Incidence of Radioiodine Induced Graves' Disease in Patients with Multinodular Toxic Goiter
Abstract
In this study, we assessed the incidence of Graves' disease (GD) following radioiodine therapy (RIT) in a large cohort of well characterized patients with autonomy in comparison to the clinical course of control patients with thyroidal autonomy not definitively treated with (131)I or surgery. 622 consecutive patients were treated with (131)I for autonomy (unifocal: n = 321; multifocal: n = 199; disseminated: n = 102) and followed up for at least 6 months post RIT. 108 consecutive patients with autonomy not definitively treated (unifocal: n = 49; multifocal: n = 42; disseminated: n = 11) followed up for at least 6 months served as controls. Initial evaluation and follow-up included determination of FT3, FT4, TSH, autoantibodies against the thyroid peroxidase (anti-TPO) and TSH-receptor antibodies (TRAb) by highly sensitive radio receptor-assay, quantitative thyroid scintigraphy and sonography. After 6 months, GD was newly diagnosed in 1/321 patients with unifocal autonomy, in 1/199 patients with multifocal autonomy and in 0/108 control patients. In patients with disseminated autonomy (group C), GD was diagnosed significantly more often compared to the other groups (5/102 patients; 4,1 %; p < 0.05). In conclusion, RIT may induce Graves' disease in a few cases with toxic multinodular goiter. The incidence in this population is small. Compared with patients suffering from uni- or multifocal autonomy, subjects with disseminated autonomy have a more than tenfold higher risk for the development of GD.
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GD might develop after RAI for TMNG in up to 4% of patients.
“GD might develop after RAI for TMNG in up to 4% of patients (280).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [280]
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Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938 · see citing works
“GD might develop after RAI for TMNG in up to 4% of patients (280).”
BackgroundMiller, F. W., Alfredsson, L. S., Costenbader, K. H., Kamen, D. L., Nelson, L. M., Norris, J. M., & Roos, A. J. D. (2012) · Journal of Autoimmunity · doi:10.1016/j.jaut.2012.05.002 · Cited by 360 · see citing works
“Radioiodine therapy for nodular toxic goiter or toxic adenoma can cause GD [63].”
BackgroundRadioactive Iodine: A Living History
Daniels, G. H., & Ross, D. S. (2023) · Thyroid · doi:10.1089/thy.2022.0344 · Cited by 24 · see citing works
“In addition, Graves’ disease develops in up to 4% of RAI-treated patients with toxic nodular goiter (53) presumably due to an immune response to released thyroid antigens.”
Therapy of large multinodular goitre using repeated doses of radioiodine
Bączyk, M., Pisarek, M., Czepczyński, R., Ziemnicka, K., Gryczyńska, M., Pietz, L., & Sowiński, J. (2009) · Nuclear Medicine Communications · doi:10.1097/mnm.0b013e328320eb03 · Cited by 11 · see citing works
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“Graves’ disease after radioactive iodine treatment for toxic nodular goiter was reported previously [12].”
BackgroundRoque, C., & Vasconcelos, C. A. (2018) · Journal of Endocrinological Investigation · doi:10.1007/s40618-018-0827-y · Cited by 9 · see citing works
Toxic Adenoma and Multinodular Toxic Goiter
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“(v) Thyrotoxicosis may be observed early after RAI treatment, secondary to RAI-induced inflammation (actinic thyroiditis) that results in release of thyroid hormones (3).”
BackgroundToxic Adenoma and Multinodular Toxic Goiter
Tonacchera, M., & Führer, D. (2017) · Endocrinology · doi:10.1007/978-3-319-29195-6_18-1 · Cited by 1 · see citing works
123I Scintigraphy Mirror Image of Graves Disease Induced by Radioiodine Treatment for Toxic Adenoma
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Radioactive Iodine-Induced Graves' Disease in a Patient with Toxic Adenoma
Yoon, S., Shin, K., Cho, E., & Kim, M. J. (2015) · Journal of Korean Thyroid Association · doi:10.11106/cet.2015.8.1.98
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A systematic review and meta-analysis of treatment outcome after I-131 for solitary toxic adenoma
van der Meeren, M. M. D., Roerink, S. H. P. P., Konings, M., Wever, K. E., Vriens, D., & Oyen, W. J. G. (2026) · The EANM Journal · doi:10.1016/j.eanmj.2026.100224
- Authors
- Meller, J., Siefker, U., Hamann, A., & Hüfner, M.
- Affiliations
- University of Göttingen (DE)
- Venue
- Experimental and Clinical Endocrinology & Diabetes
- Publisher
- Georg Thieme Verlag KG
- Published
- 2006-06-28
- Volume
- 114
- Issue
- 05
- Pages
- 235-239
- ISSN
- 0947-7349 (ISSN-L)
- 1439-3646
- OpenAlex
- W1981216176
- Cited by
- 19
- References
- 0
- Citations by year
- 2026: 1 · 2023: 1 · 2022: 2 · 2021: 1 · 2018: 2 · 2017: 2 · 2016: 1 · 2015: 1 · 2012: 2
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Experimental and Clinical Endocrinology & Diabetes (publishedVersion)
- PubMed (publishedVersion)
- GRO (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
- Graves' disease, radioiodine therapy, iodine-131, toxic multinodular goiter, thyroid autonomy, thyroid peroxidase antibodies, TSH receptor antibodies, incidence
- MeSH terms
- Adult, Aged, Female, Follow-Up Studies, Goiter, Nodular, Graves Disease, Humans, Iodine Radioisotopes, Male, Middle Aged, Radiation Injuries, Radiotherapy Dosage, Retrospective Studies, Cohort Studies, Incidence
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