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Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: a quality improvement project

Journal Article:

Abstract

Radioiodine ({sup 131}I) therapy is the definitive treatment of toxic multinodular goiter (TMNG). Treatment failure may result in relapse after {sup 131}I therapy. The present study was undertaken to reduce treatment failure rate of {sup 131}I therapy in TMNG patients. Multiple causes may have lead to treatment failure of {sup 131}I in TMNG patients making it difficult to establish a direct cause-effect relationship and take corrective action. Therefore, the JURAN methodology of quality improvement was applied. The treatment failure rate in 80 TMNG patients treated with {sup 131}I in the period 2003-06 was 29%. The root cause analysis identified delay in decision to radioablate and concomitant antithyroid drugs (ATD) with {sup 131}I therapy as factors leading to relapse. In 2007, a change in management was introduced with decision to radioablate all TMNG patients not remitting at 1 year of ATD and to withdraw ATD for 2 weeks prior to {sup 131}I therapy. A total of 63 patients of TMNG followed the changed protocol between 2007 and 2009. Further analysis showed that one of the factors identified in the initial brainstorming (high iodide pool in the patient) had not been addressed in the protocol currently followed. The protocol was modified to  More>>
Authors:
Mitra, Sujata; Muthu, Sonai G., E-mail: sujatamitra@tatasteel.com [1] 
  1. Department of Nuclear Medicine, Tata Main Hospital, Jamshedpur (India)
Publication Date:
Jan 15, 2012
Product Type:
Journal Article
Resource Relation:
Journal Name: Indian Journal of Nuclear Medicine; Journal Volume: 27; Journal Issue: 1; Other Information: 6 refs., 3 figs., 4 tabs.
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; DOSE-RESPONSE RELATIONSHIPS; GOITER; IODINE 131; POST-IRRADIATION THERAPY; RADIOTHERAPY
OSTI ID:
22166414
Country of Origin:
India
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0972-3919; CODEN: IJNMEK; TRN: IN1301933120850
Submitting Site:
INIS
Size:
page(s) 5-9
Announcement Date:
Dec 05, 2013

Journal Article:

Citation Formats

Mitra, Sujata, and Muthu, Sonai G., E-mail: sujatamitra@tatasteel.com. Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: a quality improvement project. India: N. p., 2012. Web. doi:10.4103/0972-3919.108824.
Mitra, Sujata, & Muthu, Sonai G., E-mail: sujatamitra@tatasteel.com. Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: a quality improvement project. India. doi:10.4103/0972-3919.108824.
Mitra, Sujata, and Muthu, Sonai G., E-mail: sujatamitra@tatasteel.com. 2012. "Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: a quality improvement project." India. doi:10.4103/0972-3919.108824. https://www.osti.gov/servlets/purl/10.4103/0972-3919.108824.
@misc{etde_22166414,
title = {Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: a quality improvement project}
author = {Mitra, Sujata, and Muthu, Sonai G., E-mail: sujatamitra@tatasteel.com}
abstractNote = {Radioiodine ({sup 131}I) therapy is the definitive treatment of toxic multinodular goiter (TMNG). Treatment failure may result in relapse after {sup 131}I therapy. The present study was undertaken to reduce treatment failure rate of {sup 131}I therapy in TMNG patients. Multiple causes may have lead to treatment failure of {sup 131}I in TMNG patients making it difficult to establish a direct cause-effect relationship and take corrective action. Therefore, the JURAN methodology of quality improvement was applied. The treatment failure rate in 80 TMNG patients treated with {sup 131}I in the period 2003-06 was 29%. The root cause analysis identified delay in decision to radioablate and concomitant antithyroid drugs (ATD) with {sup 131}I therapy as factors leading to relapse. In 2007, a change in management was introduced with decision to radioablate all TMNG patients not remitting at 1 year of ATD and to withdraw ATD for 2 weeks prior to {sup 131}I therapy. A total of 63 patients of TMNG followed the changed protocol between 2007 and 2009. Further analysis showed that one of the factors identified in the initial brainstorming (high iodide pool in the patient) had not been addressed in the protocol currently followed. The protocol was modified to include patient preparation and implemented after standardization. The post-{sup 131}I relapse rate in patients treated after implementation of the new protocol from 2007 to 2009 was 18% which further reduced to 16% in 2011 after modification of the protocol. The failure rate of {sup 131}I therapy in TMNG reduced from 29% to 16% through standardization of the treatment procedure achieved by the use of Juran Methodology that helped to identify process-related defects. (author)}
doi = {10.4103/0972-3919.108824}
journal = {Indian Journal of Nuclear Medicine}
issue = {1}
volume = {27}
journal type = {AC}
place = {India}
year = {2012}
month = {Jan}
}