Radioiodine therapy in patients with Graves′ disease and the effects of prior carbimazole therapy

Karyampudi, Arun; Hamide, Abdoul; Halanaik, Dhanapathi; Sahoo, Jaya Prakash; Kamalanathan, Sadishkumar

doi:10.4103/2230-8210.139234

Cited by 10 publications

(1 citation statement)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the role of antithyroid drugs remains heavily debated in literature, as multiple studies either find no change in therapeutic outcome [20,21], or suggest an inverse correlation between the use of antithyroid drugs before RAI and hypothyroidism or therapeutic efficacy after treatment [15]. Larger and prospective randomized controlled trials are needed to prove the true role of this kind of pretreatment.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

The Presence of Anti-TPO Antibodies Increase the Likelihood of Post-I131 Hypothyroidism

Quataert,

Bravenboer,

Keyaerts

et al. 2023

Horm Metab Res

View full text Add to dashboard Cite

The use of radioactive iodine in the treatment of hyperthyroidism is common practice. However, a standardized treatment protocol with regard to radioactive iodine treatment (RAI) remains subject to discussion. We retrospectively analyzed 100 patient records. Patient diagnosis, age, gender, body mass index (BMI), dose of radioactive iodine, thyroid size, the 24h radioiodine uptake (24h RAIU) and protein bound iodine (PBI) were deducted, as well as the use of antithyroid drugs prior to RAI. Biochemical parameters were obtained, such as TSH, fT4, fT3, Anti-TPO, Anti-TG antibodies and thyroid stimulating antibodies. After 5 years of follow-up, 46% of the patients proved to be hypothyroid, whereas 8% of the patients were not cured after one dose of RAI. One year after RAI, a larger proportion of patients with a toxic nodule developed hypothyroidism compared to patients with a multinodular goitre (MNG) (44.2% vs. 21.2%). Radioactive iodine dose, PBI, RAIU, BMI, size of the thyroid gland, diagnosis, age and TPO-antibodies showed statistically significant differences in the development of hypothyroidism. Furthermore, thiamazole pretherapy was shown to be a predictor of hypothyroidism, as well as a high PBI value, exhibiting a positive predictive value of 85.2% when the PBI exceeded 0.16. We suggest a standardized measurement of TPO-Ab’s to further determine their role in the development of hypothyroidism after RAI. The empirical dosing regimen was very effective, illustrating a 92% cure rate after 1 dose. We suggest a lowering of therapeutic dosage in patients with PBI values ranging from 0.17 to 0.39 to minimize hypothyroidism after RAI.

show abstract

Section: Accepted Manuscriptmentioning

confidence: 99%

The Presence of Anti-TPO Antibodies Increase the Likelihood of Post-I131 Hypothyroidism

Quataert,

Bravenboer,

Keyaerts

et al. 2023

Horm Metab Res

View full text Add to dashboard Cite

show abstract

Response to Radioiodine Therapy for Thyrotoxicosis: Disparate Outcomes for an Indigenous Population

Tamatea

Conaglen

Elston

2016

International Journal of Endocrinology

View full text Add to dashboard Cite

Despite 70 years of experience treating thyrotoxic patients with radioiodine not all patients are successfully treated by a single dose. Multiple factors predicting radioiodine efficacy have been reported. The aim of this study was to assess whether ethnicity was associated with radioiodine response. A retrospective review was performed of patients who received radioiodine therapy for thyrotoxicosis from 1 January 2008 to 31 December 2010 and had follow-up available of a minimum of 12 months. 224 patients were included, 82.4% female, and 63.7% had Graves's disease. Radioiodine failed in 21.5% of patients overall, with a higher failure rate in the indigenous population (35.2%). When controlling for other influencing factors by logistic regression, there continued to be an increased risk for the indigenous group (OR 2.82) and those treated with antithyroid drugs following radioiodine (OR 2.04). Younger age was also associated with an increased risk of failing radioiodine therapy (OR 0.97 for each year of age). Cure rates following radioiodine were lower for indigenes independent of factors known to affect radioiodine outcome. This is the first report demonstrating ethnicity as a possible independent variable for radioiodine efficacy. Further work is needed to investigate the cause of this difference.

show abstract

The effect of prior antithyroid drug use on delaying remission in high uptake Graves' disease following radioiodine ablation

Subramanian¹,

Baby²,

Seshadri³

2016

Endocrine Connections

View full text Add to dashboard Cite

Antithyroid drugs (ATDs) have been shown to attenuate the effectiveness of radioiodine (radioiodine ablation, RIA) therapy in Graves' disease. We undertook a study to look at the impact of iodine uptakes on the outcome of 131 I therapy. To determine the effect of prior ATD use on the duration of time to achieve cure in patients with high vs intermediate uptake Graves' disease who received a fixed dose (15 mCi) of 131 I radioiodine. In a retrospective study of patients with Graves' disease, 475 patients who underwent RIA were followed-up on a twomonthly basis with thyroid function tests. Of the 123 patients with a documented preablation RAIU and consistent follow-up it was observed that 40 patients had an intermediate RAIU (10-30%) and 83 subjects had a distinctly increased uptake (O30%). Successful cure was defined as the elimination of thyrotoxicosis in the form of low free thyroxin and rising TSH levels. When a standard dose of 15 mCi 131 I was administered, a cure rate of 93% was achieved. The median duration of time to cure (TC) was 129 days. Surprisingly, a direct proportional linear relationship (R 2 Z0.92) was established between time to cure and radioiodine uptake (TC O30% Z172days, TC 10-30% Z105 days, P!0.001). Patients who used ATD medications took a proportionately longer duration to achieve remission (TC NO ATD Z102days, TC ATD Z253days, P!0.001). The effect of prior ATD therapy in delaying remission was amplified in the subset of patients with higher uptakes (TC O30%CATD Z310days, TC O30%CNO ATD Z102days, P!0.001) compared to those with the intermediate uptakes (TC 10-30%CATD Z126 days, TC 10-30%CNO ATD Z99 days, P!0.001). RIA, using a dose of 15 mCi achieved a high cure rate. Higher uptakes predicted longer time to achieve remission, with prior ATD use amplifying this effect.

show abstract

Radioiodine therapy in patients with Graves′ disease and the effects of prior carbimazole therapy

Cited by 10 publications

References 20 publications

The Presence of Anti-TPO Antibodies Increase the Likelihood of Post-I131 Hypothyroidism

The Presence of Anti-TPO Antibodies Increase the Likelihood of Post-I131 Hypothyroidism

Response to Radioiodine Therapy for Thyrotoxicosis: Disparate Outcomes for an Indigenous Population

The effect of prior antithyroid drug use on delaying remission in high uptake Graves' disease following radioiodine ablation

Contact Info

Product

Resources

About