RADIOACTIVE IODINE THERAPY WITHOUT RECENT ANTITHYROID DRUG PRETREATMENT FOR HYPERTHYROIDISM COMPLICATED BY SEVERE HYPERBILIRUBINEMIA DUE TO HEPATIC DYSFUNCTION: EXPERIENCE OF A CHINESE MEDICAL CENTER.
OBJECTIVE
The objective of this work is to report our experience with (131)I therapy without recent antithyroid drug (ATD) pretreatment for refractory severe hyperthyroidism complicated by hyperbilirubinemia due to hepatic dysfunction.


METHODS
Five patients with refractory severe hyperthyroidism were treated with (131)I at 90 to 120 μCi/g-thyroid (total activity, 6.2 to 10.1 mCi). The patients previously had received ATD treatment from 2 months to 12 years and discontinued ATDs from 2 months to 4 years before (131)I treatment due to treatment failure or severe jaundice. Prior to (131)I therapy, the patients were asked to take a low-iodine diet and were treated with bisoprolol fumarate, digoxin, furosemide, S-adenosylmethionine, polyene phosphatidylcholine, and plasma exchange as supportive treatment for related clinical conditions. Four of the patients also received lithium carbonate in conjunction with their (131)I treatment. The patients were followed for 4 to 9 years after (131)I therapy.


RESULTS
After (131)I treatment, jaundice disappeared completely within 3 to 4 months in all patients, and liver function tests returned to normal. Concurrent atrial fibrillation and heart failure, leukopenia and thrombocytopenia, or thrombocytopenia and left cardiac enlargement improved remarkably in 3 patients during the follow-up period. Three to 45 months after (131)I treatment, hypothyroidism was noted in the patients and they were treated with L-thyroxine replacement therapy.


CONCLUSIONS
(131)I therapy without recent ATD pretreatment for refractory severe hyperthyroidism complicated by serious jaundice appears to be safe and effective, with good long-term results. It may be the preferred therapy for such patients and should be used as early as possible.
Yong
Y
Ding
Jialiu
J
Xing
Zewu
Z
Qiu
Yong
Y
Wang
Youren
Y
Zhang
Yi
Y
Fang
Xiaobo
X
Peng
Yahong
Y
Long
Pei
P
Deng
D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications / Q000532:radiotherapy; D002681:China; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology / Q000532:radiotherapy*; D006980:Hyperthyroidism / Q000150:complications / Q000532:radiotherapy*; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D007565:Jaundice / Q000150:complications / Q000532:radiotherapy; D008107:Liver Diseases / Q000150:complications / Q000532:radiotherapy*; D008297:Male; D008713:Methimazole / Q000009:adverse effects; D008875:Middle Aged; D011441:Propylthiouracil / Q000009:adverse effects; D012189:Retrospective Studies; D012720:Severity of Illness Index
D013956:Antithyroid Agents; D007457:Iodine Radioisotopes; D008713:Methimazole; D011441:Propylthiouracil