Document Detail

Paradoxical exacerbation of preexisting Graves' disease induced by insufficient radioiodine treatment: a report of five patients.
MedLine Citation:
PMID:  19252454     Owner:  NLM     Status:  MEDLINE    
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.
Sang-Woo Lee; Jaetae Lee; Jin-Ho Bae; Ji-Hyoung Seo; Seong-Min Kang; Byeong-Cheol Ahn; Inkyu Lee
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Nuclear medicine communications     Volume:  30     ISSN:  0143-3636     ISO Abbreviation:  Nucl Med Commun     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-09     Completed Date:  2009-05-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8201017     Medline TA:  Nucl Med Commun     Country:  England    
Other Details:
Languages:  eng     Pagination:  275-80     Citation Subset:  IM    
Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Korea.
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MeSH Terms
Graves Disease / pathology,  radionuclide imaging*
Hyperthyroidism / etiology,  pathology,  radionuclide imaging
Iodine Radioisotopes / administration & dosage,  adverse effects*,  therapeutic use*
Middle Aged
Radiopharmaceuticals / diagnostic use
Receptors, Thyrotropin / immunology,  metabolism
Sodium Pertechnetate Tc 99m / diagnostic use
Thyroxine / blood
Treatment Failure
Reg. No./Substance:
0/Iodine Radioisotopes; 0/Radiopharmaceuticals; 0/Receptors, Thyrotropin; 23288-60-0/Sodium Pertechnetate Tc 99m; 7488-70-2/Thyroxine

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