Paradoxical exacerbation of preexisting Graves' disease induced by insufficient radioiodine treatment: a report of five patients.
OBJECTIVE: This study reports on early and paradoxical aggravation of hyperthyroidism, which needs long-term treatment, in patients with Graves' disease after radioactive iodine (RAI) treatment. METHODS: Five patients (0.4%) out of 1333 consecutive patients with Graves' disease who underwent RAI treatment by using an empirical fixed dose of I between January 2000 and March 2006 revisited the emergency center because of early and markedly aggravated thyrotoxic manifestations, which seemed to differ from those for radiation-induced thyroiditis. The clinical features, changes in the laboratory, and scintigraphic findings before and after RAI treatment, and long-term follow-up of these patients were reviewed retrospectively. RESULTS: The mean interval between the RAI treatment and paradoxical exacerbation of hyperthyroidism was 47.8 days (range: 28-69 days). In all five patients, the serum levels of thyroid hormones were markedly increased compared with those before the RAI treatment. The patients also exhibited an increased uptake of radioiodine or technetium-99m pertechnetate on the scintigraphy after RAI treatment. The serum levels of thyrotropin receptor antibodies were increased compared with those before the RAI treatment. Immediate and long-term treatments with antithyroid medications or second dose of RAI treatment were required in all the patients to control persistent hyperthyroidism. CONCLUSION: The early and paradoxical exacerbation of preexisting Graves' disease, as distinct from radiation-induced thyroiditis, can occur after insufficient dose of RAI treatment for Graves' disease.[1]References
- Paradoxical exacerbation of preexisting Graves' disease induced by insufficient radioiodine treatment: a report of five patients. Lee, S.W., Lee, J., Bae, J.H., Seo, J.H., Kang, S.M., Ahn, B.C., Lee, I. Nucl. Med. Commun (2009) [Pubmed]
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