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Radioactive iodine safe, effective in Graves’ disease
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Among adults with Graves’ disease, radioactive iodine was more commonly used and yielded the best efficacy and safety profiles compared with antithyroid drugs and surgery, study data show.
Vishnu Sundaresh, MD, assistant professor of medicine at the University of Utah in Salt Lake City, and colleagues evaluated electronic medical records from the Mayo Clinic on 720 adults (mean age, 49.3 years; 76.7% women) diagnosed with Graves’ disease from 2002 to 2008 to determine the effectiveness of antithyroid drugs compared with radioactive iodine and surgery. Follow-up was a mean 3.3 years.
Participants were divided into the following treatment groups: antithyroid drugs (16.4%), radioactive iodine (75.4%), surgery (2.6%) or observation (5.6%).
Through follow-up, the overall failure rate was higher for antithyroid drugs (48.3%) compared with radioactive iodine (8%; P < .0001). Among participants originally treated with antithyroid drugs, 29 changed therapies, 10 changed to a different antithyroid drug and 25 were considered failures due to premature cessation. Antithyroid drug use for more than 12 months was used by 64 participants to obtain remission, and 27.4% experienced a relapse (P < .0001).
Among participants who experienced relapse after previous radioactive iodine or other treatment, 101 opted for radioactive iodine and 83.2% experienced successful results, treatment failed for 10.9%, and 5.9% were lost to follow-up.
All participants who underwent thyroidectomy as a second-line therapy or third-line therapy experienced success.
Forty-three participants treated with antithyroid drugs experienced adverse effects, including dysgeusia (4.4%), rash (2.8%), nausea/gastric distress (2.4%), pruritus (1.6%), urticaria (1.2%), arthralgia (0.4%), polyarthritis/antithyroid arthritis syndrome (0.4%), headache (0.4%), dizziness (0.4%), elevated liver enzymes (2.4%), cholestasis (0.8%) and agranulocytosis (0.8%). Radiation thyroiditis occurred in eight participants who underwent radioactive iodine therapy. Among 35 participants who underwent thyroidectomy as first-, second- or third-line therapy, one developed postoperative hematoma, one experienced a permanent superior laryngeal nerve injury and 10 experienced transient hypocalcemia.
“[Radioactive iodine] was the most commonly used modality within this cohort and demonstrated a good efficacy and safety profile,” the researchers wrote. “Surgery, while chosen infrequently, was also highly effective and relatively safe in the hands of experienced surgeons. While [antithyroid drugs] allow preservation of thyroid function while controlling hyperthyroidism, a high relapse rate combined with a significant adverse-effect profile was documented. While the goal of treatment for [Graves’ disease] is to eliminate the hyperthyroid state, the choice of therapy for a particular patient not only depends on the clinical scenario, but also should reflect the patient’s expectations of the disease course and treatment outcome.” – by Amber Cox
For more information:
Vishnu Sundaresh, MD, can be reached at 615 Arapeen Drive Suite #100, Utah Diabetes & Endocrinology Center, Salt Lake City, UT 84108; email: Vishnu.sundaresh@hsc.utah.edu.
Disclosure: The researchers report no relevant financial disclosures.
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