Radioactive iodine (131I) therapy for thyrotoxicosis at Groote Schuur Hospital over a 6-year period

Sagel, Julius; Epstein, Sol; Kalk, John; Mieghem, W. Van

doi:10.1136/pgmj.48.559.308

Cited by 10 publications

(4 citation statements)

References 25 publications

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“…In our patient, RAI therapy with only 6 mCi led to postablative hypothyroidism in 2002 but within a few months to hypocalcemia from hypoparathyroidism (November 2001) which is unusual. The percentage of patients who became hypothyroid post RAI therapy at a similar irradiation dose (6 mCi) as our patient was 21% in one study, while another study showed transient decline in PTH levels over time (6,20). (22,23).…”

Section: Discussionmentioning

confidence: 44%

“…The percentage of patients who became hypothyroid post RAI therapy at a similar irradiation dose (6 mCi) as our patient was 21% in one study, while another study showed transient decline in PTH levels over time (6,20). Glazebrook et al (21) investigated prospectively the relations between RAJ therapy (high doses) and secondary hypoparathyroidism and postulated a possible compromised parathyroid reserve prior to the inflicting event.…”

Section: Discussionmentioning

confidence: 99%

“…Following external irradiation, hypoparathyroidism (1)(2)(3) or hyperparathyroidism (4,5) have been reported. Postablative hypothyroidism occurs in up to 70% of patients with GD, depending on the dose of radioactive iodine (RAI) and duration of time postablation (6). GD can coexist with autoimmune hypoparathyroidism (7) or concomitant idiopathic hypoparathyroidism and SLE (8).…”

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confidence: 99%

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Graves' Disease, Hypoparathyroidism, Systemic Lupus Erythematosus, Alopecia, and Angioedema: Autoimmune Polyglandular Syndrome Variant or Coincidence?

Melcescu

Kemp

Majithia

et al. 2013

Int J Immunopathol Pharmacol

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Data on coexisting Graves' disease (GD), hypoparathyroidism, and systemic lupus erythematosus (SLE) are limited. The thyroid and parathyroid glands may be extra sensitive to irradiation damage in an underlying autoimmune condition. A 34-year-old black woman presented with tetanic-like cramps, easy skin bruising, fatigue, weight gain, nocturia and back pain. She was previously diagnosed with GD in 2001 and underwent radioiodine therapy (RAI) in 9/01 using 6 mCi. PostRAI (November 2001) she developed hypocalcemia and hypothyroidism (2/02). In 2007, SLE was diagnosed. In October 2009, s-calcium and PTH were still low at 7.1 mg/dl and 9 pg/mL, respectively, although the patient denied symptoms on vitamin D and calcium supplementation. To identify possible autoimmune damage of the parathyroids, we evaluated the presence of activating antibodies to the CaSR and also analyzed the DNA sequence of all 6 translated exons and flanking intronic sequences of her CaSR gene for a functionally significant CaSR mutation but neither was positive. The initial autoimmune damage to her thyroid and possibly parathyroid glands followed by irradiation of them seems to have contributed to her developing both hypoparathyroidism (11/01) and hypothyroidism (2002). The patient could potentially have had parathyroid autoantibodies in 2001 that disappeared by 2009 when she was tested for them. We consider that the multiple autoimmune conditions developed over the past decade of her life with the concurrent irradiation contributing to her brittle hypoparathyroidism. Select patients with GD and perhaps parathyroid autoantibodies with a slowly developing destructive impact on the parathyroid glands may then develop overt hyoparathyroidism with rather low dose RAI ablation. This patient adds to the evolving spectrum of polyglandular syndrome variants.Here, we report a patient presenting with an interesting sequential combination of Graves' disease (GD), hypoparathyroidism, alopecia, and systemic lupus erythematosus (SLE). Hypocalcemia

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Section: Discussionmentioning

confidence: 44%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Graves' Disease, Hypoparathyroidism, Systemic Lupus Erythematosus, Alopecia, and Angioedema: Autoimmune Polyglandular Syndrome Variant or Coincidence?

Melcescu

Kemp

Majithia

et al. 2013

Int J Immunopathol Pharmacol

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“…It should be borne in mind however that mild hypothyroidism may be temporary following thyroidectomy (Toft et al , 1976), and the diagnosis of permanent hypothyroidism should not be made with confidence until 6 months have elapsed after partial thyroidectomy. Temporary hypothyroidism has also been described after treatment with I 131 (Sagel et al , 1972).…”

Section: Aetiologymentioning

confidence: 99%