Antithyroid Research Articles

Awareness of Antithyroid Drug-Induced Agranulocytosis in Patients with Thyrotoxicosis

Abstract Objective Anti-thyroid drugs (ATDS)-induced agranulocytosis is a serious side effect that can be treated by early management if the patient has been educated to promptly self-identify agranulocytosis based on its presenting features. We aimed to assess the knowledge of patients taking carbimazole for hyperthyroidism regarding suspected agranulocytosis. Methods This questionnaire-based cross-sectional study with prospective follow-up analyzed adult patients with hyperthyroidism who visited an endocrine clinic, in a tertiary hospital in the UAE, between January 2023 and March 2024. They were asked about their knowledge about the symptoms of agranulocytosis and the immediate steps required upon symptom observation. They were then given bilingual agranulocytosis information cards and educated either face-to-face or telephonically. Their knowledge and awareness were re-evaluated 3-6 months later. Chi-squared tests were used to assess the differences before and after patient education. Results The initial and follow-up surveys were answered by 68 patients (mean age: 43.7 ± 17.1 years). The cohort included 48 (70.6%) females and 58 (85.3%) Emiratis. Hypothyroidism was due to Graves' disease in 64 (94.1%) patients and toxic multinodular goiter in 4 (5.9%) patients. There were 41 (60.3%) participants who responded that they had received adequate information on ATD-related agranulocytosis upon treatment initiation, which improved to 67 (98.5%) following patient education. Similarly, their self-reported confidence in identifying ATD-related side effects significantly improved (50% [34/68] vs. 100% [68/68]; p < 0.00001) after receiving education. Conclusion Patient education and information cards on ATD-induced agranulocytosis improve patient awareness regarding symptom identification and the next steps required for suspected agranulocytosis.

3 Cardiovascular outcomes in graves' disease patients treated with antithyroid medication versus total thyroidectomy: a retrospective cohort study

3 Cardiovascular outcomes in graves' disease patients treated with antithyroid medication versus total thyroidectomy: a retrospective cohort study

Neutropenic enterocolitis with colon perforation during antithyroid therapy

Neutropenic enterocolitis with colon perforation during antithyroid therapy

Thyrotoxicosis: What is the Cause in Our Population?

Thyrotoxicosis is an endocrine disorder in which excess amount of thyroid hormone is secreted in the blood stream and causes its action at the tissue level. Thyrotoxicosis highly affects the quality of life of patients suffering from the disease in carrying out daily activities. Proper treatment of thyrotoxicosis requires an accurate diagnosis. Objective: To determine the causes of thyrotoxicosis in patients reported for evaluation and management to specialized endocrine unit. Methods: This was a descriptive cross sectional observational study conducted by convenient sampling in Outpatient Department (Endocrinology Clinic) Khyber Pakhtunkhwa in six month’s duration (15th December 2023 to 15th May 2024) having sample size n=118. Thyrotoxicosis was labeled if patient has high T3, T4 (thyroxine and/or triiodothyronine) levels and suppressed thyroid stimulating hormones TSH levels. Information was gathered from the patients regarding their clinical signs and symptoms and anthropometrics. Laboratory investigations of thyroid function tests were obtained and analyzed. Results: The mean age of 118 patients was 40.39 ± 13.69 years, 28% male and 72% female patients were in enrolled in the study. Graves’ disease was most common form thyrotoxicosis making count of 50% of patients followed by toxic adenoma, toxic MNG, thyroiditis 16% and 14 % respectively. Anti-thyroid drugs count 43% of most of the patient’s treatment offered followed by radioactive iodine 28%. Conclusions: In conclusion, the main cause of thyrotoxicosis, includes grave’s disease, toxic adenoma and toxic MNG in Pakistani population. Thyrotoxicosis was more prevalent among female population as compared to males.

P-70 THYMIC HYPERPLASIA AND GRAVES' DISEASE: IS THERE A HIDDEN AUTOIMMUNE DISORDER?

Abstract Introduction Thymic hyperplasia is reported in 10-38% of patients with Graves' disease. Clinical Case We present a case of a 45-year-old female with Graves' disease and thymic hyperplasia, exhibiting non-specific symptoms. The patient was diagnosed with Graves' disease at age 42 and treated with thiamazole. While she was taking thiamazol she was felt muscle pain, spasms, and pulsations. Her pituitary and adrenal hormones were within normal limits. Three months after diagnosis, she was hospitalized for recurrent transient ischemic attacks. Myasthenia gravis was suspected, but acetylcholine receptor antibody tests, though initially elevated, were later normal. The patient also experienced flushing, and neck and facial redness without a clear diagnosis. She developed erythematous changes on her thighs, arms, and cleavage. Mastocytosis was suspected, but skin biopsy and serum tryptase tests were negative. She also reported frequent nocturnal bowel movements. Tumor markers such as chromogranin A and glucagon were slightly elevated, but a Ga-68 Dotatoc PET CT scan showed no evidence of neuroendocrine tumors. After six months of remission, the patient discontinued thiamazole, leading to symptom resolution and normalization of anti-TRAb levels. However, her TSH receptor antibodies increased seasonally, from February to August, over the next two years, resulting in hyperthyroidism. Thyroid ultrasound revealed changes consistent with autoimmune thyroid disease. The patient declined thymectomy and thyroidectomy. Due to adverse reactions to thiamazole and propranolol, possibly linked to Myasthenia gravis, she was switched to propylthiouracil with a good response. The etiology of symptoms atypical for hyperthyroidism or thymic hyperplasia, such as facial muscle tingling, spasms, pulsations, and erythematous rash, may be related to other autoimmune or neurological conditions, including Stiff Person syndrome and Myastenia gravis. Additionally, the seasonal recurrence, from February to August, of Graves' disease over three consecutive years is notable. Given the high prevalence of thymic hyperplasia in Graves' disease, ruling out neurological autoimmune diseases is advisable, as specific symptoms can affect the quality of life and may be exacerbated by antithyroid therapy.

P-55 A RARE CAUSE OF TACHYCARDIA IN A POSTPARTUM FEMALE PATIENT WITH HYPOTHYROIDISM: LEFT ATRIAL MYXOMA

Abstract Introduction Primary heart tumors are uncommon with cardiac myxoma being the most frequently observed type. This tumor occurs in about 0.03% of the general population, typically appearing sporadically in adults. It can also be inherited as part of the Carney complex. While cardiac myxoma is biologically benign, it behaves functionally as a malignant tumor due to its potential to cause obstruction within the heart, embolization, and various systemic symptoms. Hashimoto's thyroiditis (HT) is a chronic autoimmune condition characterized by lymphocytic inflammation of the thyroid gland. Clinical Case A 39-year-old female patient with a diagnosis of primary hypothyroidism visited our outpatient clinic 18 months postpartum. She had palpitations for the past 4 years, which had worsened over the last 2 years and were now severe enough to disturb her sleep. Additionally, she complained of hand tremors when hungry, severe headaches, extreme weakness, and drowsiness after meals. Her medical history included a diagnosis of HT 16 years ago and she was receiving levothyroxine 100 mcg daily. She has lost her mother due to a cerebrovascular event at age 45. On physical examination, her blood pressure was 120/80 mmHg, her heart rate was 88 beats per minute, she had rosacea on her face, and the rest of the examination was normal. Laboratory analysis was as follows: TSH: 1.2mU/L (0.55-4-78), fT3: 3.24ng/L(2.3-4.2), fT4: 1.26ng/dl(0.89-1.76), Hb: 12g/dL(12-15.6), ferritin: 6 microgram/L(10-291), anti thyroglobulin: 269.9IU/mL (<1.3), anti thyroid peroxidase: 389U/mL (<60), glucose: 86mg/dl(70-99). During follow-up, her levothyroxine dose was reduced due to tachycardia, and she was also treated for iron deficiency anemia. Although an echocardiogram was planned to investigate her tachycardia, she did not undergo the procedure. An echocardiogram of the patient revealed an ejection fraction of 60% and a 4.3x3.3cm, well-circumscribed, round shaped mass in the left atrium. This mass, which was attached to the interatrial septum with a stalk and deviated the septum to the right, was consistent with a myxoma and contained areas of calcification. The patient underwent surgery for the left atrial mass, and the pathology results confirmed cardiac myxoma. In evaluations for Carney complex, cortisol was suppresse with the 1 mg dexamethasone suppression test, the glucose-growth hormone (GH) suppression test showed GH levels <0.05 μg/L, and a genetic test could not be performed. Conclusion Tachycardia in hypothyroid patients can occur as a side effect of levothyroxine treatment. Additionally, iron deficiency anemia can also lead to sinus tachycardia in these patients. However, if a patient presents with unusual symptoms, such as nocturnal tachycardia, it is crucial to consider the possibility of an underlying cardiac condition. When cardiac myxoma is identified, it is important to evaluate the patient for Carney Complex.

A beneficial levels of 25-hydroxyvitamin D for a decrease in thyrotropin receptor antibody (TRAB) in patients with Graves’ disease: a real-world study

ObjectiveThis study aimed to determine whether a relationship exist between pre-therapy 25-hydroxyvitamin D levels and the remission/negative conversion rates of thyrotropin receptor antibody (TRAB) during treatment in patients with newly diagnosed Graves’ disease (GD).Methods171 patients were included from the Endocrinology Department of the First Affiliated Hospital of Fujian Medical University in March 2013 to April 2016. Ninety-five patients of them were diagnosed at our hospital but transferred to local hospitals for treatment. Seventy-six patients were followed and treated at our hospital with a median follow-up time of 11.03 (range 6–27) months. Patients were divided into 3 groups according to baseline 25-hydroxyvitamin D levels; <20 ng/mL (31,43.05%), 20–29 ng /mL (20,27.78%), and ≥ 30 ng/mL (20,29.17%). The TRAB remission rate and negative conversion rate was assessed among each group.ResultsThere was a higher TSH and lower TRAB titer in the 20–29 ng/mL group at initial diagnosis. Cox regression analysis suggested that 20–29 ng/mL group had significantly higher remission rates [RR; 95% CI: 7.505 (1.401–40.201), 8.975 (2.759–29.196),6.853(2.206–21.285), respectively] and negative conversion rates [RR; 95% CI: 7.835 (1.468–41.804),7.189(1.393–37.092), 8.122(1.621–40.688)] at the 6-, 12-, and 24-month follow-up, respectively . The level of 25-hydroxyvitamin D at the time of initial diagnosis was not associated with the re-normal of free Triiodothyronine(FT3), free thyroxineIndex(FT4) or TSH levels during the follow-up.ConclusionNewly diagnosed GD patients with appropriate baseline 25-hydroxyvitamin D levels (20–29 ng/mL) are beneficial for the reduction of TRAB during antithyroid therapy.

Anti-cancer effect of midazolam via downregulating YWHAH in papillary thyroid cancer cells

The work is aimed to investigate whether midazolam functions in thyroid cancer and reveal the potential mechanism of action. Cell viability was detected by CCK-8 method when treated by varying doses of midazolam to detect the cytotoxicity of midazolam on human thyroid follicular epithelial cell line and thyroid cancer cell lines. In thyroid cancer cells, EDU staining, wound healing and transwell assays were respectively used to detect cell proliferation, migration and invasion. Western blot was used to detect the expressions of matrix metalloproteinases (MMPs). Flow cytometry assay, western blot and immunofluorescence staining were used to detect cell apoptosis. CB-Dock2 server predicted midazolam-tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation protein eta (YWHAH) interaction and western blot was also used to detect YWHAH expression. Midazolam dose-dependently decreased the viability of thyroid cancer cells and demonstrated no cytotoxicity on Nthy-ori-3-1 cells. In addition, increasing concentrations of midazolam or silencing of YWHAH significantly inhibited thyroid cancer cell proliferation, migration and invasion and induced cell apoptosis. Midazolam had a molecular binding with YWHAH and midazolam downregulated YWHAH expression. YWHAH partially reversed the impacts of midazolam on the cellular events in thyroid cancer. Collectively, midazolam may act as an anti-thyroid cancer agent via its interrelation with YWHAH.

Unveiling Risk Factors for Treatment Failure in Patients with Graves' Disease: A Nationwide Cohort Study in Korea.

Antithyroid drug (ATD) treatment is the preferred initial treatment for Graves' disease (GD) in South Korea, despite higher treatment failure rates than radioactive iodine (RAI) therapy or thyroidectomy. This study aimed to evaluate the incidence of treatment failure associated with the primary modalities for GD treatment in real-world practice. We included 452,001 patients diagnosed with GD between 2004 and 2020 from the Korean National Health Insurance Service-National Health Information Database. Treatment failure was defined as switching from ATD, RAI, or thyroidectomy treatments, and for ATD specifically, inability to discontinue medication for over 2 years. Mean age was 46.2 years, with females constituting 70.8%. Initial treatments for GD included ATDs (98.0%), thyroidectomy (1.3%), and RAI (0.7%), with a noted increment in ATD application from 96.2% in 2004 to 98.8% in 2020. During a median follow- up of 8.5 years, the treatment failure rates were 58.5% for ATDs, 21.3% for RAI, and 2.1% for thyroidectomy. Multivariate analysis indicated that the hazard ratio for treatment failure with ATD was 2.81 times higher than RAI. RAI treatments ≥10 mCi had 37% lower failure rates than doses <10 mCi. ATDs are the most commonly used for GD in South Korea, followed by thyroidectomy and RAI. Although the risk of treatment failure for ATD is higher than that of RAI therapy, initial RAI treatment in South Korea is relatively limited compared to that in Western countries. Further studies are required to evaluate the cause of low initial RAI treatment rates in South Korea.

Predictors of Remission in Graves’ Disease Patients Treated With Antithyroid Drugs: A Retrospective Study

Predictors of Remission in Graves’ Disease Patients Treated With Antithyroid Drugs: A Retrospective Study

Treatment of Hyperthyroidism in Graves' Disease Complicated by Thyroid Eye Disease.

Thyroid eye disease (TED) is the most consequential extrathyroidal manifestation or complication of Graves' disease (GD). Treatment of hyperthyroidism in GD complicated by TED is challenging. Antithyroid drugs (ATDs) and thyroidectomy do not change the natural course of TED, while radioactive iodine (RAI) is associated with a small but well-documented risk of TED de novo occurrence or its progression/worsening. In the presence of mild TED, any treatment for hyperthyroidism can be used, but should RAI treatment be selected, steroid prophylaxis (short course of low-dose prednisone) is strongly recommended if TED is of recent onset and/or risk factors for progression exist. In moderate-to-severe and active TED, ATDs are the preferred treatment but thyroidectomy is a valid option. RAI ablation is generally avoided, but it might be used when the clinical situation calls for it but with extreme caution if an aggressive treatment for TED with high-dose glucocorticoids (with or without orbital radiotherapy) is administered concomitantly. In moderate-to-severe and inactive TED, all three treatments for hyperthyroidism are acceptable, and steroid prophylaxis in RAI-treated patients should be given when risk factors for TED progression are identified. Management of sight-threatening TED represents the absolute priority, and hyperthyroidism should be controlled with ATDs until TED has been cured.

A narrative review of long-term inorganic iodine monotherapy for Graves’ disease with a historical relationship between iodine and thyroid

Almost a century has passed since Plummer reported the efficacy of short-term preoperative inorganic iodine therapy for Graves' disease in the 1920s. Since there were concerns about the escape phenomenon and exacerbation with inorganic iodine, antithyroid drugs became the mainstay of pharmacotherapy for Graves' disease following their development in the 1940s. With regard to long-term inorganic iodine monotherapy, Trousseau reported a case in the 1860s, and several subsequent reports suggested its efficacy. Around 1930, Thompson et al. published a number of papers and concluded that long-term inorganic iodine monotherapy was useful if limited to mild cases under careful follow-up. From Japan, in 1970, Nagataki et al. reported that, of 12 patients treated with inorganic iodine, three remained eumetabolic for more than two years. Since 2014, some reports have also been published from Japan. A summary of these recent reports is given below. The starting dose of potassium iodide is around 50 mg/day, and candidate responders have mild disease, with FT4 <2.76 ng/dL (35.5 pmol/L), a small goiter, and are female and elderly. Response rates are relatively high, at 60-80%, and the remission rate is about 40%. In cases of insufficient response, changing therapy should be considered. Inorganic iodine can be used as a possible alternative if the patient experiences adverse events with antithyroid drugs and/or prefers conservative treatments, with an understanding of their efficacy and limitations. These recent reports have been published from Japan, where iodine is sufficient, and the dose of inorganic iodine is empirical and requires further study.

Characteristics of patients with Graves’ disease who developed drug resistance and required surgery

Although antithyroid drugs (ATDs) are the first-line treatment for patients with Graves' disease (GD) in Japan and other countries, some patients do not achieve remission due to drug resistance, leading to surgery. Even if ATD doses are increased, they often have uncontrolled thyroid function and enlarged goiters, necessitating high-risk emergency surgical treatment. In this study, we aimed to identify the characteristics of patients resistant to ATDs who underwent thyroidectomy and those who achieved remission. We retrospectively analyzed 45 patients with GD who underwent thyroidectomy and 73 patients who achieved remission with ATDs at Shinshu University Hospital between April 1, 2015 and September 30, 2023. In patients who underwent surgery, the drug-resistant patients (DR group; n = 15) had longer disease durations (8.0 vs. 3.0 years, respectively; p = 0.013), higher free triiodothyronine (FT3) / free thyroxine (FT4) ratios (5.54 vs. 3.52, respectively; p = 0.005), higher anti-TSH receptor antibody (TRAb) levels (39.16 vs. 13.31 IU/L, respectively; p = 0.002), and larger thyroid glands (251.00 vs. 54.80 g, respectively; p < 0.001) than non-drug-resistant patients (NDR group; n = 30). Compared with patients who achieved remission with ATDs (Remission group; n = 73), the DR group had higher FT3/FT4 ratios (5.54 vs. 2.99, respectively; p < 0.001) and higher TRAb levels (39.16 vs. 5.9 IU/L, respectively; p < 0.001). Notably, most of the patients in the DR group had a combination of these factors. This suggests that in patients with large thyroid, high FT3/FT4 ratios, and high TRAb levels, early consideration of definitive-curative treatment such as surgery or RI therapy may be warranted instead of continuing prolonged ineffective ATDs treatment.

A diagnostic conundrum: a patient with only complaints of palpitations and dyspnea was diagnosed with thyroid storm: a rare case report

Introduction and background: The life-threatening side effect of hyperthyroidism, the thyrotoxic storm, can be difficult to diagnose because of its wide range of vague clinical symptoms. Patient survival depends on early diagnosis and treatment. Case presentation: This report presents the case of a male patient, age 58, who had no previous history of hyperthyroidism and initially complained of palpitations and dyspnea. He had supraventricular tachycardia (SVT) and thyrotoxicosis upon evaluation. His Burch-Wartofsky Point Scale (BWPS) score of 50 indicated a high probability of thyroid storm. Propranolol and propylthiouracil were started on time, stabilizing the patient’s vital signs and converting SVT to atrial fibrillation. With further care, the thyrotoxicosis resolved. Clinical discussion: This example emphasizes how critical it is to identify thyroid storm and treat it quickly in order to maximize patient outcomes, especially when it is exacerbated by SVT. It also emphasizes how helpful the BWPS is in helping diagnose and treat patients in such cases. Conclusion: It is important for clinicians to evaluate each patient presented with cardiac symptoms of thyroid function abnormality. In order to manage thyroid storm, early intervention with beta-blockers and antithyroid drugs is essential. Better patient outcomes result from early diagnosis and treatment, which is made possible by the BWPS, particularly in cases with unexplained new-onset atrial fibrillation.

Long-term outcomes after a radioactive iodine treatment for a single autonomous functioning thyroid nodule in Japan

We investigated the association between a 500 MBq dose of radioactive iodine treatment (RAIT) and both thyroid nodule volume and thyroid function in patients with a single autonomous functioning thyroid nodule (AFTN). We retrospectively studied 201 patients with an AFTN who received RAIT at a dose of 500 MBq and were followed up for more than 2 years. Thyroid function at diagnosis, thyroid antibody positivity, treatment with antithyroid drugs before RAIT, cystic components of the nodule, and 131I uptake outside the nodule were assessed. Nodule enlargement was observed in 18 patients (9%), persistent hyperthyroidism in 13 patients (6.5%), and hypothyroidism in 45 patients (22.3%). Nodule volume before RAIT was significantly larger in the nodule enlargement group compared to the non-enlargement group. The risk factors for persistent hyperthyroidism were larger nodule volume and absence of a cystic component in multivariate analysis. The cutoff nodule volume before RAIT for predicting nodule enlargement was 15.5 mL, and for predicting persistent hyperthyroidism was 16.6 mL. Nodule volume decreased to 47% in the first year and continued to gradually decrease thereafter. This study provided long-term outcome data regarding nodule volume change and thyroid function in AFTN patients following single fixed-dose RAIT, and it identified risk factors for nodule enlargement and persistent hyperthyroidism after RAIT. Nodule volume before treatment was a good predictor of treatment response.

Pediatric Graves' disease in Argentina: analyzing treatment strategies and outcomes.

Graves' disease is the leading cause of hyperthyroidism in children. Only a small percentage of pediatric patients achieve remission with anti-thyroid drug treatment (ATD), and both definitive therapies (thyroidectomy, or radioiodine thyroid ablation) cause lifelong hypothyroidism. Our objective was to evaluate the outcome of patients with pediatric Graves' disease (PGD), treated at a single tertiary center, focusing on response to medical treatment, remission rate, adverse reactions (AR), definitive treatment (DT), and potential predictive factors for remission. Data from clinical charts of 130 patients diagnosed with PGD between 2006 and 2021 were collected: epidemiological, clinical, biochemical characteristics, outcome, remission, adverse reactions (AR), and DT were registered. Predictive factors at diagnosis were evaluated for 88 patients diagnosed at our center. Our patients were 78 % female, 98 % Hispanic, with a median age of 12.7 years (range 1.7-17.3 years). Fourteen (11 %) had Down syndrome. Severe thyrotoxicosis (FT4>5.5 ng/dL) was seen at diagnosis in 66 %. Initially, 129/130 received ATD; during the study, 17 participants (13 %) reached remission, with a median ATD duration of 3.1 years (range 1.3-6.1 years). The chance of remaining hyperthyroid was 65 %. Only one patient relapsed 1.3 years post-ATD. Forty-six percent (59/129) needed DT, 31 % (40/129) were lost to follow-up, and 10 % (11/129) remained on ATD. AR affected 26 % of the patients and most (74 %) occurred within the first 3 months, half of them severe enough to discontinue ATD. No significant predictive factors were identified. ATD, our first-line treatment, resulted in low remission rates for Hispanic pediatric patients with severe thyrotoxicosis at diagnosis. Poor adherence issues contributed to the indication of DT (46 %) and loss to follow-up (31 %) during the studied period. Based on our findings, DT should be considered at 4 years of ATD in persisting PGD. ATD, our first line treatment, resulted in low remission rates for Hispanic pediatric patients with severe thyrotoxicosis at diagnosis. Poor adherence issues contributed to the indication of DT (46 %) and loss to follow-up (31 %) during the studied period. Based on our findings, DT should be considered at 4 years of ATD in persisting PGD.

A Rare Occurrence of Dilated Cardiomyopathy and Long Qt Syndrome in a Child with Graves’ Disease: A Case Report and Review of Literature

Grave’s disease (GD) is the most common cause of hyperthyroidism in children and typically patients exhibit symptoms of hyperthyroidism such as palpitations, sweating, heat intolerance, diarrhoea and weight loss. Cardiomyopathy is a rare but serious and life-threatening complication of GD. It is more prevalent among middle-aged and elderly patients with pre-existing heart conditions. We describe a case of an 11-year-old girl with Graves’ disease complicated by thyroid storm, and dilated cardiomyopathy. She had palpitations for almost 2 years, followed by recurrent syncopal attacks for 6 months. The initial thyroid function test showed significantly high FT4 levels of 85.6pmol/L and suppressed TSH. Her TSH Receptor antibody (TRAB) was positive and her CXR revealed cardiomegaly. She received anti-thyroid drugs including oral Carbimazole, oral propranolol, Lugol’s iodine and intravenous hydrocortisone. Two anti-failure medications were used to treat her heart failure. Her symptoms improved, and she was discharged with oral carbimazole and oral propranolol. It is important to recognise and diagnose the complications associated with severe GD to prevent future cardiac decompensation during relapse. Medical practitioners need to be aware of the rare presentations of Graves’ disease to avoid delayed diagnosis and treatment.

A Belgian single centre outcome study of radioiodine treatment in adolescents with Graves’ disease

Up to 80% of children/adolescents with Graves’ disease (GD) may require second-line treatment with either surgery or radioactive iodine (RAI) therapy after treatment with antithyroid drugs. These interventions aim to induce permanent hypothyroidism, but are not always successful. We aimed to evaluate the initial success rate (within the first year) of RAI treatment and its determining factors as second-line treatment in teenagers with GD. We also assessed the tolerability of RAI therapy and the onset speed of RAI-induced hypothyroidism. We conducted a retrospective chart review of children < 18 years treated with RAI (scaled fixed dose) for GD between January 2007 and December 2022 at the UZ Brussels. Fourteen teenagers treated with RAI were identified. Their ages at time of treatment ranged from 9.8 to 17.3 years, with administered I131 doses between 5.8 and 15.0mCi (median 7.9mCi). All but two patients responded within six months. Thyroxine treatment was started between 4 and 14 weeks (median 9 weeks) after RAI therapy. The time to thyroxine substitution correlated positively with age (Rho = 0.498; p = 0.099) and total I131-dose (Rho = 0.582; p = 0.047). One patient experienced transient RAI induced sialadenitis. None of the patients relapsed during a follow-up period of 1.2 to 13 years. A cure rate of 86% was observed in GD teenagers receiving a second-line RAI treatment, with no major complications. Most patients became hypothyroid within three months, underscoring the importance of early thyroid function monitoring.

Predictive factors influencing hypothyroidism following the radioactive iodine treatment of Graves’ disease in different periods

In China, due to the risks of hypothyroidism after radioiodine treatment, radioiodine is not commonly used as a first-line treatment. In this study, factors influencing the development of hypothyroidism after 131I therapy for Graves’ hyperthyroidism were evaluated. This was a retrospective study with a 12-month follow-up. Retrospectively, we investigated 1,264 patients with diagnosed Graves’ disease who received 131I therapy using the Marinelli-Quimby formula. The first three months after 131I therapy, hypothyroidism risk was higher among patients with lighter thyroid weight, higher levels of thyroglobulin antibody (TGAb), and shorter durations of Antithyroid drug (ATD) treatment before 131I therapy (P < 0.05). After 6 months, patients with lighter thyroid weight, shorter ATD treatment duration before 131I therapy, and higher iodine intake showed an increased risk of hypothyroidism. (P < 0.05). After one year, lower 24-h iodine uptake was the only risk factor for hypothyroidism (P < 0.05). Our results show that 131I is an effective therapy for GD. Even if over time, the occurrence of hypothyroidism may ultimately depend on the patients’ radiosensitivity to 131I before treatment. But in the first 3 to 6 months or even one year, we can still take measures to effectively improve the quality of life of patients.

Graves' Disease and the Risk of Type 2 Diabetes: A Korean Population-Based Study.

Background: Several meta-analyses have found no association between Graves' disease (GD) and an increased risk of incident diabetes; however, the intricate relationship between thyroid dysfunction and diabetes remains underexplored. In this study, we aimed to evaluate the risk of incident type 2 diabetes (T2DM) in a population newly diagnosed with GD, focusing on different treatment methods and treatment duration. Methods: This was a retrospective population-based study utilizing data from the Korean National Health Insurance database. We included 36,243 patients with GD and 36,243 controls, matched with age and sex. We calculated the incidence of T2DM among patients and controls based on treatment methods, such as medical therapy, radioactive iodine therapy (RAIT), and surgery. We examined the cumulative dose and duration of antithyroid drug (ATD) use for each patient. Results: The majority of patients (34,867, 96.2%) were treated with ATDs, followed by RAIT (1093 patients, 3%), and surgery (283 patients, 0.8%). After adjusting for age; sex; income; comorbidities, including hypertension, dyslipidemia, and cancer; body mass index; smoking; drinking; and exercise, patients with GD exhibited a higher risk of developing diabetes (hazard ratio [HR] = 1.13 [95% confidence interval 1.06-1.21]) than controls (5.1% vs. 4.5%, respectively). While the risk was the highest within the first six months after GD diagnosis (HR = 3.21), it was significant between six months and two years (HR = 1.36) and was comparable with the controls two years after GD diagnosis (HR = 0.93). A longer duration of ATD treatment and a higher cumulative dose were associated with an increased risk of diabetes. However, the risks for T2DM did not differ according to treatment modality or clinical outcomes, which was probably related to the small number of patients in each subgroup. Conclusions: Our findings highlight the negative impact of GD on the development of T2DM. Patients newly diagnosed with GD can be considered for diabetes screening to facilitate early detection and intervention.