Incorporating Clinical Factors into the Calculation of Radioiodine Dose for Graves’ Disease: Improving the Success Rate of Treatment

Alisara Wongsuttilert, MD¹, Sathapakorn Siriwong, MD², Yoswanich Maiprasert, MD², Wanlop Jaidee, PhD³, Ruchirek Thamcharoen, MD⁴

Affiliation : ¹ Department of Radiology and Nuclear Medicine, Faculty of Medicine, Burapha University, Chonburi, Thailand; ² Department of Medicine, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, Chonburi, Thailand; ³ Faculty of Public Health, Burapha University, Chonburi, Thailand; ⁴ Department of Internal Medicine, Queen Sirikit Hospital, Chonburi, Thailand

Background: There is a hypothesis that additional radioiodine activity for each clinical risk factor would increase the success rate of radioiodine therapy (RIT) for Graves’ disease (GD).
Objective: To compare the success rates of RIT using standard and new dosage calculation protocols.
Materials and Methods: The present study was a retrospective cohort study that enrolled 341 GD patients who received RIT between January 2014 and July 2023 at Burapha University Hospital, Thailand. Participants were divided into two groups: those who received protocol 1, a standard radioiodine dosage calculation method, and those who received protocol 2, a risk-modified dosage calculation method. The primary outcome was the success rate of RIT with the two protocols at the 6-month follow-up.
Results: The group receiving protocol 2 displayed a significantly higher RIT success rate than those who received protocol 1 (69.2% versus 49.7%, p<0.001). Based on the measured effects of protocols 1 and 2, the risk of treatment failure was higher in protocol 1 (RR 1.39, 95% CI 1.16 to 1.68, p<0.001) than in protocol 2. After matching analysis with sex and thyroid size, the risk of treatment failure was more conspicuous (RR 1.64, 95% CI 1.20 to 2.25, p=0.001).
Conclusion: The new precision protocol, which incorporates clinical risk factors into radioiodine dosage calculation, significantly improves treatment outcomes in patients undergoing RIT for Graves’ disease.

Received 25 September 2025 | Revised 14 January 2026 | Accepted 19 January 2026
DOI: 10.35755/jmedassocthai.2026.3.03649

Keywords : Calculated dosage; Graves’ disease; Radioactive iodine treatment; Success rate


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