journal of lnternal Medicine 1992; 231: 13-17

Radioiodine treatment of recurrent hyperthyroidism in patients previously treated for Graves’ disease by subtotal thyroidectomy H. VESTERGAARD & P. LAURBERG* From the Department of Internal Medicine 111. Aarhus Amtssggehus and the llepartmerit of Clinical Phgsiology and Nuclear Medicine. Arhus Kommunehospital. and the *Department of Internal Medicine and Endocrinologg, Aalborg Regional Hospital. Aalborg, Denmark

Abstract. Vestergaard H, Laurberg P (Department of Internal Medicine 111, Aarhus Amtssygehus and Department of Clinical Physiology and Nuclear Medicine, Arhus Kommunehospital, and Department of Internal Medicine and Endocrinology, Aalborg Regional Hospital, Aalborg, Denmark). Radioiodine treatment of recurrent hyperthyroidism in patients previously treated for Graves’ disease by subtotal thyroidectomy. journal of Internal Medicine 1992 ; 231 : 13-1 7. Kadioiodine therapy is often employed for treatment of patients with relapse of hyperthyroidism due to Graves’ disease, after previous thyroid surgery. Little is known about the outcome of this treatment compared to patients with no previous surgery. A total of 20 patients who had received surgical treatment for Craves’ hyperthyroidism 1 4 6 years previously and with relapse of the hyperthyroidism, and 25 patients with hyperthyroidism due to Graves’ disease and no previous thyroid surgery were treated with radioiodine. following the same protocol. Early after treatment the previously operated patients showed a higher sensitivity to radioiodine, with more cases of early hypothyroidism, than non-operated patients. However, after 50 months of follow-up the outcome was identical. The results indicate that frequent assessment is necessary after radioiodine treatment of previously operated patients, since some patients develop early hypothyroidism. Keywords: Graves’ disease, hyperthyroidism, radioiodine treatment, relapse, thyroidectomy.

Introduction Considerable controversies exist regarding the type of treatment that should be given to patients suffering from hyperthyroidism due to Graves’ disease [ 11.In a previous study we have found that patients from our region with newly diagnosed hyperthyroidism due to Graves’ disease show a favourable response to a course of anti-thyroid drugs, if they have a small thyroid gland [ 2 ] . Consequently, it was suggested that antithyroid drugs represent the treatment of choice in such patients. On the other hand, patients with a medium-sized or large goitre very often suffered relapse of the hyperthyroidism after withdrawal of antithyroid drugs. Therefore some kind of destructive therapy (surgery or radioiodine) was recommended in such patients 121.

In patients with relapse after previous therapy, the tendency to recommend destructive therapy is stronger [l],and in patients with relapse of hyperthyroidism after previous thyroid surgery, radioiodine therapy will often be the treatment of choice [l].However, our knowledge of the effect of radioiodine (RAI) on thyroid function in patients previously operated for hyperthyroidism due to Graves’ disease is limited. In the present study we have evaluated the effect of a single dose of I 3 l I given as therapy in a group of previously operated patients, compared to a group of patients with Graves’ disease, but no previous thyroid surgery.

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Table 1. Clinical characteristics of the patients Previous thyroid surgery

n Sex (F/M) Age (years) Before medical treatment* sT, (nmoll-') sT, (nrnol I-') Initial dose of methimazole MMI (mg d-')

20 1713 60 (31-79)

40

No previous surgery

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Radioiodine treatment of recurrent hyperthyroidism in patients previously treated for Graves' disease by subtotal thyroidectomy.

Radioiodine therapy is often employed for treatment of patients with relapse of hyperthyroidism due to Graves' disease, after previous thyroid surgery...
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