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

BMJ 2007; 334 doi: (Published 08 March 2007) Cite this as: BMJ 2007;334:514
  1. Martin A Walter, research associate1,
  2. Matthias Briel, research associate2,
  3. Mirjam Christ-Crain, research associate3,
  4. Steen J Bonnema, professor of medicine4,
  5. John Connell, professor of endocrinology5,
  6. David S Cooper, professor of medicine6,
  7. Heiner C Bucher, professor of medicine2,
  8. Jan Müller-Brand, professor of nuclear medicine7,
  9. Beat Müller, professor of endocrinology3
  1. 1Institute of Nuclear Medicine, University Hospital Basel, Switzerland, and Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel
  2. 2Basel Institute for Clinical Epidemiology, University Hospital Basel
  3. 3Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel
  4. 4Department of Endocrinology and Metabolism, University Hospital Odense, Denmark
  5. 5Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow
  6. 6Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, USA
  7. 7Institute of Nuclear Medicine, University Hospital Basel, Switzerland
  1. Correspondence to: M A Walter{at}
  • Accepted 4 January 2007


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.


  • We thank Peter Wolf for assistance in electronic libraries search and Liu Kun, Sibylle Tschumi, and Martin Stoecklin for translations. We also thank Marcel Wolbers for statistical advice and Helmut Rasch and Anthony Toft for their valuable comments on the manuscript.

  • Contributors: MAW designed the study, collected and analysed the data, wrote the manuscript, and is guarantor. MB performed quality assessment, did all statistical analyses, and participated in the design of the study and writing of the manuscript. MC-C performed data extraction and quality assessment and contributed to the writing of the manuscript. SJB, DSC, JC, HCB, and JM-B participated in data collection, interpretation, and writing of the manuscript. BM directed study design, data analysis, and writing of the manuscript.

  • Funding: MB and HCB are supported by grants from santésuisse and the Gottfried and Julia Bangerter-Rhyner-Foundation.

    Competing interests: None declared.

  • Ethical approval: Not needed.

  • Accepted 4 January 2007
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