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Cited by 84Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

Transition of Nodular Toxic Goiter to Autoimmune Hyperthyroidism Triggered by 131I Therapy

NYGAARD, BIRTE, FABER, JENS, VEJE, ANNEGRETE, HEGEDÜS, LASZLO, HANSEN, JENS MØLHOLM·1999·Thyroid
DOI 10.1089/thy.1999.9.477
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Abstract

The use of 131I treatment in nodular toxic goiter is widely accepted. In this article, we describe transition of nodular toxic goiter into an autoimmune toxic goiter with development of thyrotropin receptor antibodies (TRAb) as a side effect of 131I treatment. In this retrospective study, 149 patients with nodular toxic goiter (100 with multinodular goiter, 49 with a solitary autonomously functioning toxic nodule) were studied. Of these 149 patients 100 became permanently euthryoid after 1 dose of 131I, and due to persistent hyperthyroidism, 32 patients needed 2-5 doses to became euthyroid. After becoming euthyroid, none of these 132 patients had relapse of hyperthyroidism in the follow-up period. Based on evaluation of the thyroid hormone variables, 17 of 149 patients had a distinctly different pattern in the changes in thyroid hormones. They developed an increase in FT4I 3-6 months posttreatment after an initial fall in FT4I. Twelve of these 17 patients were treated with antithyroid drugs before the initial 131I dose. On samples of frozen sera (-20 degrees C) anti-thyroid peroxidase (TPO) and TRAb were followed for 6 months after 131I treatment in these 17 patients. A similar follow-up was done in 20 patients (10 with and 10 without antithyroid drug pretreatment), randomly selected from the patients who did not relapse. In the remaining 112 patients, anti-TPO and TRAb levels were measured only before the 131I treatment. Of the 17 patients with relapse, 6 developed TRAb concomitant with recurrence of hyperthyroidism (4% of the study group). In 5 of the 17 patients TRAb values remained absent throughout the follow-up period. The remaining 6 patients had elevated TRAb values before 131I treatment. Among the 132 patients who did not relapse, an additional 7 cases with presence of TRAb were found. A total of 9% of the study group was found to have TRAb before 131I pretreatment. Anti-TPO was found in 20 of 149 patients (13%) before 131I treatment. Complications, either hypothyroidism or TRAb-associated hyperthyroidism, were seen in 8 of 20 patients (40%) with anti-TPO before 131I treatment, compared to 9 of 129 (7%) without (p<0.005). In conclusion, TRAb and a Graves' like hyperthyroidism can be triggered by 131I treatment in patients with nodular toxic goiter. The presence of anti-TPO seem to be a marker of an increased risk of development of TRAb-associated hyperthyroidism as well as hypothyroidism, but both side effects can be seen despite the absence of anti-TPO autoantibodies.

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Authors
NYGAARD, B., FABER, J., VEJE, A., HEGEDÜS, L., & HANSEN, J. M.
Affiliations
University of Copenhagen (DK)
ORCID
Venue
Thyroid
Publisher
SAGE Publications
Published
1999-05
Volume
9
Issue
5
Pages
477-481
ISSN
  • 1050-7256 (ISSN-L)
  • 1557-9077
DOI
10.1089/thy.1999.9.477
OpenAlex
W2025677531
Cited by
84
References
19
Citations by year
2025: 2 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 4 · 2019: 2 · 2018: 1 · 2017: 4 · 2016: 3 · 2015: 4 · 2014: 5 · 2013: 1 · 2012: 2
FWCI
1.84
Type
journal article
Language
en
Open access
closed
Licence
www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations
  • Thyroid (publishedVersion)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (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
autoimmune hyperthyroidism, 131I therapy, TSH receptor antibodies, thyroid peroxidase antibodies, multinodular goiter, hyperthyroidism relapse, Graves' disease, Hashimoto's thyroiditis
MeSH terms
Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Goiter, Nodular, Graves Disease, Humans, Iodine Radioisotopes, Male, Middle Aged, Radiotherapy, Retrospective Studies, Thyroid Function Tests, Thyroid Gland, Time Factors

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