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Natural course of iodine-induced thyrotoxicosis (Jodbasedow) in endemic goiter area: A 5 year follow-up

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Abstract

In the Balsas region of North Brazil (85% prevalence of goiter), 1876 goitrous subjects (1663 with goiter grade I and II and 103 with grade III multinodular goiter) were treated with 1 ml of iodized oil im (I-oil). From the population with grade III goiter we were able to follow-up for 5 yr 13 euthyroid goitrous patients (group 1 ) and 8 goitrous individuals (group 2) who developed iodine-induced thyrotoxicosis (NT, 0.42% of the total population or 7.76% of the multinodular goiter subjects). The two groups were matched for age and goiter size, and had no significant differences in the baseline levels of thyroid hormone concentration, T3/T4 ratio or mean serum TSH. However, group 2 had a higher concentration of serum Tg, and 48 h after challenge with 10 U of bovine TSH (bTSH) had a significantly higher absolute release of T3 and Tg than group 1. In 4 patients IIT was transitory and resolved by 12 months. Four other subjects, however, maintained a mild clinical form of IIT that only normalized at 50 months. Only one patient needed treatment with methylmercaptoimidazol. There was no evidence of autoantibodies (TSH-receptor inhibiting antibody, anti-Tg or anti-microsomal antibodies) against thyroid antigens in group 2 patients. All subjects, including those with thyrotoxicosis, showed a remarkable shrinkage of the goiter by 60 months which was reflected by a significantly lower absolute response of T3 and Tg after bTSH. We conclude that IIT induced by I-oil is a rare complication of I-oil prophylaxis in a general goitrous population, is more common in patients with multinodular goiters and has a transient form and a persistent form that tends to resolve spontaneously by 60 months.

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Authors and Affiliations

  1. Thyroid Laboratory, Division of Endocrinology, Hospital das Clinicas, University of Sao Paulo Medical School, 05403, Sao Paulo, Brazil

    M. C. Martins, N. Lima, M. Knobel & G. Medeiros-Neto

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  1. M. C. Martins
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  2. N. Lima
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  3. M. Knobel
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  4. G. Medeiros-Neto
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Martins, M.C., Lima, N., Knobel, M. et al. Natural course of iodine-induced thyrotoxicosis (Jodbasedow) in endemic goiter area: A 5 year follow-up. J Endocrinol Invest 12, 239–244 (1989). https://doi.org/10.1007/BF03349973

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