Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials

Abstract

Objective To determine the effect of adjunctive antithyroid drugs on the risk of treatment failure, hypothyroidism, and adverse events after radioiodine treatment. Design Meta-analysis. Data sources Electronic databases (Cochrane central register of controlled trials, Medline, Embase) searched to August 2006 and contact with experts. Review methods Three reviewers independently assessed trial eligibility and quality. Pooled relative risks for treatment failure and hypothyroidism after radioiodine treatment with and without adjunctive antithyroid drugs were calculated with a random effects model.

Radioiodine therapy in elderly patients with subclinical hyperthyroidism due to non-voluminous nodular goiter and its effect on bone metabolism

“…In addition, the chance of success (resolution of hyperthyroidism) may be greater in patients who did not receive antithyroid drugs (ATDs) before the administration of 131 I (5). On the other hand, treatment with ATDs reduces the risk of acute exacerbation of thyrotoxicosis (5), which is a matter of concern, particularly in older patients.…”

“…If 131 I is administered in the presence of undetectable levels of TSH, normal thyroid tissue does not take up, or takes up very little radioiodine, reducing the risk of hypothyroidism (3,4). In addition, the chance of success (resolution of hyperthyroidism) may be greater in patients who did not receive antithyroid drugs (ATDs) before the administration of 131 I (5). On the other hand, treatment with ATDs reduces the risk of acute exacerbation of thyrotoxicosis (5), which is a matter of concern, particularly in older patients.…”

Medical Management of Hyperthyroidism

“…Antithyroid drugs should not be given immediately before or after RAI as this may increase treatment failure rate. 16 Furthermore, the use of carbimazole or methimazole prior to RAI is preferred over the use of propylthiouracil, which is associated with higher RAI treatment failure, although this effect is perhaps smaller than previously thought. 16 Immediate side effects of RAI are rare and include transient nausea and pain over the thyroid gland 1-3 days after administration.…”

“…16 Furthermore, the use of carbimazole or methimazole prior to RAI is preferred over the use of propylthiouracil, which is associated with higher RAI treatment failure, although this effect is perhaps smaller than previously thought. 16 Immediate side effects of RAI are rare and include transient nausea and pain over the thyroid gland 1-3 days after administration. 17 Thyroid storm may occur rarely after RAI, particularly in those with large goiters and severe hyperthyroidism.…”

Változások a pajzsmirigybetegségek radiojódkezelésében

“…Több probléma tisztázódott a preterápiás metimazolkezeléssel kapcsolatban: 14 tanulmány összesítése alapján állítható, hogy ez a sikertelen izotópkezelések számát növeli, és a terápia utáni hypothyreosisok valószínűségét csökkenti [9], bár ez nem egyértelműen elfogadott. Megváltoztatja a jódkinetikát, a radioszenzitivitást, szabadgyök-fogó.…”