Endocrine Abstracts

Iodine-131 is increasingly the treatment of choice of the hyperthyroidism of Graves’ disease and nodular goitre and is gaining popularity as a means of achieving significant goitre shrinkage in euthyroid patients. There is, however, anxiety among a significant number of patients about the dangers of radiation in general and it is these same patients who pose the question of whether prolonged treatment with antithyroid drugs is an acceptable alternative. In the past, physicians have argued that there is little to be gained in terms of remission rates in continuing antithyroid drugs longer than 18–24 months. However, a recent small study has demonstrated that there was no disadvantage in treating patients with Graves’ disease with an antithyroid drug for 10 years when compared to iodine-131 therapy in terms of cost or complications.¹ At a time when there is no consensus about the correct form or dose of thyroid hormone replacement it is perhaps unwise to champion the more liberal use of iodine-131, at least in the treatment of Graves’ disease when the majority will develop thyroid failure within months of receiving a standard dose of 400 MBq. Furthermore, there is some evidence for increased morbidity and mortality from cardiovascular disease in patients with both autoimmune and non-autoimmune forms of thyroid disease, and iodine-131 therapy may be a contributing factor.² Perhaps it is time to re-consider the relative roles of antithyroid drugs, iodine-131 and surgery. After all, although none of these treatments is perfect, each is effective and there is evidence that patients have no particular preference.³

1. Azizi F, et al. Eur J Endocrinol 2005; 152: 695.

2. Nyirenda MJ, et al. Thyroid 2005; 15: 718.

3. Ljunggren JG, et al. Thyroid 1998; 8: 653.