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Time Interval Between the Last Dose of Propylthiouracil and I-131 Therapy Influences Cure Rates in Hyperthyroidism Caused by Graves' Disease

TURTON, DAVID B., M.D.*; SILVERMAN, EUGENE D., M.D.*; SHAKIR, K. M. MOHAMED, M.D.

Original Articles
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Purpose: To examine the effects of propylthiouracil (PTU) pretreatment on the outcome of initial I-131 therapy for Graves' disease.

Design: A retrospective chart review was done.

Patients and Methods: The authors studied 106 patients in an outpatient nuclear medicine setting who were given initial I-131 therapy for Graves' disease from September 1989 to March 1993 and followed for at least 6 months after therapy. These patients were divided into groups based on whether they had ever received PTU or, if they had received PTU, the length of time between the last dose of PTU and the I-131 therapy dose. Measured failure rates of initial I-131 therapy were based on recurrent or continued hyperthyroidism.

Results: Treatment failure rates increased markedly from 2.5% in non-PTU-treated patients (n = 80) to 23.1% (n = 26) in patients pretreated with PTU (P = 0.003). Although not significant, two PTU-pretreated subgroups showed a trend toward increased failure rates. The failure rate was 15.4% (n = 13) in patients whose last dose of PTU was 7-14 days before I-131 therapy, and it increased further to 30.8% (n = 13) in patients whose last dose of PTU was within 1 week of I-131 therapy.

Conclusions: PTU pretreatment within 2 weeks of I-131 treatment is a strong independent risk factor in failure rates after initial I-131 therapy in patients with Graves' disease. Patients should be free of PTU for 2 weeks before I-131 therapy if they are able to tolerate it, otherwise the dose of I-131 may need to be adjusted upward to diminish the risk that the initial I-131 therapy will fail.

From the Departments of Radiology* and Internal Medicine,† National Naval Medical Center, Bethesda, Maryland

Received February 19, 1998. Accepted April 21, 1998.

The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States government.

Reprint requests: CDR David B. Turton, MC, USN, Nuclear Medicine Division, Department of Radiology, National Naval Medical Center, Bethesda, Maryland 20889-5600.

© 1998 Lippincott Williams & Wilkins, Inc.