BMJ, doi: 10.1136/bmj.39114.670150.BE, (Published 19 February 2007)

RESEARCH

Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials

Martin A Walter ^1*, Matthias Briel ², Mirjam Christ-Crain ³, Steen J Bonnema ⁴, John Connell ⁵, David S Cooper ⁶, Heiner C Bucher ², Beat Müller ³, Jan Müller-Brand ⁷

¹ Institute of Nuclear Medicine, University Hospital Basel, Switzerland, and Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel
² Basel Institute for Clinical Epidemiology, University Hospital Basel
³ Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel
⁴ Department of Endocrinology and Metabolism, University Hospital Odense, Denmark
⁵ Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow
⁶ Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, USA
⁷ Institute of Nuclear Medicine, University Hospital Basel, Switzerland

^* Correspondence to: m.a.walter{at}gmx.net.

Objective To determine the effect of adjunctive antithyroid drugs on the risk of treatment failure, hypothyroidism, and adverse events after radioiodine treatment.

Design Meta-analysis.

Data sources Electronic databases (Cochrane central register of controlled trials, Medline, Embase) searched to August 2006 and contact with experts.

Review methods Three reviewers independently assessed trial eligibility and quality. Pooled relative risks for treatment failure and hypothyroidism after radioiodine treatment with and without adjunctive antithyroid drugs were calculated with a random effects model.

Results We identified 14 relevant randomised controlled trials with a total of 1306 participants. Adjunctive antithyroid medication was associated with an increased risk of treatment failure (relative risk 1.28, 95% confidence interval 1.07 to 1.52; P=0.006) and a reduced risk for hypothyroidism (0.68, 0.53 to 0.87; P=0.006) after radioiodine treatment. We found no difference in summary estimates for the different antithyroid drugs or for whether antithyroid drugs were given before or after radioiodine treatment.

Conclusions Antithyroid drugs potentially increase rates of failure and reduce rates of hypothyroidism if they are given in the week before or after radioiodine treatment, respectively.

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(Accepted 4 January 2007)
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This article has been cited by other articles:

• Brent, G. A. (2008). Graves' Disease. NEJM 358: 2594-2605 [Full text]  
• Walter, M. A., Muller-Brand, J., Muller, B. (2007). Antithyroid Drugs and Radioiodine and the Absence of Evidence. JNM 48: 1403a-1403a [Full text]  
• McDougall, I. R., Iagaru, A. (2007). Reply: Antithyroid Drugs and Radioiodine and the Absence of Evidence. JNM 48: 1403b-1404 [Full text]  
• (2007). Radioiodine Treatment and the Effects of Antithyroid Drugs. JWatch General 2007: 4-4 [Full text]  
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