Radioactive Iodine Therapy Without Recent Antithyroid Drug Pretreatment For Hyperthyroidism Complicated By Severe Hyperbilirubinemia Due To Hepatic Dysfunction: Experience Of A Chinese Medical Center |
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| Affiliation: | 1. From the Department of Nuclear Medicine, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.;2. Department of Gastrointestinal Medicine, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.;3. Department of Endocrinology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.;1. From the Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India;2. Neuro Oncology group, Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai;3. Department of Neurosurgery, Seth G S Medical College and KEM Hospital, Mumbai, India.;1. From the University of Texas Medical Branch, Department of Pediatrics,;2. University of California, San Francisco, Department of Pediatrics;3. Boston University School of Medicine, Department of Pediatrics;4. University of Texas Medical Branch, Department of Preventive Medicine and Community Health;5. Stanford University Medical Center, Department of Pediatrics.;1. Global Stem cell Technology, ANACURA group, Evergem, Belgium;2. Pell Cell Medicals, ANACURA group, Evergem, Belgium;3. Department of Comparative Biomedicine and Food Science, University of Padova, Italy;4. Department of Surgery and Anaesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium;1. From the Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, and Kaleida Health, Buffalo, New York. |
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| Abstract: | Objective: The objective of this work is to report our experience with 131I therapy without recent antithyroid drug (ATD) pretreatment for refractory severe hyperthyroidism complicated by hyperbilirubinemia due to hepatic dysfunction.Methods: Five patients with refractory severe hyperthyroidism were treated with 131I at 90 to 120 μCi/g-thyroid (total activity, 6.2 to 10.1 mCi). The patients previously had received ATD treatment from 2 months to 12 years and discontinued ATDs from 2 months to 4 years before 131I treatment due to treatment failure or severe jaundice. Prior to 131I therapy, the patients were asked to take a low-iodine diet and were treated with bisoprolol fumarate, digoxin, furosemide, S-adenosylmethionine, polyene phosphatidylcholine, and plasma exchange as supportive treatment for related clinical conditions. Four of the patients also received lithium carbonate in conjunction with their 131I treatment. The patients were followed for 4 to 9 years after 131I therapy.Results: After 131I treatment, jaundice disappeared completely within 3 to 4 months in all patients, and liver function tests returned to normal. Concurrent atrial fibrillation and heart failure, leukopenia and thrombocytopenia, or thrombocytopenia and left cardiac enlargement improved remarkably in 3 patients during the follow-up period. Three to 45 months after 131I treatment, hypothyroidism was noted in the patients and they were treated with L-thyroxine replacement therapy.Conclusion:131I therapy without recent ATD pretreatment for refractory severe hyperthyroidism complicated by serious jaundice appears to be safe and effective, with good long-term results. It may be the preferred therapy for such patients and should be used as early as possible.Abbreviations:ATD = antithyroid drugFT4 = free thyroxinePTU = propylthiouracilRAIU = radioactive iodine uptakeTSH = thyroid-stimulating hormone |
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