The I-131 Story

The I-131 story, like the Technetium story is fascinating and details regarding differ slightly between different authors. The history of iodine and its relation to the thyroid goes back many years. See below for Silverstein’s outline of iodine’s early history from a 2012 SNM talk. The use of radioiodine in medicine is well chronicled in a series of important articles. Prominent among them are articles by Fermi, Livingood and Seaborg, 2 articles by Swain and Becker, Adelstein, Hertz and Schuller, and in 2012 by Silberstein where he defines radioiodine as the first theranostic agent in nuclear medicine’s evolving armamentarium, i.e. agents used for both diagnosis and therapy.

Sorting through these articles reveals that MGH, and UC Berkeley contend for different first uses of radioactive iodine. Boston had an early start clinically, since Professor Means first established the Thyroid clinic at MGH in 1920. He noted prominent effects of stable iodine when given to hyperthyroid patients. In 1923, he used X-ray therapy to treat patients with toxic goiter patients. The Mass General Hospital, and UC Berkeley groups contend for different “firsts” in the radioiodine story. J. Howard Means established the Thyroid clinic at MGH in 1920 by which time the important role of iodine in thyroid function was known. Saul Hertz, member and later Director of the MGH Thyroid Clinic (1931-43), attended a meeting in Vanderbilt Hall, Boston in 1936 attended by MIT President, Karl Compton, Robley Evans, Means, and others. In the Q/A session Hertz asked Compton “if iodine could be made radioactive”. Whether he or Means asked the question is uncertain, but a few weeks later, Compton replied in the affirmative, at which point Means and Evans agreed to establish a cooperative MGH/MIT program to produce I-128 and study its potential use in medicine. Hertz worked with Arthur Roberts, an MIT-based physicist, who made the I-128 for their experiments at MIT using a neutron source. Hertz and Roberts then studied its thyroid uptake in rabbits in late1937 with results reported in 1938. Joe Hamilton and Mayo Soley at Berkeley also did studies in rabbits that same year. Both groups were aware of the other’s activities, and shared findings. Hamilton asked Seaborg in 1936 if a longer-lived iodine isotope (about a week half-life) could be produced. A few days later, Livingood and Seaborg used deuterons from the Berkeley cyclotron to bombard Te-128, making I-130 (T1/2-12 h), and the desired I-131 (T1/2=8 d.). This provided earlier access to the use of radioiodine isotopes in Berkeley by Hamilton and Soley than to the Boston group. Berkeley shared isotopes with collaborators around the world, but it is not clear whether this included MGH users. Articles in Proc. Soc. and Am J. Physiol. were published by both groups in 1938. In 1940, Berkeley reported the first study of radioiodine accumulation by the normal human thyroid gland (Am J. Physiol.), using external detectors. In 1941, Hertz and Roberts used a mixture of I-130 (90%), and I-131 (10%) from the new MIT cyclotron to treat the first of a growing number of hyperthyroid patients. A few months later, the Berkeley group treated hyperthyroid patients (referred from UCSF colleagues) also using a mixture of radioiodine isotopes.

The “I-131 Story” has been dated back to ancient times by Silberstein in 2012 SNM talk. In it he notes that:

“Chinese texts claim the use of seaweed treatment of goiter in 340 C.E. by Ko Hung, an alchemist who used alcoholic extracts of seaweed and in 650 C.E. Sun Ssu-Mo, a Tang dynasty physician used dried powdered mollusk shells chopped thyroid gland, burned sponge and seaweed…

Bernard Courtois (1977-1829) discovered iodine (1811) by accident using as a source of material for Napolean’s gunpowder.

William Prout, M.D. (1785-1859In 1816,) relates goiter therapy with seaweed to iodine, and suggested iodine as treatment…

Eugene Baumann (1846-96) in 1895 reported iodine as a natural constituent of the thyroid hormone, called iodothyrin.

David Marine (1888-1976) In 1907, Western Reserve: treated Graves’ disease with iodine, noting concentration of iodine in partially a thyroidectomized dog’s thyroid.

Malcom Seymour, MGH In 1917, used X-rays to treat 144 patients with Graves’ disease.

Henry S. Plummer, Mayo Clinic, In 1922, used I-127 instead of thyroidectomy as a gland suppressant and

Charles R. Harrington and G. Barger in 1926, determined the correct levothyroxine structure”.

Herman Blumgart, in 1933 used surgical ablation of the thyroid gland to treat symptoms of intractable angina (later he used I-131).

Irene and Joliot Curie’s 1934 demonstration of the ability to produce radioisotopes artificially was followed in the same year by

Enrico Fermi who produced I-128 by bombarding stable iodine containing compounds with neutrons from a naturally occurring isotope source. This event that laid the basis for its many uses in medicine. Physics reports of I-128 production by Fermi, were followed 2 years later by Livingood and Seaborg’s papers on I-130, and I-131 production. The fact that 2 years lapsed without medical applications has been attributed to chaotic political times in Europe.

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