Radioiodine therapy outcome in toxic multinodular goiter patient with concomitant hereditary Hasharon hemoglobinopathy

This research describes a clinical case of treatment of a patient with thyrotoxicosis with concomitant hematological pathology – carriage of unstable hemoglobin Hasharon. A patient diagnosed with «Diffuse toxic nodular goiter. Thyrotoxicosis of medium severity. Drug-induced hypothyroidism» was admitted to the Department of radionuclide therapy for the purpose of treatment with radioactive iodine. Onset of disease - summer 2018 (thyroid-stimulating hormone (TSH) – 0 mIU/ml). The instrumental studies (ultrasound, scintillation scanning of the thyroid gland) were performed at the pre-radioiodine therapy (RIT) diagnostic stage. The history of the disease indicates, that in 2000 the patient was suspected of having abnormal hemoglobin, since then no examinations have been conducted and anemia has never been detected. The diagnosis of ancestral hemoglobinopathy with the presence (17%) of unstable Hasharon-Sinai-Sealy hemoglobin in a heterozygous form was verified during the preparation to RIT. The radionuclide therapy I¹³¹ with activity of 400 MBq was performed on 02.07.2019. The monthly monitoring of laboratory and instrumental indicants was carried out during the post-therapeutic period: the state of hypothyroidism was reached by the end of 2 months after RT, no episodes of significant increase in bilirubin levels were observed during the observation period; no side effects from RT were stated. It becomes possible based on the example of the above observation, to judge the safety of conducting RT for treatment of thyrotoxicosis in patients with similar hemoglobinopathy, without excluding, however, the need for an individual approach in each case.

1. De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016;388(10047):906−918. doi: 10.1016/S0140-6736(16)00278-6.

2. Трошина Е.А., Ванушко В.Э., Румянцев П.О, и др. Федеральные клинические рекомендации Российской ассоциации эндокринологов по диагностике и лечению токсического зоба // Клиническая и экспериментальная тиреоидология. — 2014. —Т.10. — №3. — С. 8−19. [Troshina EA, Sviridenko NYu, Vanushko VE, et al. Russian association of endocrinologists clinical practice guidelines for thyrotoxicosis diagnosis and treatment. Clinical and experimental thyroidology. 2014;10(3):8−19. (In Russ).] doi: 10.14341/ket201438.19.

3. Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011;99:39–51. doi: 10.1093/bmb/ldr030.

4. Аметов А.С., Кондратьева Л.В., Бугова Л.А. Болезнь Грейвса и функциональная автономия щитовидной железы в регионе с легким йодным дефицитом // Клиническая и экспериментальная тиреоидология. — 2011. — Т.7. — №4. — С. 51−55. [Ametov AS, Kondrat’eva LV, Bugova LA. Graves’’ disease and thyroid functional autonomy in the region of mild iodine deficiency. Clinical and experimental thyroidology. 2011;7(4):51−55. (In Russ).]

5. Goichot B, Caron P, Landron F, et al. Clinical presentation of hyperthyroidism in a large representative sample of outpatients in France: Relationships with age, aetiology and hormonal parameters. Clin Endocrinol (Oxf). 2016;84(3):445−451. doi: 10.1111/cen.12816.

6. Devereaux D, Tewelde SZ. Hyperthyroidism and thyrotoxicosis. Emerg Med Clin North Am. 2014;32(2):277–292. doi: 10.1016/j.emc.2013.12.001.

7. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343−1421. doi: 10.1089/thy.2016.0229.

8. Sarkar SD. Thyroid gland. In: Elgazzar AH. The pathophysiologic basis of nuclear medicine. Springer Nature Switzerland AG; 2006. Р. 209−221.

9. Van Mohamed WM, Sayuti SC, Draman N. Hypothyroidism and its associated factors after radioactive iodine therapy among patients with hyperthyroidism in the Northeast Coast State of Malaysia. J Taibah Univ Med Sci. 2018;13(5):432−437. doi: 10.1016/j.jtumed.2018.06.004.

10. Kaplan MM, Meier DA, Dworkin HJ. Treatment of hyperthyroidism with radioactive iodine. Endocrinol Metab Clin North Am. 1998;27(1):205−223. doi: 10.1016/S0889-8529(05)70307-8.

11. Румянцев П.О., Кияев А.В. Шеремета М.С., и др. Радиойодтерапия тиреотоксикоза у детей и подростков. Показания, эффективность и безопасность. Обзор литературы // Эндокринная хирургия. — 2016. — Т.10. — №4. — С. 6−12. [Rumiantsev PO, Kiyaev AV, Sheremeta MS, et al. Radioiodine therapy of thyrotoxicosis in children and adolescents. Indications, efficacy and safety. Literature review. Endocrine surgery. 2016;10(4):6−12. (In Russ).] doi: 10.14341/serg201646-12.

12. Fard-Esfahani P, Beiki D, Fallahi B, et al. Radioiodine therapy for hyperthyroidism. Iranian Journal of Nuclear Medicine. 2011;19(2):1−12. doi: 10.1056/nejmc1103014.

13. Modell B, Darlison M. Global epidemiology of haemoglobin disorders and derived service indicators. Bull World Health Organ. 2008;86(6):480–487. doi: 10.2471/BLT.06.036673.

14. Kohne E. Hemoglobinopathies: clinical manifestations, diagnosis, and treatment. Dtsch Arztebl Int. 2011;108(31-32):532–540. doi: 10.3238/arztebl.2011.0532.

15. Hardison RC, Chui DH, Giardine B, et al. HbVar: A relation database of human hemoglobin variants and thalassemia mutations at the globin gene server. Hum Mutat. 2002;19(3):225−233. doi: 10.1002/humu.10044.

16. Patrinos GP, Wajcman H. Recording human globin gene variation. Hemoglobin. 2004;28(2):v-vii.

17. Лохматова М.Е., Сметанина Н.С., Финогенова Н.А. Эпидемиология гемоглобинопатий в Москве // Педиатрия. Журнал им. Г.Н. Сперанского. — 2009. — Т.87. — №4. — С. 46−49. [Lokhmatova ME, Smetanina NS, Finogenova NA. Epidemiologiya gemoglobinopatii v Moskve. Pediatriya. Zhurnal im. G.N. Speranskogo. 2009;87(4):46−50. (In Russ).]

18. Moradkhani K, Prehu C, Old J, et al. Mutations in the paralogous human alpha-globin genes yielding identical hemoglobin variants. Ann Hematol. 2009;88(6):535−543. doi: 10.1007/s00277-008-0624-3.

19. Halbrecht I, Isaacs WA, Lehmann H, et al. Hemoglobin hasharon (alpha-47 aspartic acid-histidine). Isr J Med Sci. 1967;3(6):827−831.

20. Schneider RG, Ueda S, Alperin JB, et al. Hemoglobin sealy (alpha 2-47His-beta 2): a new variant in a Jewish family. Amer J Hum Genet. 1968;20(2):151−156.

21. Carache S, Mondzac AM, Gessner U. Hemoglobin Hasharon (alpha-2-47 his(CD5)beta-2): a hemoglobin found in low concentration. J Clin Invest. 1969;48(5):834−847. doi 10.1172/JCI106041.