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Outcome of radioiodine therapy without, on or 3days off carbimazole: a prospective interventional three-group comparison

Walter, Martin ; Christ-Crain, Mirjam ; Schindler, Christian ; Müller-Brand, Jan ; Müller, Beat

In: European Journal of Nuclear Medicine and Molecular Imaging, 2006, vol. 33, no. 6, p. 730-737

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    Titre
    • Outcome of radioiodine therapy without, on or 3days off carbimazole: a prospective interventional three-group comparison
    Auteur
    • Walter, Martin. Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031, Basel, Switzerland
    • Christ-Crain, Mirjam. Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
    • Schindler, Christian. Institute of Social and Preventive Medicine, University Hospital Basel, Basel, Switzerland
    • Müller-Brand, Jan. Institute of Nuclear Medicine, University Hospital, Petersgraben 4, 4031, Basel, Switzerland
    • Müller, Beat. Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • European Journal of Nuclear Medicine and Molecular Imaging, 2006, vol. 33, no. 6, p. 730-737. Springer-Verlag
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:316853
    Summary
    Purpose: Carbimazole ameliorates hyperthyroidism but reduces radioiodine uptake and adversely affects the outcome of simultaneous radioiodine therapy. We explored whether withdrawal of carbimazole for 3 days can restore the outcome of radioiodine treatment without concurrent exacerbation of hyperthyroidism. By generating three groups with comparable radioiodine uptake, we also investigated whether the effect of carbimazole depends on the radioiodine uptake. Methods: Stratified by a radioiodine uptake >30%, 227 consecutive adult patients were prospectively assigned to radioiodine therapy (target dose 200Gy) without, on or 3days off carbimazole. Patients were clinically (Crooks-Wayne score) and biochemically (T3, fT4, TSH) followed up after 3, 6 and 12months. Primary endpoint was outcome 12months after radioiodine therapy. Results: A total of 207 patients completed follow-up (toxic nodular goitre, n=117; Graves' disease, n=90). The overall success rate was 71.5%. Patients without and 3days off carbimazole had similar biochemical (81.4% and 83.3%, respectively; p=0.82) and clinical outcomes [median (range) Crooks-Wayne score 0 (0-16) and 1 (0-10), respectively; p=0.73], which were both higher than in patients on carbimazole [42.6%, p<0.001; Crooks-Wayne score 3 (0-30), p<0.03]. Time to achieve cure was delayed on carbimazole. No changes in thyroid hormone levels occurred after 3days' discontinuation of carbimazole. Logistic regression revealed that all observed cure rates were independent of entity, sex, age, thyroid volume, radioiodine uptake, radioiodine half-life, fT4, T3 and TSH. Conclusion: Patients under carbimazole treatment can be referred for radioiodine therapy after withdrawal of carbimazole for only 3days. Three days of carbimazole withdrawal is long enough to restore the success of radioiodine therapy and short enough to avoid the risk of exacerbation of hyperthyroidism