Effect of Methimazole Pretreatment on Serum Thyroid Hormone Levels after Radioactive Treatment in Graves’ Hyperthyroidism1
Abstract
Radioiodine (131I) is the preferred definitive treatment for Graves' hyperthyroidism. Pretreatment with antithyroid drugs is often used to avoid thyroid hormone discharge after 131I ablation. However, this may represent an unnecessary increase in risk and costs. Fifty-one patients with Graves' disease were randomly assigned to receive 131I alone (28 patients) or 131I plus pretreatment with methimazole (30 mg/day; 23 patients). Methimazole was interrupted 4 days before 131I therapy. Serum T4, free T4 (FT4), and T3 were measured on days -4 and -1, on the day of treatment, and on days 2, 5, 7, 14, 20, and 30. In patients receiving 131I alone, mean serum T4 levels did not change after therapy. Mean serum FT4 and T3 levels decreased significantly 5 days after 131I administration (15% and 18%, respectively). Serum T3 reached its lowest level on day 30 (38%). With pretreatment, mean serum T4, FT4, and T3 levels increased (38%, 39%, and 70%, respectively) after methimazole discontinuation and before 131I administration. After 131I, serum T4 levels peaked on day 7 (23% vs. treatment day; 70% vs. baseline); FT4 levels peaked on day 14 (53% vs. treatment day; 107% vs. baseline). The serum T3 concentration increased 9% on day 2 (85% vs. baseline) and decreased from day 14 (15%) to day 30 (21%). We conclude that interruption of antithyroid drugs causes a short term increase in serum thyroid hormone levels in patients with Graves' hyperthyroidism receiving 131I. Thyroid hormone levels stabilize or decrease during the first 30 days after 131I therapy.
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Use of higher activities of RAI may offset the reduced effectiveness of RAI therapy following antithyroid medication.
“Use of higher activities of RAI may offset the reduced effectiveness of RAI therapy following antithyroid medication (75,76).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [76]
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Radioiodine Therapy of Benign Thyroid Diseases
Campennì, A., Deandreis, D., Finessi, M., Ruggeri, R. M., & Baldari, S. (2019) · Springer eBooks · doi:10.1007/978-3-030-17494-1_2
- Authors
- Andrade, V. A., Gross, J. L., & Maia, A. L.
- Affiliations
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, 90035–003 Porto Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul (BR)
- Corresponding author
- Maia, Ana Luiza
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1999-11-01
- Volume
- 84
- Issue
- 11
- Pages
- 4012-4016
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2009414182
- Cited by
- 53
- References
- 22
- Citations by year
- 2023: 2 · 2020: 2 · 2019: 1 · 2018: 2 · 2016: 1 · 2015: 3 · 2014: 1 · 2013: 4 · 2012: 2
- FWCI
- 2.07
- 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 › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- Graves' hyperthyroidism, methimazole, radioiodine therapy, iodine-131, serum thyroid hormones, free thyroxine, triiodothyronine, pretreatment
- MeSH terms
- Adult, Female, Graves Disease, Humans, Iodine Radioisotopes, Male, Methimazole, Antithyroid Agents, Thyroxine, Triiodothyronine
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