Outcome of thyroid function in Graves' patients treated with radioiodine: role of thyroid-stimulating and thyrotropin-blocking antibodies and of radioiodine-induced thyroid damage.
We investigated the interrelationship and the influence of thyroid-stimulating antibodies (TSAb), TSH-blocking antibodies (TSHBAb), and of radioiodine (131I)-induced thyroid damage in the early (within 1 yr) outcome of thyroid function in hyperthyroid patients with Graves' disease (GD) treated with 131I. TSAb, TSHBAb, and ultrasound thyroid volume (as an index of thyroid damage) were simultaneously measured before and at 1, 3, 6, and 12 months after 131I in 31 GD patients. One year after radioiodine, 9.7% of patients were hyperthyroid (Hyper-group), requiring methimazole; 12.9% were euthyroid (Eu-group); and 77.4% were hypothyroid (Hypo-group). Pretreatment thyroid volume in the Eu-group and Hyper-group was significantly greater (P = 0.009) than in the Hypo-group. Pre-131I TSAb levels were higher in the Hyper-group vs. the Hypo-group (P = 0.01) or the Eu-group (P = 0.03). A significant post-131I increase in TSAb levels occurred in 66% of patients developing hypothyroidism but not in those remaining hyperthyroid. After 131I, TSHBAb appeared in 7 patients, in all but one associated with high levels of TSAb. One year after radioiodine: 1) the mean percent reduction in thyroid volume was greater in the Hypo-group (80.7%) or the Eu-group (83.5%) than in the Hyper-group (35.7%) (P = 0.007 and 0.0033 respectively); 2) hypothyroid patients had smaller (P = 0.0058) post-131I thyroids than hyperthyroid patients; and 3) TSAb were still elevated in 75% hypothyroid patients, but all of them had a thyroid volume < or = 8 mL, indicating major postradioiodine gland damage.


CONCLUSIONS
1) the early outcome of thyroid function after 131I for GD is mainly related to pretreatment thyroid volume and to the degree of its reduction after therapy; 2) high TSAb levels before 131I are associated with a relative resistance to therapy; 3) a postradioiodine increase in TSAb levels is related to the development of hypothyroidism; and 4) the concomitant appearance of TSHBAb and disappearance of TSAb are not frequent after 131I and play a role in the development of early postradioiodine hypothyroidism only in a minority of patients.
Chiovato
L
L
Institute of Endocrinology, University of Pisa, Italy.
Fiore
E
E
Vitti
P
P
Rocchi
R
R
Rago
T
T
Dokic
D
D
Latrofa
F
F
Mammoli
C
C
Lippi
F
F
Ceccarelli
C
C
Pinchera
A
A
D000328:Adult; D000368:Aged; D013956:Antithyroid Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000532:radiotherapy*; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy / Q000453:epidemiology; D007037:Hypothyroidism / Q000453:epidemiology; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood*; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008713:Methimazole / Q000627:therapeutic use; D008875:Middle Aged; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000528:radiation effects*; D013972:Thyrotropin / Q000097:blood* / Q000276:immunology; D013997:Time Factors; D014463:Ultrasonography
D013956:Antithyroid Agents; D001323:Autoantibodies; D018828:Immunoglobulins, Thyroid-Stimulating; D007457:Iodine Radioisotopes; D008713:Methimazole; D013972:Thyrotropin