scholarly journals The effect of prior antithyroid drug use on delaying remission in high uptake Graves' disease following radioiodine ablation

2016 ◽  
Vol 5 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Muthiah Subramanian ◽  
Manu Kurian Baby ◽  
Krishna G Seshadri
Keyword(s):  
Standard Dose ◽  
Antithyroid Drug ◽  
Fixed Dose ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Cure Rate ◽  
Monthly Basis ◽  
Radioiodine Ablation ◽  
The Impact

Antithyroid drugs (ATDs) have been shown to attenuate the effectiveness of radioiodine (radioiodine ablation, RIA) therapy in Graves' disease. We undertook a study to look at the impact of iodine uptakes on the outcome of 131I therapy. To determine the effect of prior ATD use on the duration of time to achieve cure in patients with high vs intermediate uptake Graves' disease who received a fixed dose (15 mCi) of 131I radioiodine. In a retrospective study of patients with Graves' disease, 475 patients who underwent RIA were followed-up on a two-monthly basis with thyroid function tests. Of the 123 patients with a documented preablation RAIU and consistent follow-up it was observed that 40 patients had an intermediate RAIU (10–30%) and 83 subjects had a distinctly increased uptake (>30%). Successful cure was defined as the elimination of thyrotoxicosis in the form of low free thyroxin and rising TSH levels. When a standard dose of 15 mCi 131I was administered, a cure rate of 93% was achieved. The median duration of time to cure (TC) was 129 days. Surprisingly, a direct proportional linear relationship (R2=0.92) was established between time to cure and radioiodine uptake (TC>30%=172days, TC10–30%=105 days, P<0.001). Patients who used ATD medications took a proportionately longer duration to achieve remission (TCNO ATD=102days, TCATD=253days, P<0.001). The effect of prior ATD therapy in delaying remission was amplified in the subset of patients with higher uptakes (TC>30%+ATD=310days, TC>30%+NO ATD=102days, P<0.001) compared to those with the intermediate uptakes (TC10–30%+ATD=126 days, TC10–30%+NO ATD=99 days, P<0.001). RIA, using a dose of 15 mCi achieved a high cure rate. Higher uptakes predicted longer time to achieve remission, with prior ATD use amplifying this effect.

Effects of high and low doses of methimazole in patients with Graves' thyrotoxicosis

1987 ◽  
Vol 116 (1_Suppl) ◽  
pp. S312-S317 ◽  
Author(s):  
G. Benker ◽  
D. Reinwein ◽  
H. Creutzig ◽  
H. Hirche ◽  
W. D. Alexander ◽  
...  
Keyword(s):  
Antithyroid Drug ◽  
Drug Dosage ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Duration Of Treatment ◽  
Disease Heterogeneity ◽  
Remission Rates ◽  
Set Up ◽  
The Many ◽  
The Impact

Abstract. In spite of the long-established use of antithyroid drugs, there are many unsettled questions connected with this treatment of Graves' disease. There is a lack of controlled prospective trials studying the results of antithyroid drug therapy while considering the many variables such as disease heterogeneity, regional differences, drug dosage and duration of treatment. Therefore, a multicenter study has been set up in order to compare the effects of two fixed doses of methimazole (10 vs 40 mg) with thyroid hormone supplementation on the clinical, biochemical and immunological course of Graves' disease and on remission rates. Experience accumulated so far suggests that treatment is safe using either 10 or 40 mg of methimazole. While there is a tendency for an advantage of the higher dose within the first weeks (higher effectiveness in controlling hyperthyroidism), this difference is not significant. The impact of dosage on remission rates remains to be shown.

scholarly journals Remission Rate of Graves' Disease and the Trend of Changes in Serum TSH Receptor Antibodies in Prolonged Antithyroid Drug Treatment

2020 ◽  
Vol 18 (Suppl) ◽  
Author(s):  
Danilo Villagelin ◽  
Roberto Bernardo Santos ◽  
João Hamilton Romaldini
Keyword(s):  
Drug Treatment ◽  
Remission Rate ◽  
Antithyroid Drug ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Remission Rates ◽  
Thyrotropin Receptor Antibodies ◽  
Antithyroid Drug Treatment ◽  
The Impact ◽  
Receptor Antibodies

Context: Graves’ disease is an autoimmune disease caused by thyrotropin receptor antibodies (TRAb). These antibodies can be measured and used for the diagnosis, prediction of remission, and risk of Graves’ orbitopathy development. There are three treatments for Graves’ disease that have remained unchanged for the last 75 years: Antithyroid drugs, radioiodine, and surgery. Antithyroid drugs are the first treatment option worldwide and are usually used for 12 - 18 months. Recent reports suggest the use of antithyroid drugs for more than 18 months with better outcomes. This review focuses on two aspects of treatment with antithyroid drugs: The impact of using antithyroid drugs for more than 12 - 18 months on remission rates and the trend of TRAb during prolonged antithyroid drug treatment. Evidence Acquisition: A review was performed in Medline on the published work regarding the duration of ATD treatment and remission of Graves' disease and also ATD treatment and TRAb status during the 1990 - 2019 period. Results: Remission rates are variable (30% - 80%), and many clinical and genetic factors serve as predictors. The long-term use of antithyroid drugs appears to increase remission rates. TRAb values usually decline during ATD treatment, but the trend could occur in two ways: Becoming negative or showing a fluctuating pattern. However, approximately 10% of the patients will remain TRAb-positive after five years of treatment with antithyroid drugs. Conclusions: Antithyroid drugs can be used for long periods with an increase in remission rates, and a gradual decrease in TRAb levels, with the disappearance of TRAb in 90% of the patients after 60 months.

scholarly journals Factors Affecting and Outcome of Radioactive Iodine Therapy in Hyperthyroidism: A study at Institute of Nuclear Medicine & Allied Sciences (INMAS), Sylhet

2018 ◽  
Vol 19 (1) ◽  
pp. 19-23
Author(s):  
Kamrun Nahar ◽  
Papia Akhter
Keyword(s):  
Radioactive Iodine ◽  
Antithyroid Drug ◽  
Nodular Goiter ◽  
Fixed Dose ◽  
Graves Disease ◽  
Radioactive Iodine Therapy ◽  
Cure Rate ◽  
Toxic Adenoma ◽  
Significant Difference ◽  
One Year

Objective: Radioactive iodine therapy (RIT) is the most commonly used modality to treat hyperthyroidism and is indeed in most cases, the treatment of choice. The aim of this study was to assess the clinical outcome one year after radioactive Iodine-131 (RAI -131) therapy and to identify the factors associated with response of the therapy.Patients and Methods: A total 107 hyperthyroid patients were included in this study. All patients were pre-treated with anti-thyroid drugs (ATD). A fixed dose of 8 mCi of radioiodine was given to the patients with Graves’ disease, 12 mCi to patients with single toxic adenoma and 15 mCi to patients with toxic multi-nodular goiter . The patients were done serum FT4 initially and followed up with serum T3, T4, and TSH at three months , six months and one year of RAI therapy . The clinically and biochemically euthyroid and hypothyroid patients were considered as cure of the disease.Results : The cure rate was about 94.7% seen in female patients and 93.8% in male ( P=0.92), 93.6% in younger age group (below 40 years) and 95.0% of the older patients ( P=1.51), 95.5% of the patients who were taking ATD for more than one year and 92.7% of the patients who were taking ATD for less than one year before therapy( P=1.95), 95.4 % of the patients who had initial FT4 level less than 35 pmol/L and 92.7 % of the patients who had high initial FT4 ( P=1.54). Cure rate of Graves’ disease was 45/53 (92.5%), multi-nodular goiter 41/43 (95.3% ) and for single toxic adenoma was 11/11 (100% ) (P= 0.65). The incidence of radioiodine induced hypothyroidism was 6.5 % at three months, 13.1 % at six months and 15.0 % at one year. Overall incidence of cure rate of RAI therapy after one year was 101 (94.4 %).Conclusion: No statistically significant difference was found in the cure rate when sex, age, duration of pretreatment with antithyroid drug, initial FT4 level and cause of hyperthyroidism were considered.   From this study it can be concluded that cure rate of RAI therapy is quite good and the pretreatment factors have little influence on the final outcome.Bangladesh J. Nuclear Med. 19(1): 19-23, January 2016

Graves' disease and radioiodine therapy

2008 ◽  
Vol 47 (04) ◽  
pp. 153-166 ◽  
Author(s):  
I. Weber ◽  
W. Eschner ◽  
F. Sudbrock ◽  
M. Schmidt ◽  
M. Dietlein ◽  
...  
Keyword(s):  
Success Rate ◽  
Thyroid Function ◽  
Therapeutic Dose ◽  
Radioiodine Therapy ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Inclusion Criteria ◽  
End Point ◽  
Point Measure ◽  
The Impact

SummaryAim: This study was performed to analyse the impact of the choice of antithyroid drugs (ATD) on the outcome of ablative radioiodine therapy (RIT) in patients with Graves' disease. Patients, material, methods: A total of 571 consecutive patients were observed for 12 months after RIT between July 2001 and June 2004. Inclusion criteria were the confirmed diagnosis of Graves' disease, compensation of hyperthyroidism and withdrawal of ATD two days before preliminary radioiodine-testing and RIT. The intended dose of 250 Gy was calculated from the results of the radioiodine test and the therapeutically achieved dose was measured by serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The pretreatment ATD was retrospectively correlated with the results achieved. Results: Relief from hyperthyroidism was achieved in 96 % of patients. 472 patients were treated with carbimazole or methimazole (CMI) and 61 with propylthiouracil (PTU). 38 patients had no thyrostatic drugs (ND) prior to RIT. The success rate was equal in all groups (CMI 451/472; PTU 61/61; ND 37/38; p=0.22). Conclusion: Thyrostatic treatment with PTU achieves excellent results in ablative RIT, using an accurate dosimetric approach with an achieved post-therapeutic dose of more than 200 Gy.

scholarly journals Radioiodine Treatment of Hyperthyroidism—Prognostic Factors for Outcome

2001 ◽  
Vol 86 (8) ◽  
pp. 3611-3617 ◽  
Author(s):  
Amit Allahabadia ◽  
Jacquie Daykin ◽  
Michael C. Sheppard ◽  
Stephen C. L. Gough ◽  
Jayne A. Franklyn
Keyword(s):  
Single Dose ◽  
Prognostic Factors ◽  
Nodular Goiter ◽  
Fixed Dose ◽  
Graves Disease ◽  
Cure Rate ◽  
Toxic Nodular Goiter ◽  
Large Size ◽  
Lower Cure Rate ◽  
Lower Cure

There is little consensus regarding the most appropriate dose regimen for radioiodine (131I) in the treatment of hyperthyroidism. We audited 813 consecutive hyperthyroid patients treated with radioiodine to compare the efficacy of 2 fixed-dose regimens used within our center (185 megabequerels, 370 megabequerels) and to explore factors that may predict outcome. Patients were categorized into 3 diagnostic groups: Graves’ disease, toxic nodular goiter, and hyperthyroidism of indeterminate etiology. Cure after a single dose of 131I was investigated and defined as euthyroid off all treatment for 6 months or T4 replacement for biochemical hypothyroidism in all groups. As expected, patients given a single dose of 370 megabequerels had a higher cure rate than those given 185 megabequerels, (84.6% vs. 66.6%, P &lt; 0.0001) but an increase in hypothyroidism incidence at 1 yr (60.8% vs. 41.3%, P &lt; 0.0001). There was no difference in cure rate between the groups with Graves’ disease and those with toxic nodular goiter (69.5% vs. 71.4%; P, not significant), but Graves’ patients had a higher incidence of hypothyroidism (54.5% vs. 31.7%, P&lt; 0.0001). Males had a lower cure rate than females (67.6% vs. 76.7%, P = 0.02), whereas younger patients (&lt;40 yr) had a lower cure rate than patients over 40 yr old (68.9% vs. 79.3%, P &lt; 0.001). Patients with more severe hyperthyroidism (P &lt; 0.0001) and with goiters of medium or large size (P &lt; 0.0001) were less likely to be cured after a single dose of 131I. The use of antithyroid drugs, during a period 2 wk before or after 131I, resulted in a significant reduction in cure rate in patients given 185 megabequerels 131I (P &lt; 0.01) but not 370 megabequerels. Logistic regression analysis showed dose, gender, goiters of medium or large size, and severity of hyperthyroidism to be significant independent prognostic factors for cure after a single dose of 131I. We have demonstrated that a single fixed dose of 370 megabequerels 131I is highly effective in curing toxic nodular hyperthyroidism as well as Graves’ hyperthyroidism. Because male patients and those with more severe hyperthyroidism and medium or large-sized goiters are less likely to respond to a single dose of radioiodine, we suggest that the value of higher fixed initial doses of radioiodine should be evaluated in these patient categories with lower cure rates.

Aeromedical Decision Making for Military Aircrew with Graves’ Disease

2021 ◽  
Vol 92 (12) ◽  
pp. 980-986
Author(s):  
Edwin Hong-Teck Loh ◽  
Feng Wei Soh ◽  
Brian See ◽  
Benjamin Boon Chuan Tan
Keyword(s):  
Decision Making ◽  
Air Force ◽  
Case Series ◽  
Definitive Treatment ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
First Line Therapy ◽  
The Mean ◽  
Stable Maintenance ◽  
The Impact

BACKGROUND: Graves’ Disease (GD) is a common cause of hyperthyroidism. Although definitive treatment with radioactive iodine (RAI) is preferred for military aircrew, there are cultural and individual differences in receptivity toward RAI, and clinical guidelines that recommend antithyroid drugs (ATD) as the first line therapy. We examined a case series of Republic of Singapore Air Force (RSAF) aviators with GD treated with ATD and the impact of their condition on aeromedical disposition.CASE SERIES: All RSAF aircrew diagnosed with GD and treated with ATD over a 15-yr period were retrospectively identified and analyzed to determine the impact on their fitness for flying duties. The mean age of the 13 aircrew was 33 ± 7.1 yr (range, 25–47 yr), with 11 (84.6%) being males. There were 10 (76.9%) who had ATD as the only treatment while 3 (23.1%) were initially treated with ATD but subsequently underwent RAI or surgery. Of the 10 treated with only ATD, 3 (30.0%) were returned to restricted flying, 6 (60.0%) were returned to unrestricted flying, and 1 (10.0%) is still undergoing ATD titration. There were 10 (76.9%) aircrew who were returned to some form of flying duties while on low doses of ATD.DISCUSSION: This case series suggests that ATD is a viable treatment modality in the aeromedical management of military aviators with GD and it is possible to return military aircrew on a stable maintenance dose of ATD to flying duties. A framework is proposed to support the aeromedical decision-making process for military aircrew in the treatment of GD.Loh EH-T, Soh FW, See B, Tan BBC. Aeromedical decision making for military aircrew with Graves’ disease. Aerosp Med Hum Perform. 2021; 92(12):980–986.

scholarly journals SAT-434 Phenotype and Genotype Analysis of Patients with Resistance to Thyroid Hormone β: A Single-Center Experience

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Karn Wejaphikul ◽  
Prapai Dejkhamron ◽  
Stefan Groeneweg ◽  
W Edward Visser ◽  
Kevalee Unachak ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Mutation Analysis ◽  
Novel Mutation ◽  
Family Members ◽  
Antithyroid Drugs ◽  
Thyroid Function Tests ◽  
Resistance To Thyroid Hormone ◽  
The Mean ◽  
The Impact

Abstract Introduction Resistance to thyroid hormone β (RTHβ) is caused by mutations in THRB, the gene that encodes thyroid hormone receptor β. The clinical phenotype is variable and may include goiter, tachycardia, and learning disability with or without hyperactive behavior. The biochemical hallmark of RTHβ is elevated T4 and T3 with non-suppressed TSH concentrations. We here describe the phenotype and genotype of three Thai patients diagnosed with RTHβ in a pediatric referral center. Patients had previously been misdiagnosed and inappropriately treated with antithyroid drugs (ATDs). Methods Clinical features and thyroid function tests (TFTs) of three unrelated RTHβ patients were retrospectively reviewed. Genomic DNA of the RTHβ patients and affected family members was amplified for exon 7-10 of the THRB gene and sequenced to identify mutation by Sanger sequencing. The impact of the p.L341V novel mutation on the affinity for T3 and T3-induced transcriptional activity was previously determined in vitro. Results Three female patients were diagnosed with RTHβ. All of them had been misdiagnosed with hyperthyroidism and treated with ATDs prior to referral. The mean age at diagnosis was 8 years. The main presenting symptoms were diffuse goiter and tachycardia. The mean duration of ATD treatment was 3 years. During the treatment, patients had fluctuating thyroid hormone and increased TSH levels. An older sister and mother of one patient also had similar TFTs abnormalities, for which the mother had undergone a subtotal thyroidectomy. RTHβ was diagnosed based on the high FT3 and FT4 with normal (non-suppressed) TSH concentrations and confirmed by mutation analysis. Anti-thyroid peroxidase, anti-thyroglobulin, and TSH receptor antibody (TRAb) were negative, excluding autoimmune thyroid disease. Heterozygous missense mutations of the THRB gene were identified in all patients and affected family members. Two mutations had been previously reported (p.R243W and p.L456F), and one mutation was novel (p.L341V). In vitro studies confirmed an important role of Leu341 in T3 binding of the TRβ and functional impairment of the p.L341V novel mutation and were reported separately. According to available literature, only nine Thai RTHβ patients (in three families) carrying three different mutations (p.G251V, p.M313T, and p.A317T) had been previously reported. Goiter was the most common clinical finding, and almost all patients had a history of receiving unnecessary treatment with ATDs. Conclusion We report a series of RTHβ patients carrying THRB gene mutations, including one novel mutation (p.L341V). Clinicians should be alert that RTHβ can be found in patients with goiter and tachycardia. Elevated T4 and T3 with non-suppressed TSH concentration is the main diagnostic clue for this disease. Mutation analysis allows definitive diagnosis of RTHβ and may help to avoid potential misdiagnosis and improper treatment.

scholarly journals SAT-413 Does Dipeptidyl Peptidase-4 Inhibitor Exacerbate Graves’ Disease?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Tomonori Sekizaki ◽  
Hiraku Kameda ◽  
Kyu Yong Cho ◽  
Nakamura Akinobu ◽  
Kiyohiko Takahashi ◽  
...  
Keyword(s):  
Antithyroid Drug ◽  
Multivariate Logistic Regression Analysis ◽  
Dipeptidyl Peptidase ◽  
Drug Dose ◽  
University Hospital ◽  
Graves Disease ◽  
Dipeptidyl Peptidase 4 ◽  
Institutional Review ◽  
Baseline Characteristics ◽  
The Impact

Abstract Abstract: [Background] Dipeptidyl peptidase-4 (DPP-4) is expressed as CD26 on the surface of immune cells including T cells, suggesting that inhibition of DPP-4 may affect the immune system (1). Actually, DPP-4 inhibitor (DPP-4i)-induced polyarthritis and bullous pemphigoid have been reported (2, 3). It has also been reported that the prevalence of Hashimoto’s thyroiditis was significantly higher in patients on DPP-4i treatment (4). However, relationships between DPP-4i and Graves’ disease has been unclear. [Methods] To investigate the impact of DPP-4i administration on the activity of Graves’ disease, we conducted a multicenter observational trial that included patients with both Graves’ disease and type 2 diabetes mellitus who were administered an oral hypoglycemic agent (OHA) including DPP-4i from December in 2009 to April in 2018. Patients who had systemic diseases affecting thyroid function and those who underwent thyroidectomy or radioiodine treatment within 6 months before or after OHA administration were excluded. Exacerbation of Graves’ disease was defined as an increase in antithyroid drug dose within 6 months after OHA administration. The trial was approved by the institutional review board of Hokkaido University Hospital. [Results] Eighty-three patients were enrolled in the study, and they were divided into an exacerbation group (n = 18) and a non-exacerbation group (n = 65). Comparing baseline characteristics, the percentage of DPP-4i administration was higher in the exacerbation group (83.3%) than in the non-exacerbation group (32.3%) (p = 0.0001). Mean age was also significantly higher in the exacerbation group (p = 0.04), and the duration of Graves’ disease was significantly shorter (p = 0.01). Multivariate logistic regression analysis using factors extracted by comparing baseline characteristics demonstrated a significant association between DPP-4i administration and Graves’ disease exacerbation (odds ratio 5.62, 95% confidence interval 1.16–27.0, p = 0.02). [Conclusion] The current study suggests that DPP-4i administration is associated with exacerbation of Graves’ disease. Reference: (1) Morimoto C et al., Immunol Rev. 1998 Feb;161:55–70. (2) Yokota K et al., Intern Med. 2012;51(15):2041–4. (3) Yoshiji S et al. J Diabetes Investig. 2018 Mar;9(2):445–447. (4) Kridin K et al. Immunol Res. 2018 Jun;66(3):425–430.

DEMOGRAFINIŲ VEIKSNIŲ SĄSAJOS SU KLINIKINE GREIVSO LIGOS IŠRAIŠKA IR BAIGTIMI

2013 ◽  
Vol 23 (2) ◽  
pp. 76-80
Author(s):  
Dalia Daukšienė ◽  
Narseta Mickuvienė
Keyword(s):  
Clinical Features ◽  
Disease Onset ◽  
Antithyroid Drug ◽  
Treatment Withdrawal ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Thyroid Disorder ◽  
Age And Gender ◽  
Large Goiter ◽  
And Gender

Graves‘ disease is an autoimmune thyroid disorder characterized by the presence of autoantibodies against thyrotropin receptor. Antithyroid drugs are effective in controlling hyperthyroidism, but only one-third of patients achieve long-term remission after antithyroid drug treatment withdrawal. Influence of demographic factors (such as age and gender) on clinical features and outcome of Graves’ disease remains unclear despite decades of scientific research. The aim of the study was to determine the influence of age and gender on clinical features and outcome of Graves’ disease. Matherial and methods. We performed a retrospective study of 194 adult patients with newly diagnosed Graves’ disease. Outcome after antithyroid drugs was defined as remission or failed. Results. The mean age of males was greater than females (p=0,022). Males and females had the same outcome after medical therapy. The presence of large goiter was associated with lower mean age at diagnosis in both females and males. Patients less than 40 yr. of age were more likely to have large goiter (grade III) than smaller goiter (grade I/II) compared with older patients (OR 2.81, 95% CI 1.35 –5.84). Age at disease onset had no significant relationship with the medical treatment failure. Conclusions. Age less than 40 yr. is a significant predictor for the presence of large goiter at diagnosis. Age and gender did not predict the outcome of Graves’ disease.

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