#37;&#44; p&#8239;&#61;&#8239;0&#46;75&#41;&#46; Females exhibited higher response rates &#40;42&#46;5&#37; vs&#46; 20&#46;0&#37;&#44; p&#8239;&#61;&#8239;0&#46;008&#41; and hypothyroidism incidence &#40;46&#46;3&#37; vs&#46; 13&#46;3&#37;&#44; p&#8239;&#61;&#8239;0&#46;004&#41; compared to males &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Among patients developing hypothyroidism&#44; onset occurred at a mean of 24&#46;0&#8239;&#177;&#8239;29&#46;2 months&#44; with a median of 8 months&#46; Cumulative incidences over time in six and twelve months post-treatment were 47&#37; and 60&#37;&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">The fixed doses of radioactive iodine &#40;RAI&#41; utilized in various studies have ranged from as low as 111 Mbq<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> to as high as 1480 Mbq&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> with Iagraru recommending an appropriate dosage of 370&#8211;555 Mbq&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It&#39;s evident from studies that higher doses correlate with higher response rates for hyperthyroidism&#46; For instance&#44; Allahabadia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and Esfahani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> studies respectively showed response rates of 66&#46;6&#37; versus 84&#46;6&#37; and 48&#46;5&#37; versus 88&#46;5&#37; when comparing 185 Mbq to 370 Mbq doses&#46; Pusuwan et al&#46; study<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> demonstrated rates of 52&#37; versus 70&#37; with 296 Mbq versus 377 Mbq&#44; while Boelaert et al&#46; study<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> showed rates of 63&#37; versus 74&#46;9&#37; versus 84&#46;1&#37; with 185 Mbq&#44; 370 Mbq&#44; and 555 Mbq&#44; respectively&#46; Similarly&#44; Husseni et al&#46; study<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> exhibited rates of 41&#46;6&#37; versus 68&#46;0&#37; with 370 Mbq versus 555 Mbq&#46; A systematic review and meta-analysis highlighted that patients treated with a fixed high dose had an 18&#46;1&#37; higher cure rate &#40;risk ratio&#8239;&#61;&#8239;1&#46;2&#41; compared to those treated with fixed low dose protocols&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> In our study&#44; a mean dose of 214&#46;6 Mbq was used&#44; with an overall response rate of 36&#46;1&#37;&#44; encompassing 29&#46;7&#37; hypothyroidism and 6&#46;3&#37; euthyroidism&#46; Notably&#44; the higher dose group exhibited a higher 43&#46;5&#37; response rate compared to a 33&#46;6&#37; response rate in the lower dose group&#44; although this difference was not statistically significant&#44; likely due to an insufficient dose separation &#40;240&#46;5 Mbq and 159&#46;1 Mbq&#41; between the two groups&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Our observed response rate of 36&#46;1&#37; was notably lower than similar doses used in some previous studies&#46; Several factors could influence the efficacy of RAI&#44; including antithyroid medications&#44; thyroid gland volume or weight&#44; iodine uptake ratio&#44; and the severity of hyperthyroidism&#46; While we followed the Society of Nuclear Medicine and Molecular Imaging practice guideline<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> regarding dietary restrictions and medication cessation before RAI administration&#44; patient compliance was not monitored closely&#46; Moreover&#44; although it&#8217;s been suggested that propylthiouracil may need to be discontinued for more than 55 days<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> while antithyroid medications should not restart within seven days&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> we only asked the patients to discontinue antithyroid medications for seven days and resume them three days after RAI&#46; Therefore&#44; the treatment efficacy may not be optimal or as expected&#44; resulting in the lower response rate&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding demographic factors&#44; we found that females had a significantly higher response rate compared to males &#40;42&#46;5&#37; vs&#46; 13&#46;3&#37;&#44; p&#8239;&#60;&#8239;0&#46;01&#41;&#46; This observation aligns with some previous studies indicating gender-based differences in response rates&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;22</span></a> though other studies opposed the differences&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;23&#8211;25</span></a> Similarly&#44; some papers reported that age was not a predicting factor for treatment outcome&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;23&#8211;25</span></a> but some reported that younger people were more likely to present persistent hyperthyroidism after RAI therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;22&#44;26&#44;27</span></a> We did not find a difference between our lower &#40;&#60;45 years old&#41; and higher &#40;&#8805;45 years old&#41; age groups&#44; but when we moved the dividing age down to 30 years old&#44; the difference became significant &#40;p&#8239;&#61;&#8239;0&#46;018&#41;&#46; A greater resistance to radiation of younger thyroid tissue had been suggested by Ceccarelli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> though Allahabadia considered that the difference between ages was attributed to a strong association with goiter and severity of hyperthyroidism&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;22</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In terms of hypothyroidism incidence post-RAI&#44; studies have shown a clear correlation with both the time elapsed post-RAI and the dosage administered&#46; In Franklyn et al&#46; study&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> the cumulative incidences of hypothyroidism were 18&#37; at 5 years and 42&#37; at 20 years after RAI&#46; Similarly&#44; in Ceccarelli et al&#46; study&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> 7&#46;6&#37;&#44; 28&#37;&#44; 46&#37;&#44; and 60&#37; of patients developed hypothyroidism at 1&#44; 5&#44; 10&#44; and 20 years post-treatment&#46; Metso et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> reported incidences of 24&#37;&#44; 59&#37;&#44; and 82&#37; in Graves&#8217; disease patients and 4&#37;&#44; 15&#37;&#44; and 32&#37; in toxic multinodular goiter patients at 1&#44; 10&#44; and 25 years&#44; respectively&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In our study&#44; the incidence of hypothyroidism was 29&#46;7&#37;&#46; In those becoming hypothyroid&#44; almost half of them &#40;47&#37;&#41; occured within six months with the majority &#40;60&#37;&#41; within one year after treatment&#46; Though the cumulative incidence was expected to increase steadily over time&#44; surprisingly&#44; instead of a slow rise to the end&#44; the curve showed a high percentage from the beginning &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; This finding suggested that hypothyroidism could manifest early after treatment even with low-dose RAI&#44; and to our best knowledge&#44; the finding was not found in the literature&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Higher doses of RAI have been associated with both a higher response rate and an increased incidence of hypothyroidism&#46; Boelaert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> reported incidences of hypothyroidism at 60&#46;4&#37;&#44; 49&#46;2&#37;&#44; and 38&#46;1&#37; when using doses of 600&#8239;MBq&#44; 370&#8239;MBq&#44; and 185&#8239;MBq of RAI&#44; respectively&#46; Similarly&#44; Esfahani et al&#46; study<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> showed incidences of 50&#46;0&#37; and 18&#46;2&#37; with doses of 370 Mbq and 185 Mbq&#44; respectively&#46; Husseni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and Rokni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> reported similar findings&#44; with an odds ratio of 2&#46;95 for hypothyroidism with higher doses and a higher risk ratio for permanent hypothyroidism with fixed high doses&#44; respectively&#46; A study utilizing very low doses of RAI reported a hypothyroidism rate of 25&#37; with a mean dose of 103&#46;6 Mbq and a rate of 29&#37; with a mean dose of 218&#46;3 Mbq&#44; with no significant difference between the two groups&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Similarly&#44; we did not find a significant difference between our higher dose group &#40;mean&#58; 240&#46;5 Mbq&#41; and the lower dose group &#40;mean&#58; 159&#46;1 Mbq&#41;&#44; likely due to an insufficient dose separation between the two groups&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Besides the timing and dosage&#44; several other factors may contribute to the development of hypothyroidism after RAI&#46; As mentioned earlier&#44; there was a higher cumulative incidence of hypothyroidism in Graves&#8217; disease patients compared to those with toxic multinodular goiter&#44; as shown in Metso et al&#46; study&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Allahabadia also reported a higher incidence of hypothyroidism in Graves&#39; disease patients compared to those with toxic nodular goiter &#40;54&#46;5&#37; vs&#46; 31&#46;7&#37;&#44; P&#8239;&#60;&#8239;0&#46;0001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In addition&#44; our study revealed a higher incidence of hypothyroidism in females than in males &#40;46&#46;3&#37; vs&#46; 13&#46;3&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41;&#44; as suggested by Boelaert et al&#46; study&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> which showed an adjusted odds ratio of 1&#46;46 for females&#46; The lower incidence of hypothyroidism in toxic nodular goiter patients after RAI might be attributed to the radiation being predominantly delivered to the toxic nodule&#44; thereby sparing the normal thyroid tissues and preserving some thyroid function&#46; However&#44; the reason why females had a higher incidence of hypothyroidism after RAI remains unclear&#46; The association between age and the incidence of hypothyroidism after RAI is controversial&#46; No correlation was found between the development of hypothyroidism and age in Husseni et al&#46; study<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and ours&#44; but a slightly increased incidence of hypothyroidism in younger age groups &#40;adjusted odds ratio&#58; 1&#46;03&#41; was reported in Boelaert et al&#46; study&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> while a higher incidence of hypothyroidism in individuals over 45 years old was reported in Ceccarelli et al&#46; study&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">There were several limitations in our study&#46; First&#44; in our institution&#44; only six patients were treated with 370 Mbq or higher RAI during the study period&#46; Therefore&#44; even the higher dose group in our study generally had lower doses than in other studies&#44; and hence the difference between the higher and lower dose groups might not be distinguishable as both were in the low dose domain&#46; Second&#44; the etiology of hyperthyroidism&#44; such as Graves&#8217; disease or toxic nodule goiter&#44; the volume of the thyroid gland&#44; radioactive iodine uptake values&#44; and the severity of hyperthyroidism&#44; all of which may affect the response rate or incidence of hypothyroidism&#44; could not be obtained from our database&#46; Third&#44; the duration of discontinuing propylthiouracil before RAI and the restart of antithyroid medications after RAI may not be long enough&#46; Despite these limitations&#44; we found that the response rate was lower in males and young people&#44; as reported in some other studies&#44; suggesting that the dose of RAI may need to be adjusted in these groups&#46; Additionally&#44; even with low doses&#44; there was a significant incidence of hypothyroidism&#44; and onset could occur early after treatment&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion&#44; while low-dose RAI treatment for hyperthyroidism aims to mitigate hypothyroidism risks&#44; it concurrently diminishes treatment response rates and may not effectively prevent early onset of hypothyroidism&#46; Gender and age also play significant roles in influencing treatment outcomes&#46; Patients should be thoroughly informed about the potential risks of hypothyroidism and the likelihood of lower response rates associated with low-dose RAI&#46; Physicians must engage in comprehensive discussions with patients to tailor treatment strategies&#44; consider individual factors&#44; and optimize dosage selection to achieve a better balance between therapeutic outcomes and adverse effects&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical statement</span><p id="par0095" class="elsevierStylePara elsevierViewall">The ethical&#44; methodological&#44; and protocol aspects of this investigation were approved by the MacKay Memorial Hospital Institutional Review Board &#40;IRB Number&#58; 23MMHIS405e&#41; on 2023&#47;12&#47;22&#46;</p></span></span>"
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          "identificador" => "sec0005"
          "titulo" => "Introduction"
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        5 => array:3 [
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          "titulo" => "Materials and methods"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patients"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Methods"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Radioiodine treatment"
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            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Outcomes assessment"
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            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Ethical statement"
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        6 => array:2 [
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          "titulo" => "Statistical analysis"
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          "titulo" => "Results"
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          "titulo" => "Discussion"
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          "identificador" => "sec0055"
          "titulo" => "Ethical statement"
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        10 => array:2 [
          "identificador" => "xack775110"
          "titulo" => "Acknowledgements"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2024-04-29"
    "fechaAceptado" => "2024-08-22"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1878964"
          "palabras" => array:5 [
            0 => "Low-dose"
            1 => "Radioactive iodine"
            2 => "Outcome"
            3 => "Hypothyroidism"
            4 => "Hyperthyroidism"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1878965"
          "palabras" => array:5 [
            0 => "Baja dosis"
            1 => "Yodo radioactivo"
            2 => "Resultado"
            3 => "Hipotiroidismo"
            4 => "Hipertiroidismo"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The study aimed to analyze the outcome of low-dose radioactive iodine &#40;RAI&#41; treatment for hyperthyroidism&#44; disclose whether age and gender influence the outcome and determine the incidence and onset time of hypothyroidism following low-dose RAI&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 158 patients who received doses less than 370 Mbq RAI were enrolled in the study&#46; Treatment outcome and incidence of hypothyroidism were compared between different gender &#40;45 male vs&#46;113 female&#41;&#44; age &#40;77 patients &#8805;45 years old vs&#46; 81 patients &#60;45 years old&#41; and dose &#40;39 patients receiving higher doses RAI vs&#46; 119 receiving lower dose with a cutoff of 222 MBq&#41; groups&#46; Treatment outcomes were categorized into post-treatment hypothyroidism&#44; treatment failure &#40;persistent hyperthyroidism&#41;&#44; and euthyroidism&#46; In those becoming hypothyroid&#44; time to develop hypothyroidism was calculated for cumulative incidences over time&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Out of 158 patients&#44; 47 &#40;29&#46;7&#37;&#41; developed hypothyroidism&#44; 101 &#40;63&#46;9&#37;&#41; had treatment failure&#44; and 10 &#40;6&#46;3&#37;&#41; remained euthyroid after treatment&#46; Response rates &#40;33&#46;6&#37; vs&#46; 43&#46;5&#37;&#44; p&#8239;&#61;&#8239;0&#46;260&#41; and hypothyroidism incidences &#40;26&#46;9&#37; vs&#46; 38&#46;5&#37;&#44; p&#8239;&#61;&#8239;0&#46;170&#41; did not differ significantly between lower and higher dose groups&#44; neither between lower and higher age groups &#40;p&#8239;&#61;&#8239;0&#46;69 in response rates and p&#8239;&#61;&#8239;0&#46;75 in hypothyroidism incidence&#41;&#46; Females exhibited higher response rates &#40;42&#46;5&#37; vs&#46; 20&#46;0&#37;&#44; p&#8239;&#61;&#8239;0&#46;008&#41; and hypothyroidism incidence &#40;46&#46;3&#37; vs&#46; 13&#46;3&#37;&#44; p&#8239;&#61;&#8239;0&#46;004&#41; compared to males&#46; Hypothyroidism onset occurred at a mean of 24&#46;0&#8239;&#177;&#8239;29&#46;2 months&#44; and the cumulative incidences over time were 47&#37; and 60&#37; in six and twelve months&#44; respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Low-dose RAI has a low response rate for treating hyperthyroidism&#46; Although there may be a lower incidence of hypothyroidism following low-dose RAI compared to high-dose RAI&#44; hypothyroidism may occur early after treatment&#46; Besides&#44; females have higher response rates but more incidence of hypothyroidism&#46; The balance between the risks and benefits of using low-dose RAI should be taken into deliberate consideration&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El estudio tuvo como objetivo analizar el resultado del tratamiento con yodo radioactivo de baja dosis &#40;RAI&#41; para el hipertiroidismo&#44; revelar si la edad y el g&#233;nero influyen en el resultado&#44; y determinar la incidencia y el tiempo de inicio del hipotiroidismo despu&#233;s del RAI de baja dosis&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Un total de 158 pacientes que recibieron dosis menores de 370 Mbq de RAI fueron incluidos en el estudio&#46; Los resultados del tratamiento y la incidencia de hipotiroidismo se compararon entre diferentes grupos de g&#233;nero &#40;45 hombres vs&#46; 113 mujeres&#41;&#44; edad &#40;77 pacientes &#8805;45 a&#241;os vs&#46; 81 pacientes &#60;45 a&#241;os&#41; y dosis &#40;39 pacientes que recibieron dosis m&#225;s altas de RAI vs&#46; 119 que recibieron dosis m&#225;s bajas con un l&#237;mite de 222 MBq&#41;&#46; Los resultados del tratamiento se categorizaron en hipotiroidismo post-tratamiento&#44; fracaso del tratamiento &#40;hipertiroidismo persistente&#41; y eutiroidismo&#46; En aquellos que desarrollaron hipotiroidismo&#44; se calcul&#243; el tiempo para desarrollar hipotiroidismo para las incidencias acumulativas a lo largo del tiempo&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">De los 158 pacientes&#44; 47 &#40;29&#46;7&#37;&#41; desarrollaron hipotiroidismo&#44; 101 &#40;63&#46;9&#37;&#41; tuvieron fracaso del tratamiento y 10 &#40;6&#46;3&#37;&#41; permanecieron eutiroideos despu&#233;s del tratamiento&#46; Las tasas de respuesta &#40;33&#46;6&#37; vs&#46; 43&#46;5&#37;&#44; p&#8239;&#61;&#8239;0&#46;260&#41; y las incidencias de hipotiroidismo &#40;26&#46;9&#37; vs&#46; 38&#46;5&#37;&#44; p&#8239;&#61;&#8239;0&#46;170&#41; no difirieron significativamente entre los grupos de dosis m&#225;s baja y m&#225;s alta&#44; ni entre los grupos de edad m&#225;s baja y m&#225;s alta &#40;p&#8239;&#61;&#8239;0&#46;69 en tasas de respuesta y p&#8239;&#61;&#8239;0&#46;75 en incidencia de hipotiroidismo&#41;&#46; Las mujeres exhibieron tasas de respuesta m&#225;s altas &#40;42&#46;5&#37; vs&#46; 20&#46;0&#37;&#44; p&#8239;&#61;&#8239;0&#46;008&#41; e incidencia de hipotiroidismo &#40;46&#46;3&#37; vs&#46; 13&#46;3&#37;&#44; p&#8239;&#61;&#8239;0&#46;004&#41; en comparaci&#243;n con los hombres&#46; El inicio del hipotiroidismo ocurri&#243; a una media de 24&#46;0&#8239;&#177;&#8239;29&#46;2 meses&#44; y las incidencias acumulativas a lo largo del tiempo fueron del 47&#37; y 60&#37; a los seis y doce meses&#44; respectivamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">El RAI de baja dosis tiene una baja tasa de respuesta para tratar el hipertiroidismo&#46; Aunque puede haber una menor incidencia de hipotiroidismo despu&#233;s del RAI de baja dosis en comparaci&#243;n con el RAI de alta dosis&#44; el hipotiroidismo puede ocurrir tempranamente despu&#233;s del tratamiento&#46; Adem&#225;s&#44; las mujeres tienen tasas de respuesta m&#225;s altas pero mayor incidencia de hipotiroidismo&#46; El equilibrio entre los riesgos y beneficios de utilizar RAI de baja dosis debe ser considerado cuidadosamente&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 906
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            "Tamanyo" => 72124
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        "detalles" => array:1 [
          0 => array:3 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cumulative incidence of hypothyroidism with time after RAI&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">For the 47 patients who eventually developed hypothyroidism&#44; 47&#37; experienced it within six months&#44; and 60&#37; within twelve months&#46; The cumulative incidence over time exhibited a slowly rising curve with a high starting percentage&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>148&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hypothyroidism Numbers &#40;percentages&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment failure Numbers &#40;percentages&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">42 &#40;29&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">101 &#40;63&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
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                  \t\t\t\t">Gender</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;13&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36 &#40;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">41 &#40;36&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">65 &#40;57&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7 &#40;6&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
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                  \t\t\t\t">Age &#40;years old&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>20&#8764;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;13&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;86&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>30&#8764;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17 &#40;38&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;56&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>40&#8764;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11 &#40;25&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">28 &#40;63&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;11&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>50&#8764;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;25&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;67&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>60&#8764;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;45&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;45&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;9&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>70&#8764;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lower age group &#40;&#60;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;30&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;65&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#40;3&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Higher age group &#40;&#8805;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;62&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;9&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
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                  \t\t\t\t">Dose</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lower dose group &#40;111&#8764;185 Mbq&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;26&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;66&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Higher dose group &#40;222&#8764;296 Mbq&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Numbers &#40;cumulative percentages&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lower dose group numbers &#40;cumulative percentages&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Higher dose group numbers &#40;cumulative percentages&#41;&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 22538089
Original language: English

DOI:10.1016/j.remnie.2024.500056

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