[Radioiodine therapy of Graves' disease--quality assurance and radiation protection].

Radioiodine (I-131) is used successfully since more than 50 years for treatment of hyperthyroidism in Graves' disease. In the USA, more than half of the patients with a Graves' hyperthyroidism are treated primarily with radioiodine, whereas in Europe the frequency is less than a quarter of the patients. In Germany consensus could be achieved, the antithyroid drugs are indicated in patients with manifest hyperthyroidism to induce euthyroidism before radioiodine treatment. Typical indications for radioiodine treatment are: Treatment with antithyroid drugs without success for more than one year, drug-incompatibility and increased risk for surgery. In relation to the radiation dose applied, hyperthyroidism is eliminated after radioiodine treatment; in 80-100% of the patients the incidence of hypothyroidism ranges between 50 and 100%. In Germany, for reasons of quality assurance and radiation protection, radioiodine treatment is carried out in hospitals with wards equipped with radiation protection facilities; fractionated treatment with radioiodine is not allowed. Due to recent changes in radiation protection regulations, patients can be dismissed earlier from the wards than before; the mean duration of stay could be decreased from 10-12 to 3-4 days. Radioiodine treatment is safe and has only few side effects. However, patients have to be followed-up for life. Considering the cost-benefit-relation, radioiodine treatment has advantages especially in patients with small goiters as compared to surgery.