INCREASED RISK OF RADIOIODINE TREATMENT FAILURE ASSOCIATED WITH GRAVES DISEASE REFRACTORY TO METHIMAZOLE

Objective: Iodine 131 (I-131) radioactive iodine (RAI) therapy has been the preferred treatment for Graves disease in the United States; however, trends show a shift toward antithyroid drug (ATD) therapy as first-line therapy. Consequently, this would favor RAI as second-line therapy, presumably for ATD refractory disease. Outcomes of RAI treatment after first-line ATD therapy are unclear. The purpose of this study was to investigate treatment failure rates and potential risk factors for treatment failure, including ATD use prior to RAI treatment. Methods: A retrospective case control study of Graves disease patients (n = 200) after I-131 RAI therapy was conducted. Treatment failure was defined as recurrence or persistence of hyperthyroidism in the follow-up time after therapy (mean 2.3 years). Multivariable regression models were used to evaluate potential risk factors associated with treatment failure. Results: RAI treatment failure rate was 16.5%. A majority of patients (70.5%) used ATD prior to RAI therapy, predominantly methimazole (MMI) (91.9%), and approximately two-thirds of patients used MMI for >3 months prior to RAI therapy. Use of ATD prior to RAI therapy ( P = .003) and higher 6-hour I-123 thyroid uptake prior to I-131 RAI therapy ( P<.001) were associated with treatment failure. MMI use >3 months was also associated with treatment failure ( P = .002). Conclusion: More patients may be presenting for RAI therapy after failing first-line ATD therapy. MMI use >3 months was associated with RAI treatment failure. Further studies are needed to investigate the association between long-term first-line ATD use and RAI treatment failure. Abbreviations: ATD = antithyroid drug; BMI = body mass index; EMR = electronic medical record; I-123 = iodine 123; I-131 = iodine 131; MMI = methimazole; PTU = propylthiouracil; RAI = radioactive iodine; TRAb = TSH receptor antibody; TSH = thyroid-stimulating hormone

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Should radioiodine be the first-line treatment for paediatric Graves’ disease?

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2014-0176 ◽

2015 ◽

Vol 28 (7-8) ◽

Cited By ~ 1

Author(s):

James D. West ◽

Timothy D. Cheetham ◽

Carole Dane ◽

Anuja Natarajan

Keyword(s):

Radioactive Iodine ◽

Antithyroid Drug ◽

District General Hospital ◽

Graves Disease ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Younger Age ◽

Severe Autism ◽

Optimal Treatment Strategy

AbstractDebate exists regarding the optimal treatment strategy for paediatric Graves’ disease with radioiodine (RAI), and surgery, usually reserved for failure of medical therapy. We present our own experience to introduce a review of the published literature focussing on the predictors of remission after antithyroid drug (ATD) therapy from diagnosis, and discuss whether RAI should be considered as a first-line therapy.A retrospective analysis of all diagnosed cases of paediatric Graves’ disease presenting to a large District General Hospital.Thirteen patients were diagnosed with Graves’ disease between February 2004 and May 2013. The median age at diagnosis was 13.7 years (range 7.2–17.1 years) with a female:male ratio of 11:2. Some nine patients completed a 2-year course of carbimazole out of which 8 relapsed after a mean duration of 0.82 years (range 0.08–1.42 years); the ninth currently remains in remission. Of the eight patients who relapsed, three have undergone RAI treatment. Two patients failed to tolerate carbimazole treatment, one of whom received RAI treatment because surgery was contraindicated and one patient with severe autism proceeded to RAI treatment due to poor compliance and persistent hyperthyroidism.Prognostic factors at presentation predicting a low likelihood of remission following ATD treatment include younger age, non-Caucasian ethnicity, and severe clinical and/or biochemical markers of hyperthyroidism. Psycho-social factors including compliance also influence management decisions.In specifically selected patients presenting with paediatric Graves’ disease, the benefits and risks of radioactive iodine as a potential first-line therapy should be communicated allowing families to make informed decisions.

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Hypertension in Continuous Ambulatory Peritoneal Dialysis Patients: What do we know and What can we do about It?

Peritoneal Dialysis International ◽

10.1177/089686089901902s22 ◽

1999 ◽

Vol 19 (2_suppl) ◽

pp. 138-143 ◽

Cited By ~ 4

Author(s):

Jhoong S. Cheigh ◽

Hyang Kim

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Cardiovascular Risk ◽

Potential Risk ◽

Antihypertensive Treatment ◽

Antihypertensive Drugs ◽

Dialysis Patients ◽

First Line ◽

Hemodynamic Stability ◽

Potential Risk Factors

Despite many advantages of CAPD in maintaining hemodynamic stability, approximately 50% -60% of CAPD patients have hypertension and require antihypertensive treatment. ACE inhibitors and betablockers are the preferred first-line antihypertensive drugs in these patients, but some patients may require additionallong-acting calcium antagonists to enhance antihypertensive effects. Despite antihypertensive treatment, many patients often fail to maintain BP within optimal ranges, and this fact may contribute to the high incidences of cardiovascular morbidity an d mortality. Vigilance is clearly desirable by the patient and the physician to maintain BP within target ranges most of the time. Because dialysis patients also have many other cardiovascular risk factors, the strategy to decrease cardiovascular mortality should be a combined effort targeting all potential risk factors at the same time.

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Success Rate of Fungal Peri-Prosthetic Joint Infection Treated by 2-Stage Revision and Potential Risk Factors of Treatment Failure: A Retrospective Study

Medical Science Monitor ◽

10.12659/msm.909168 ◽

2018 ◽

Vol 24 ◽

pp. 5549-5557 ◽

Cited By ~ 3

Author(s):

Zhisen Gao ◽

Xiang Li ◽

Yinqiao Du ◽

Yawen Peng ◽

Wenming Wu ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Treatment Failure ◽

Success Rate ◽

Prosthetic Joint Infection ◽

Potential Risk ◽

Joint Infection ◽

Prosthetic Joint ◽

Potential Risk Factors

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Premature Arterial Disease Associated with Familial Antithrombin III Deficiency

Thrombosis and Haemostasis ◽

10.1055/s-0038-1645677 ◽

1990 ◽

Vol 63 (01) ◽

pp. 013-015 ◽

Cited By ~ 15

Author(s):

E J Johnson ◽

C R M Prentice ◽

L A Parapia

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Potential Risk ◽

Antithrombin Iii ◽

Arterial Disease ◽

Coagulation System ◽

Early Age ◽

Arterial Thromboembolism ◽

Potential Risk Factors ◽

Antithrombin Iii Deficiency

SummaryAntithrombin III (ATIII) deficiency is one of the few known abnormalities of the coagulation system known to predispose to venous thromboembolism but its relation to arterial disease is not established. We describe two related patients with this disorder, both of whom suffered arterial thrombotic events, at an early age. Both patients had other potential risk factors, though these would normally be considered unlikely to lead to such catastrophic events at such an age. Thrombosis due to ATIII deficiency is potentially preventable, and this diagnosis should be sought more frequently in patients with arterial thromboembolism, particularly if occurring at a young age. In addition, in patients with known ATIII deficiency, other risk factors for arterial disease should be eliminated, if possible. In particular, these patients should be counselled against smoking.

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