Remission After Potassium Iodide Therapy in Patients With Graves' Hyperthyroidism Exhibiting Thionamide-Associated Side Effects

Okamura, Ken; Sato, Kaori; Fujikawa, Megumi; Bandai, Sachiko; Ikenoue, Hiroshi; Kitazono, Takanari

doi:10.1210/jc.2013-4466

Cited by 49 publications

(54 citation statements)

References 31 publications

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“…In such cases, careful consideration must be given to the potential for escape phenomenon, or a rapid exacerbation of thyrotoxicosis after treatment discontinuation. A study of adult patients with relatively small goiters, FT4 levels ≤ 2.5 ng/dL, and relatively low TRAb levels, showed that approximately two-thirds of patients treated with inorganic iodine monotherapy did not develop escape phenomenon and maintained normal thyroid function for a long period; furthermore, approximately 60% of these patients achieved remission after an average of 7.4 yr of treatment (88, 89). In adults with Graves’ disease, combined treatment with MMI and inorganic iodine was used to reduce the MMI dose (83, 90, 91).…”

Section: Drug Therapies For Graves’ Diseasementioning

confidence: 99%

Guidelines for the treatment of childhood-onset Graves’ disease in Japan, 2016

Minamitani¹,

Sato

Ohye

et al. 2017

Clin Pediatr Endocrinol

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Abstract.Purpose behind developing these guidelines: Over one decade ago, the “Guidelines for the Treatment of Graves’ Disease with Antithyroid Drug, 2006” (Japan Thyroid Association (JTA)) were published as the standard drug therapy protocol for Graves’ disease. The “Guidelines for the Treatment of Childhood-Onset Graves’ Disease with Antithyroid Drug in Japan, 2008” were published to provide guidance on the treatment of pediatric patients. Based on new evidence, a revised version of the “Guidelines for the Treatment of Graves’ Disease with Antithyroid Drug, 2006” (JTA) was published in 2011, combined with the “Handbook of Radioiodine Therapy for Graves’ Disease 2007” (JTA). Subsequently, newer findings on pediatric Graves’ disease have been reported. Propylthiouracil (PTU)-induced serious hepatopathy is an important problem in pediatric patients. The American Thyroid Association’s guidelines suggest that, in principle, physicians must not administer PTU to children. On the other hand, the “Guidelines for the Treatment of Graves’ Disease with Antithyroid Drug, 2011” (JTA) state that radioiodine therapy is no longer considered a “fundamental contraindication” in children. Therefore, the “Guidelines for the Treatment of Childhood-Onset Graves’ Disease with Antithyroid Drug in Japan, 2008” required revision.

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Section: Drug Therapies For Graves’ Diseasementioning

confidence: 99%

Guidelines for the treatment of childhood-onset Graves’ disease in Japan, 2016

Minamitani¹,

Sato

Ohye

et al. 2017

Clin Pediatr Endocrinol

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“…It is well known that the effects of KI in GD often diminish during administration, described as the "escape phenomenon" [24]. However, Okamura et al reported that many GD patients who were treated with KI continuously for a long duration went into remission in Japan [14]. We continued KI treatment for GD patients unless they had significant hyperthyroidism and almost all patients in the KI group showed mild hyperthyroxinemia.…”

Section: Discussionmentioning

confidence: 94%

“…Takata et al demonstrated the usefulness of KI combined with ATD therapy [13]. In addition, Okamura et al reported the effectiveness of only KI in GD patients who showed adverse effects to MMI [14]. Therefore, in Japan, KI is often administered to GD patients who are showing adverse ATD effects.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Efficacy of Potassium Iodide Preparation for Radioactive Iodine Therapy in Graves’ Disease: A Retrospective Chart Review

2017

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Background: Pretreatment by antithyroid drugs (ATDs) before radioactive iodine therapy (RAIT) for Graves' disease (GD) is often performed to avoid aggravation of thyroid function including thyroid storm. However, in patients suffering from adverse effects of ATDs, potassium iodide (KI) is often selected to treat hyperthyroidism before RAIT in Japan. The aim of this study was to evaluate the efficacy of KI preparation for RAIT in GD and whether a short-term discontinuation of KI before RAIT is a safe and useful method in GD patients showing adverse effects from ATDs.

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“…It has been reported that T4 and T3 start to increase again after 21 days of iodine treatment in hyperthyroid patients (33). On the other hand, in Japan long-term treatment with iodine has been used, alone or together with anti-thyroid drugs, to achieve euthyroidism with good results (34). Whether this also works in patients with other ethnic backgrounds and iodine sufficiency is not known and should be explored in future trials.…”

Section: Discussionmentioning

confidence: 99%

Rescue pre-operative treatment with Lugol’s solution in uncontrolled Graves’ disease

Calissendorff

Falhammar

2017

Endocrine Connections

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BackgroundGraves’ disease is a common cause of hyperthyroidism. Three therapies have been used for decades: pharmacologic therapy, surgery and radioiodine. In case of adverse events, especially agranulocytosis or hepatotoxicity, pre-treatment with Lugol’s solution containing iodine/potassium iodide to induce euthyroidism before surgery could be advocated, but this has rarely been reported.MethodsAll patients hospitalised due to uncontrolled hyperthyroidism at the Karolinska University Hospital 2005–2015 and treated with Lugol’s solution were included. All electronic files were carefully reviewed manually, with focus on the cause of treatment and admission, demographic data, and effects of iodine on thyroid hormone levels and pulse frequency.ResultsTwenty-seven patients were included. Lugol’s solution had been chosen due to agranulocytosis in 9 (33%), hepatotoxicity in 2 (7%), other side effects in 11 (41%) and poor adherence to medication in 5 (19%). Levels of free T4, free T3 and heart rate decreased significantly after 5–9 days of iodine therapy (free T4 53–20 pmol/L, P = 0.0002; free T3 20–6.5 pmol/L, P = 0.04; heart rate 87–76 beats/min P = 0.0007), whereas TSH remained unchanged. Side effects were noted in 4 (15%) (rash n = 2, rash and vomiting n = 1, swelling of fingers n = 1). Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications.ConclusionTreatment of uncontrolled hyperthyroidism with Lugol’s solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. Side effects were limited. Lugol’s solution could be recommended pre-operatively in Graves’ disease with failed medical treatment, especially if side effects to anti-thyroid drugs have occurred.

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Remission After Potassium Iodide Therapy in Patients With Graves' Hyperthyroidism Exhibiting Thionamide-Associated Side Effects

Abstract: Among hyperthyroid patients with thionamide-associated side effects, KI therapy was effective in two-thirds of cases, and about 40% of the patients experienced remission after KI therapy alone. The chance of remission was small among the patients refractory to KI.

Cited by 49 publications

References 31 publications

Guidelines for the treatment of childhood-onset Graves’ disease in Japan, 2016

Guidelines for the treatment of childhood-onset Graves’ disease in Japan, 2016

Evaluation of the Efficacy of Potassium Iodide Preparation for Radioactive Iodine Therapy in Graves’ Disease: A Retrospective Chart Review

Rescue pre-operative treatment with Lugol’s solution in uncontrolled Graves’ disease

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