REPLY
Radioiodine Therapy in Graves Disease
Henry B. Burch;
Kenneth D. Burman; and
Leonard Wartofsky
1 April 1995 | Volume 122 Issue 7 | Page 555
IN RESPONSE:
Dr. Tibaldi suggests that in the elderly, the duration of thyrotoxicosis may have more relevance than the magnitude of thyroid hormone level elevation in the occurrence of clinically significant disease. He further implies that the surge in thyroid hormone levels that we observed [1] after antithyroid drug therapy was discontinued and before Iodine-131 administration is unlikely to be clinically relevant. No data or references were given to support this contention. On the contrary, published evidence suggests that short-term increases in thyroid hormone levels may be harmful and may in fact be the mechanism underlying several known precipitants of thyroid storm [2]. Further, if pretreatment with antithyroid drugs is intended to prevent short-term elevations in thyroid hormone levels after Iodine-131 administration, Dr. Tibaldi's comments might be used to argue against (rather than for) this practice.
1. Burch HB, Solomon BL, Wartofsky L, Burman KD. Discontinuing antithyroid therapy before ablation with radioiodine in Graves disease. Ann Intern Med. 1994; 121:553-9.
2. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis: thyroid storm. Endocrinol Metab Clin North Am. 1993; 22:263-77.
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