Clinical and biochemical changes following 131I therapy for hyperthyroidism in patients not pretreated with antithyroid drugs
Abstract
Background Radioiodine therapy (131I) for the treatment of hyperthyroidism has been shown to be effective and safe. Despite the extensive experience with radioiodine therapy, the necessity for pretreatment with antithyroid drugs is controversial. Pretreatment is partly based on the concept that antithyroid drugs deplete the thyroidal hormonal stores, thereby reducing the risk of a radioiodine-induced aggravation of hyperthyroidism or thyroid storm. Few data are available on the frequency of clinically significant exacerbations of hyperthyroidism following 131I therapy without prior treatment with antithyroid drugs. The aim of the present study was to determine prospectively the early clinical and biochemical changes after 131I therapy in patients who were not pretreated with antithyroid drugs.Methods Patients with Graves' disease (n = 21), toxic multinodular goiter (n = 11) or toxic adenoma (n = 2) were studied before and after 131I therapy. Clinical and biochemical parameters of thyroid function were investigated before and 1, 2, 8, 11, 18 and 25 days after 131I treatment. Patients were given no antithyroid drugs prior to 131I therapy, all patients received beta-blocking agents for symptomatic relief.Results In 19 of 34 patients, a transient increase in thyroid hormone levels was observed, predominantly in the first week following 131I therapy. None of these patients experienced worsening of thyrotoxic symptoms. This transient increase in thyroid hormone levels was demonstrated in all patients with toxic multinodular goiter, whereas it was found in only six of 21 patients with Graves' disease. This difference could not readily be explained by differences in pretreatment thyroid hormone levels, administered dose or effectively absorbed dose of 131I.Conclusions 131I treatment of hyperthyroidism without pretreatment with antithyroid drugs may cause a transient increase in thyroid hormone levels. Clinically significant exacerbations of hyperthyroidism were, however, not observed in our study population. Increased hormone levels following 131I therapy were more often seen in patients with toxic multinodular goiter than in patients with Graves' disease.
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Worsened chemical hyperthyroidism with increased heart rate and rare supraventricular tachycardia, including atrial fibrillation and atrial flutter, have been observed in patients treated with RAI for TMNG or nontoxic MNG.
“Worsened chemical hyperthyroidism with increased heart rate and rare cases of supraventricular tachycardia, including atrial fibrillation and atrial flutter, have been observed in patients treated with RAI for either TMNG or nontoxic multinodular goiter (MNG) (267-269).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [269]
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- Authors
- Koornstra, J.
- Affiliations
- Medisch Centrum Leeuwarden (NL)
- Corresponding author
- Koornstra, J
- Venue
- The Netherlands Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 1999-11
- Volume
- 55
- Issue
- 5
- Pages
- 215-221
- ISSN
- 0300-2977 (ISSN-L)
- OpenAlex
- W1977970957
- Cited by
- 36
- References
- 22
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 1 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 4 · 2014: 2 · 2013: 1 · 2012: 1
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Netherlands Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- radioiodine therapy, iodine-131, hyperthyroidism, Graves' disease, toxic multinodular goiter, toxic adenoma, transient hyperthyroidism, thyroid hormone levels, thyroid storm, beta-blockers
- MeSH terms
- Adenoma, Adult, Aged, Female, Goiter, Nodular, Graves Disease, Humans, Hyperthyroidism, Iodine Radioisotopes, Male, Middle Aged, Premedication, Prospective Studies, Antithyroid Agents, Thyroid Function Tests, Thyroid Hormones, Thyroid Neoplasms, Treatment Outcome, Drug Monitoring
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