Pretreatment with Propylthiouracil But Not Methimazole Reduces the Therapeutic Efficacy of Iodine-131 in Hyperthyroidism

Imseis, Raed; VanMiddlesworth, Lester; Massie, James D.; Bush, Andrew; Vanmiddlesworth, N. Rue

doi:10.1210/jcem.83.2.4538

Cited by 101 publications

(32 citation statements)

References 12 publications

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“…It is more than likely that patients with the mildest degrees of hyperthyroidism initially were over-represented in the group receiving no adjunctive antithyroid drugs. In the most recent retrospective studies, the radioprotective effect of propylthiouracil was shown to persist for at least 7 days (48,49), and as long as 55 days (50).…”

Section: Propylthiouracilmentioning

confidence: 99%

Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres

Bonnema

Bartalena

Toft

et al. 2002

European Journal of Endocrinology

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In routine use for more than 50 years, radioiodine ( 131 I) is generally considered safe and devoid of major side effects. Therefore, it is surprising that relatively many aspects of radioiodine therapy are controversial, as illustrated by recent international questionnaire studies. Our review aims at highlighting three of these areas -namely, the influence of 131 I on the course of Graves' ophthalmopathy, the possible radioprotective effects of antithyroid drugs, and the use of 131 I in large goitres. 131 I therapy carries a small (but definite) risk of causing progression of Graves' ophthalmopathy. Identification of risk factors (thyroid dysfunction, high level of thyroid-stimulating hormone (TSH) receptor antibodies, cigarette smoking) allows the identification of patients at risk and the institution of concomitant glucocorticoid treatment, thereby hindering progression of eye disease.On the basis, largely, of retrospective data, it appears that carbimazole (or methimazole), if stopped 3-5 days before treatment, does not influence the outcome of 131 I therapy. Simultaneous thyrostatic medication most probably reduces the efficacy of 131 I, as does restarting it within 7 days. Propylthiouracil seems to have a more prolonged radioprotective effect than carbimazole.Surgery is the treatment of first choice in patients with a large goitre. However, in the case of patient ineligibility or preference, 131 I therapy may be an option. The treatment has a favourable effect on tracheal compression and inspiratorycapacity, but the reduction in thyroid volume is only 30-40%. Inpatient treatment, necessitated by the large doses, makes the treatment cumbersome.Controversy related to radioiodine therapy is mainly based on the lack of adequate prospective randomised studies comparing efficacy, side effects, cost and patient satisfaction.

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Section: Propylthiouracilmentioning

confidence: 99%

Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres

Bonnema

Bartalena

Toft

et al. 2002

European Journal of Endocrinology

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“…Embora o efeito do 131 I na oftalmopatia ainda seja controverso, estudos recentes, bem conduzidos, sugerem que a piora da oftalmopatia relacionada ao tratamento é transitória e pode ser prevenida pelo uso concomitante de glicocórticoides (63). O tratamento com 131 I apresenta como principal efeito colateral uma alta incidência de hipotireoidismo permanente, cuja freqüência no primeiro ano de tratamento varia de acordo com a dose de 131 I administrada (64), enquanto que a incidência posterior (3% ao ano) depende de fatores imunológicos (65), da associação ou não com drogas antitireoidianas (66), tamanho do bócio (67), radiosensibilidade individual, homogeneidade da distribuição de iodo na glândula tireóide e duração do seguimento dos pacientes tratados (68). Hipotireoidismo transitório pode ocorrer no período de 2 a 5 meses após o uso do radioisótopo (9-58% dos casos) (69).…”

Section: Iodo Radioativo Iodo Radioativounclassified

Tratamento do hipertireoidismo da Doença de Graves

Andrade

Gross

Maia

2001

Arq Bras Endocrinol Metab

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A Doença de Graves constitui a forma mais comum de hipertireoidismo e três abordagens terapêuticas são atualmente utilizadas: drogas antitireoidianas (DAT), cirurgia e iodo radioativo (131I). As DAT continuam como tratamento de primeira escolha em pacientes com doença leve, bócios pequenos, crianças e adolescentes, e em situações especiais como na gravidez. Por outro lado, o 131I tem sido cada vez mais utilizado, porque é considerado um tratamento seguro, definitivo e de fácil aplicação. O risco de exacerbação do hipertireoidismo após administração do 131I, os fatores prognós-ticos de falência e o cálculo da dose administrada têm sido alguns dos aspectos discutidos na literatura recentemente, e são particulamente comentados nesta revisão. O tratamento cirúrgico constitui quase um tratamento de exceção, com indicação para os casos em que as terapias anteriores não possam ser utilizadas. ABSTRACT ABSTRACTGraves' disease is the most frequent cause of hyperthyroidism and current treatments consist of antithyroid drugs (ATD), radioiodine (131I) and surgery. ATD are the first choice of treatment in patients with mild disease, small goiters, children, adolescents and in special situations as pregnancy. On the other hand, 131I is increasingly being used as definitive therapy, because it long has proven to be a safe, cheap and effective treatment. The risk of exacerbation of hyperthyroidism after 131I administration, factors that may predict the response to radioiodine and the dose to be administrated have been discussed in the literature and we comment the controversies in this review. Surgery is rarely employed, and it is indicated only in cases where ATD have not been effective, radioiodine is contraindicated or not acceptable to the patients. A DOENÇA DE GRAVES CONSTITUI A FORMA mais comum de hipertireoidismo (60%-80%), afetando principalmente as mulheres (5-10:1) entre 40-60 anos (1). Na Inglaterra apresenta uma prevalência de 2% em mulheres e 0,2% em homens, enquanto nos EUA estima-se que acometa 0,4% da população (2). A maioria dos estudos relata taxas de incidência de 0,5/1000 indivíduos/ano e o risco calculado de mulheres e homens desenvolverem hipertireoidismo em alguma fase de suas vidas é de 5% e 1% respectivamente (3).O hipertireoidismo da Doença de Graves é caracterizado imunologicamente por infiltração linfocitária da glândula tireóide e por ativação

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“…Despite its efficacy, radioiodine therapy (RAIT) fails in 10-50% of cases (4). The success of RAIT is influenced by many variables, including gender, age, thyroid volume, prior use of antithyroid drugs and baseline free thyroxine (FT4) levels; however, none of these variables reliably predict the outcome after RAIT (5)(6)(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Low iodine diet does not improve the efficacy of radioiodine for the treatment of Graves’ disease

Santarosa

Orlandi

Fiorin

et al. 2015

Arch. Endocrinol. Metab.

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Objective: Consuming a low-iodine diet (LID) is a widely accepted practice before administering radioiodine ( 131 I) to evaluate and to treat thyroid disease. Although this procedure is well established for the management of patients with differentiated thyroid cancer, its use in patients with benign disease is unclear. So, we aimed to evaluate the influence of a LID on the outcome in patients with Graves' disease (GD) treated with 131 I. Subjects and methods: We evaluated 67 patients with GD who were divided into 2 groups: one group (n = 31) consumed a LID for 1-2 weeks, and the second group (n = 36) was instructed to maintain a regular diet (RD). Results: The LID group experienced a 23% decrease in urinary iodine after 1 week on the diet and a significant 42% decrease after 2 weeks on the diet. The majority (53%) of the patients in the LID group had urinary iodine levels that were consistent with deficient iodine intake. However, there was no difference in the rate of hyperthyroidism's cure between the LID and the RD groups 6 months after 131 I therapy. Furthermore, the therapeutic efficacy did not differ in patients with varying degrees of sufficient iodine intake (corresponding urinary iodine levels: < 10 μg/dL is deficient; 10-29.9 μg/dL is sufficient; and > 30 μg/dL is excessive). Conclusion:In the present study, we demonstrated that although a LID decreased urinary iodine levels, those levels corresponding with sufficient or a mild excess in iodine intake did not compromise the therapeutic efficacy of 131 I for the treatment of GD. Arch Endocrinol Metab. 2015;59(6):501-6

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Pretreatment with Propylthiouracil But Not Methimazole Reduces the Therapeutic Efficacy of Iodine-131 in Hyperthyroidism

Cited by 101 publications

References 12 publications

Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres

Controversies in radioiodine therapy: relation to ophthalmopathy, the possible radioprotective effect of antithyroid drugs, and use in large goitres

Tratamento do hipertireoidismo da Doença de Graves

Low iodine diet does not improve the efficacy of radioiodine for the treatment of Graves’ disease

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