Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials
Open accessAbstract
OBJECTIVE: To determine the effect of adjunctive antithyroid drugs on the risk of treatment failure, hypothyroidism, and adverse events after radioiodine treatment. DESIGN: Meta-analysis. DATA SOURCES: Electronic databases (Cochrane central register of controlled trials, Medline, Embase) searched to August 2006 and contact with experts. Review methods Three reviewers independently assessed trial eligibility and quality. Pooled relative risks for treatment failure and hypothyroidism after radioiodine treatment with and without adjunctive antithyroid drugs were calculated with a random effects model. RESULTS: We identified 14 relevant randomised controlled trials with a total of 1306 participants. Adjunctive antithyroid medication was associated with an increased risk of treatment failure (relative risk 1.28, 95% confidence interval 1.07 to 1.52; P=0.006) and a reduced risk for hypothyroidism (0.68, 0.53 to 0.87; P=0.006) after radioiodine treatment. We found no difference in summary estimates for the different antithyroid drugs or for whether antithyroid drugs were given before or after radioiodine treatment. CONCLUSIONS: Antithyroid drugs potentially increase rates of failure and reduce rates of hypothyroidism if they are given in the week before or after radioiodine treatment, respectively.
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ATDs may increase the rate of hypothyroidism when given in the week before radioiodine treatment.
“Radioiodine may induce hypothyroidism and ATDs may increase and reduce the rate of hypothyroidism when given in the week before or after radioiodine treatment, respectively [122] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [122]
The Hypothyroidism section reports a risk ratio of 0.76 for hypothyroidism when antithyroid drugs were given before radioiodine treatment, indicating a possible reduction, not an increase; the confidence interval includes no effect. The Discussion also describes reduced hypothyroidism rates with antithyroid drugs given in the week before or after treatment. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredRadioiodine may induce hypothyroidism.
“Radioiodine may induce hypothyroidism and ATDs may increase and reduce the rate of hypothyroidism when given in the week before or after radioiodine treatment, respectively [122] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [122]
ATDs may reduce the rate of hypothyroidism when given in the week after radioiodine treatment.
“Radioiodine may induce hypothyroidism and ATDs may increase and reduce the rate of hypothyroidism when given in the week before or after radioiodine treatment, respectively [122] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [122]
Thyroid storm occurs only rarely following administration of RAI.
“Thyroid storm occurs only rarely following the administration of RAI (70)(71)(72).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [71]
A recent meta-analysis of randomized controlled trials found that MMI, carbimazole, and propylthiouracil reduce the success rate of RAI if given in the week before or after RAI treatment.
“However, a recent meta-analysis of randomized controlled trials also found that MMI, carbimazole, and propylthiouracil (PTU) reduce the success rate if given in the week before or after RAI treatment (71).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [71]
The risk of exacerbation of hyperthyroidism after radioactive iodine therapy is low.
“Given the low risk of exacerbation ( 71), the risks of ATD therapy may outweigh any potential small benefit.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [71]
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- Authors
- Walter, M. A., Briel, M., Christ-Crain, M., Bonnema, S. J., Connell, J., Cooper, D. S., Bucher, H. C., Müller-Brand, J., & Müller, B.
- Affiliations
- University Hospital of Basel (CH)
- University of Southern Denmark (DK)
- University of Glasgow (GB)
- Johns Hopkins University (US)
- Corresponding author
- Walter, Martin A
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2007-02-19
- Volume
- 334
- Issue
- 7592
- Pages
- 514
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1819480
- OpenAlex
- W2057822378
- Cited by
- 202
- References
- 23
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 7 · 2023: 4 · 2022: 17 · 2021: 11 · 2020: 11 · 2019: 7 · 2018: 9 · 2017: 8 · 2016: 9 · 2015: 12 · 2014: 11 · 2013: 8 · 2012: 13
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- antithyroid drugs, radioiodine therapy, treatment failure, hypothyroidism, adverse events, hyperthyroidism, thyroid surgery, adjunctive therapy
- MeSH terms
- Humans, Hyperthyroidism, Hypothyroidism, Iodine Radioisotopes, Risk Factors, Antithyroid Agents, Randomized Controlled Trials as Topic, Treatment Failure
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