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Radioiodine Treatment in Patients with Graves’ Disease

  • Chapter
Graves' Disease

Abstract

Radioiodine is one of the three options for treating Graves’ hyperthyroidism. It has been used for almost seven decades and has proven to be safe even among older children when administered in a dose that destroys most thyroid tissue and results in hypothyroidism. It is contraindicated in pregnancy and lactation and when patients are unable to comply with radiation safety precautions. It is relatively contraindicated in patients with active ophthalmopathy. The exacerbation of ophthalmopathy seen after radioiodine administration may be prevented by concurrent corticosteroid therapy in patients with mild active orbital activity. Patients with significant hyperthyroid symptoms, the elderly, and those with moderately severe chemical hyperthyroidism are usually pretreated with antithyroid drugs to attain a euthyroid state before administering radioiodine. Antithyroid drugs are stopped 2–3 days before administering radioiodine and are frequently restarted 3–7 days after administering radioiodine. Both fixed dose and calculated dose regimens appear equally effective. Radioiodine usually results in hypothyroidism 8–16 weeks after its administration. Patients are monitored at 4–8-week intervals until transitioned from antithyroid drugs (if pretreated) to thyroid hormone replacement therapy. Fourteen percent of patients fail the first treatment and require an additional treatment. Patient’s satisfaction with long-term outcomes is similar after radioiodine, surgery, or prolonged treatment with antithyroid drugs.

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Authors and Affiliations

  1. Thyroid Unit WAC 730S, Massachusetts General Hospital, Boston, MA, 02114, USA

    Douglas S. Ross M.D.

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  1. Douglas S. Ross M.D.
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Correspondence to Douglas S. Ross M.D. .

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  1. Mayo Clinic College of Medicine, Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota, USA

    Rebecca S. Bahn

Checklist for Radioiodine Therapy for Hyperthyroidism

Checklist for Radioiodine Therapy for Hyperthyroidism

Pretreatment

Beta-blockers for most patients

Antithyroid drugs for patients at increased risk of hyperthyroid complications

Elderly, severe symptoms, free T4 more than 2–3 times upper normal

Stop antithyroid drugs 2–3 days before treatment

Pregnancy test when appropriate

Patient not lactating

Measure radioiodine uptake in a patient with recent or ongoing iodine exposure

Patient can comply with radiation safety precautions

Ask about young children or pregnant women in the home

Ask about proximity to co-workers

Ask about urinary incontinence

Restart antithyroid drugs 3–7 days after treatment in most pretreated patients

Consider prophylactic steroid coverage in patients with ophthalmopathy

Especially smokers

Monitor free T4 and TSH every 4–8 weeks until “cured” and stable

Antithyroid drugs can usually be stopped between 8 and 16 weeks after radioiodine

Levothyroxine is started when free T4 becomes subnormal (TSH may still be low)

Watch for occasional patients who are transiently eu- or hypothyroid, then relapse

Retreat by 12–18 weeks if goiter and moderately severe hyperthyroidism persist

Consider measurement of the 6-h/24-h radioiodine uptake ratio

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Ross, D.S. (2015). Radioiodine Treatment in Patients with Graves’ Disease. In: Bahn, R. (eds) Graves' Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2534-6_7

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  • DOI: https://doi.org/10.1007/978-1-4939-2534-6_7

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