Remission After Potassium Iodide Therapy in Patients With Graves' Hyperthyroidism Exhibiting Thionamide-Associated Side Effects
Abstract
CONTEXT: Thionamides have various side effects. OBJECTIVE: The effectiveness of potassium iodide (KI) was evaluated in hyperthyroid patients who experienced side effects to thionamides. DESIGN AND SETTING: An observational study was conducted at an academic medical center. PATIENTS: Among 1388 patients with Graves' hyperthyroidism treated with thionamides, 204 (14.7%) exhibited side effects, and 44 were treated with KI and followed for 17.6 (median; range, 8.6-28.4) years. MAIN OUTCOME MEASURES: The primary endpoint was the initial response to KI, and the secondary endpoint was the long-term prognosis. RESULTS: The conditions of 29 (65.9%) of the 44 patients were well controlled with KI alone (10-400 mg/d) (A group), and 17 (38.6%) patients went into remission after 7.4 (1.9-23.0) years. The conditions of 15 (34.1%) patients were not controlled with KI alone (B group), even at a high dose (100-750 mg/d), but seven patients (15.9%) were controlled with a combination of KI and low-dose thionamides, resulting in remission after 7.2 (2.8-10.8) years. The initial parameters did not predict the response to KI or long-term prognosis. However, remission occurred in 70.8% of the patients treated with less than 200 mg of KI, compared with 35.0% of the patients who required 200 mg or more of KI (P < .05). CONCLUSIONS: Among hyperthyroid patients with thionamide-associated side effects, KI therapy was effective in two-thirds of cases, and about 40% of the patients experienced remission after KI therapy alone. The chance of remission was small among the patients refractory to KI.
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Initial free T4 concentration and goiter size did not predict a response to KI therapy.
“Initial free T 4 concentration and goiter size did not predict a response to therapy.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [243]
Among 15 nonresponders to KI, 11 (25% of all patients) escaped the inhibitory effects of iodine and four patients did not respond at all to KI.
“Among 15 nonresponders, 11 (25% of all patients) escaped the inhibitory effects of iodine and four patients did not respond at all to KI.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [243]
Among 44 Japanese patients who had adverse reactions to ATD and who were treated with KI alone, 66% were well controlled for an average of 18 years and 39% achieved a remission after 7 years.
“Among 44 Japanese patients who had adverse reactions to ATD and who were treated with KI alone, 66% were well controlled for an average of 18 years (range 9-28 years), and 39% achieved a remission after 7 years (range 2-23 years) (243).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [243]
Recent studies have suggested a potential role for iodine in patients who have had adverse reactions to ATD and who also have a contraindication or aversion to RAI or surgery.
“Recent studies have suggested a potential role for iodine in patients who have had adverse reactions to ATD and who also have a contraindication or aversion to RAI or surgery (243,244).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [243]
None of the 44 Japanese patients treated with KI alone for adverse reactions to ATD had side effects.
“None of the patients had side effects.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [243]
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Eponymous Terms and Selected Historical Figures in Endocrinology
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Asymmetrical Graves’ disease in children: potential usefulness of potassium iodide monotherapy
Fukahori, K., Sawano, K., Yoshida, H., & Nagasaki, K. (2022) · BMJ Case Reports · doi:10.1136/bcr-2022-249571
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Takotsubo cardiomyopathy as the primary manifestation of decompensated Graves' disease
Lang, F., Sajorda, B. J., Pagan-Mendez, M., Lowe, H., & Ali, S. R. (2024) · Journal of Cardiology Cases · doi:10.1016/j.jccase.2023.12.004
Suzuki, N., Noh, J. Y., Watanabe, N., Yoshihara, A., Fukushita, M., Matsumoto, M., Koshibu, M., Kawai, M., Kitao, A., Sugino, K., et al. (2026) · Journal of the Endocrine Society · doi:10.1210/jendso/bvag137
- Authors
- Okamura, K., Sato, K., Fujikawa, M., Bandai, S., Ikenoue, H., & Kitazono, T.
- Affiliations
- Kyushu University (JP)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2014-11
- Volume
- 99
- Issue
- 11
- Pages
- 3995-4002
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2073885718
- Cited by
- 64
- References
- 41
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 11 · 2023: 8 · 2022: 5 · 2021: 3 · 2020: 8 · 2019: 3 · 2018: 4 · 2017: 7 · 2016: 4 · 2015: 2 · 2014: 1
- FWCI
- 3.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Keywords
- potassium iodide, Graves' hyperthyroidism, antithyroid drug adverse effects, remission, long-term prognosis, combination therapy
- MeSH terms
- Adolescent, Adult, Aged, Drug Administration Schedule, Female, Graves Disease, Humans, Male, Methimazole, Middle Aged, Potassium Iodide, Propylthiouracil, Remission Induction, Antithyroid Agents, Treatment Outcome, Retreatment, Young Adult
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