Change in BMI after radioactive iodine ablation for graves disease

Abstract

BackgroundWe aimed to determine the extent of post-treatment weight gain that occurs in pediatric patients in the first year following radioactive iodine (RAI) therapy for Graves disease (GD) and its relationship to clinical characteristics.MethodsA retrospective chart review of patients receiving RAI therapy for GD between 1998–2015 was performed. Change in BMI SDS (∆BMI SDS) from baseline to one year after treatment was determined. We also investigated whether individual clinical and/or biochemical factors were associated with the weight trajectory in these patients.ResultsOne hundred fifty seven patients aged 12.7 ± 3 years (80% girls) were included in the analysis. Average ∆BMI SDS was 0.70 ± 0.71 (p < 0.001) at 1 year. Patients with weight loss at presentation had a greater ∆BMI SDS than those without (0.92 vs 0.56, p = 0.005), whereas no association was seen with gender, pubertal status, use of antithyroid drugs, history of ADHD, or Down syndrome. Baseline BMI SDS was negatively correlated with ∆BMI SDS, with a stronger correlation in males. From baseline to 1 year, the proportion of overweight and obese patients increased from 9.6% to 18.5% and from 6.4% to 21%, respectively. In a subset of 81 patients, a positive correlation was noted between time to euthyroidism and ∆BMI SDS, particularly in boys.ConclusionsThe number of our patients in the overweight category doubled and the number in the obese category more than tripled in the first year following RAI treatment for GD. Anticipatory guidance regarding this important issue is badly needed.

Comparison of long‐term antithyroid drugs versus radioactive iodine or surgery for Graves' disease: A review of the literature

“…41 In a paediatric cohort of 157 GD patients treated with RAI, BMI increased in the first year after treatment, leading to a doubling of overweight patients and tripling of those in the obese category. 42 162 surgically treated GD patients gained approximately 10 kg/2 years, twice that of RAI and ATD-treated patients. 43 While transient hypothyroidism may play a role in initial weight change, in the long term the weight curves continue to diverge, suggesting that despite biochemical euthyroidism, post-ablative therapy with LT4 is not able to mitigate ongoing weight change.…”

“…Although both treatments were associated with weight gain, treatment with RAI was associated with an additional 0.6 kg of weight gain compared to ATD over mean 23 months of follow‐up 41 . In a paediatric cohort of 157 GD patients treated with RAI, BMI increased in the first year after treatment, leading to a doubling of overweight patients and tripling of those in the obese category 42 . 162 surgically treated GD patients gained approximately 10 kg/2 years, twice that of RAI and ATD‐treated patients 43 …”

Weight Gain after Treatment of Thyroid Dysfunction and Thyroid Surgery

“…15 There are a number of studies that show weight gain in children with Graves' disease during the first months after treatment and subsequent increase over the following months. 16,17…”

A New Perspective in the Management of Graves’ Hyperthyroidism

“…As shown in Table 1, LT-ATD treatment is favored for the treatment of Graves' hyperthyroidism to RAI treatment, because it provides more sustained euthyroidism (8)(9)(10)(11)(12) and less chance of variations in serum TSH, causing lower occurrences of both subclinical and clinical hypo-and hyperthyroidism during long years of management (8,(10)(11)(12)(13)(14)(15)(16)(17). In addition, RAI therapy is strongly associated with the worsening of thyroid orbitopathy (11,(18)(19)(20), increased BMI, and derangement of lipid profile (21)(22)(23)(24)(25). Furthermore, the quality of life is decreased in RAI versus LT-ATD-treated subjects (8,26).…”