Optimal iodine supplementation during antithyroid drug therapy for Graves’ disease is associated with lower recurrence rates than iodine restriction

Huang, Huibin; Shi, Yue; Liang, Bo; Cai, Huiyao; Cai, Qingyan; Lin, Ruhai

doi:10.1111/cen.13543

Cited by 14 publications

(8 citation statements)

References 25 publications

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“…A recent prospective study in China compared treatment outcomes of ATD in Graves’ patients with iodine supplementation (urinary iodine concentration [UIC], 135 to 162 μg/L) with those of patients with iodine restriction (UIC 30 to 58 μg/L) [ 56 ]. The recurrence rate within 12 months after stopping ATD was significantly lower in the iodine supplementation group than in the iodine-restricted group (35.5% vs. 45.5%).…”

Section: Iodine Intake During Treatment Of Graves’ Diseasementioning

confidence: 99%

Antithyroid Drug Treatment in Graves’ Disease

Chung

2021

Endocrinol Metab

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Graves' disease is associated with thyrotropin (TSH) receptor stimulating antibody, for which there is no therapeutic agent. This disease is currently treated through inhibition of thyroid hormone synthesis or destruction of the thyroid gland. Recurrence after antithyroid drug (ATD) treatment is common. Recent studies have shown that the longer is the duration of use of ATD, the higher is the remission rate. Considering the relationship between clinical outcomes and iodine intake, recurrence of Graves' disease is more common in iodine-deficient areas than in iodine-sufficient areas. Iodine restriction in an iodine-excessive area does not improve the effectiveness of ATD or increase remission rates. Recently, Danish and Korean nationwide studies noted significantly higher prevalence of birth defects in newborns exposed to ATD during the first trimester compared to that of those who did not have such exposure. The prevalence of birth defects was lowest when propylthiouracil (PTU) was used and decreased by only 0.15% when methimazole was changed to PTU in the first trimester. Therefore, it is best not to use ATD in the first trimester or to change to PTU before pregnancy.

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Section: Iodine Intake During Treatment Of Graves’ Diseasementioning

confidence: 99%

Antithyroid Drug Treatment in Graves’ Disease

Chung

2021

Endocrinol Metab

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“…After 9 months of intervention, the TRAb in the insufficient iodine intake (iodine restriction) group began to be significantly higher than that in the adequate iodine intake (iodine supplementation) group ( P < 0.001), which lasted until the end of follow-up (24 months). The overall recurrence rate was significantly higher in the insufficient iodine intake group than in the adequate iodine intake group within 12 months after ATD withdrawal (45.5% vs. 35.5%, HR = 1.381, P = 0.04) ( 16 ).…”

Section: Resultsmentioning

confidence: 99%

Effect of iodine nutritional status on the recurrence of hyperthyroidism and antithyroid drug efficacy in adult patients with Graves’ disease: a systemic review

Xie,

Zhang,

et al. 2023

Front. Endocrinol.

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AimTo probe the appropriate iodine nutritional status for patients with Graves’disease (GD) hyperthyroidism and on antithyroid drugs (ATD) or after drugwithdrawal.MethodStudies were retrieved from three databases (Embase, Medline, and Cochrane Library) and were screened and evaluated using predefined criteria. The risk of bias of each trial was assessed using a tool from Cochrane. The iodine nutritional status of the subjects was redefined according to the World Health Organization (WHO) criteria and classified as insufficient/adequate/above requirements/excessive iodine intake.ResultTwo randomized controlled trials (RCTs) and 3 observational studies were selected from the 376 retrieved papers, which had different degrees of risk of bias in study design. The heterogeneity among them prevented us from further synthesizing effect indicators and subsequent statistical analyses. Two RCTs with high quality showed that insufficient or above requirements iodine intake was detrimental for ATD-treated GD patients; adequate iodine intake was associated with a lower risk of recurrence and better efficacy in controlling thyrotoxicosis. It could be speculated from three low-quality observational studies that excessive iodine intake may be associated with higher (or similar) recurrence rates and lower remission rates compared to above requirements iodine intake in these patients, but none of them could answer the question of the effect of insufficient or adequate iodine intake on this issue.ConclusionAlthough the available evidence is suboptimal, this systematic review tentatively suggests that in adult patients with GD hyperthyroidism receiving ATDs and according to WHO criteria for iodine nutritional status, adequate iodine intake is associated with a lower recurrence rate, a higher remission rate and a better efficacy to control thyrotoxicosis than insufficient, above requirement, or excessive iodine intake. Future RCTs with large samples are expected to elucidate the actual impact of different iodine nutritional statuses on the recurrence rate of hyperthyroidism and the efficacy of ATD to control thyrotoxicosis in these patients.Systematic review registrationidentifier CRD42022359451.

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“…However, the above feedback currently lacks evidence-based assessment. An RCT in China found that if GD patients were supplied with adequate iodine during medication, the relapse risk could be significantly reduced ( 20 ). A retrospective survey in South Korea found that GD patients with different clinical outcomes after drug withdrawal had no significant difference in urinary iodine levels, and GD patients with different iodine intakes had no significant differences in relapse or remission rate after drug withdrawal ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

A Chinese survey on clinical practice in hyperthyroidism management: comparison with recent studies and guidelines

Wang

Teng

et al. 2021

Endocrine Connections

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Objective: To conduct a questionnaire survey of the current clinical practice for overt hyperthyroidism in China. Methods: An online questionnaire survey was conducted in July 2020. The two questionnaires covered 35 and 8 questions about nonpregnancy and pregnancy clinical practice for overt hyperthyroidism, respectively. Results: One thousand, two hundred fifty-six physicians participated. Chief physicians and associate chief physicians accounted for 58.6% of the participants. Approximately 95.2% of the respondents chose the thyrotropin receptor antibody (TRAb) test to clarify the etiology of thyrotoxicosis, while only 27.0% of them chose radioactive iodine uptake (RAIU). In terms of the treatment for nonpregnant patients, antithyroid drugs (ATDs) were the first choice, and most of the clinicians chose methimazole. Compared with clinicians in recent studies, Chinese physicians used serum TRAb to diagnose Graves’ disease more commonly, and there were obviously more physicians preferring ATDs. For maternal hyperthyroidism, most physicians preferred propylthiouracil administration before or during the first trimester, which is consistent with the 2016 American Thyroid Association (ATA) guidelines. In terms of the initial ATD dose, monitoring of the treatment process, indications for ATD withdrawal, and treatment of special cases, the preferences of Chinese physicians were generally consistent with the guidelines. Conclusion: Chinese physicians can generally follow the ATA guidelines for the diagnosis and treatment of hyperthyroidism. Moreover, there are small differences from foreign studies or the guidelines with respect to particular problems. These findings provide evidence for future clinical research in China.

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Optimal iodine supplementation during antithyroid drug therapy for Graves’ disease is associated with lower recurrence rates than iodine restriction

Abstract: Optimal dietary iodine supplementation during antithyroid drug therapy for GD is associated with lower recurrence rates than iodine restriction, and therefore, diet control with strict iodine restriction might be an adverse factor in the management of GD.

Cited by 14 publications

References 25 publications

Antithyroid Drug Treatment in Graves’ Disease

Antithyroid Drug Treatment in Graves’ Disease

Effect of iodine nutritional status on the recurrence of hyperthyroidism and antithyroid drug efficacy in adult patients with Graves’ disease: a systemic review

A Chinese survey on clinical practice in hyperthyroidism management: comparison with recent studies and guidelines

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