When Graves' "The study gets at a question that we have thyroid cancer, but its role in benign disease

often wondered about," says Jason Wexler, like Graves' is unclear, according to the

Disease Patients
MD, an endocrinologist at MedStar researchers from the Universidade Federal
Washington Hospital Center and an de Sao Paulo and other facilities.
assistant professor of medicine at
Should Stop Georgetown University. He reviewed
the findings, which were published online
They assigned 67 patients with Grave's

Methimazole September 29 in Nuclear Medicine

Communications.
disease into two groups before they had
RIT. One ate a low- iodine diet for a week

Before RIT
Written by Kathleen Doheny
With commentary by Jason Wexler, MD,
endocrinologist at MedStar Washington
Hospital Center, D.C., and Spyros Mezitis,
MD, PhD, endocrinologist at Lenox Hill
Hospital, New York
For years, there's been no clear agreement
on the best time for Graves' Disease
patients to stop
taking methimazole (Tapazole) before they
undergo radioactive iodine therapy or RIT.
"For many of us, we've often had the
intuitive sense that people don't have to
stop for as long as we have been advising
them to stop. This [study] suggests that
probably for the majority of patients
stopping for a shorter period of time may
be as effective as stopping it for a longer
period of time."
The new research is important, agrees
Spyros Mezitis, MD, PhD, an endocrinologist
at Lenox Hill Hospital in New York who also
reviewed the findings. Withholding the
medicine for more than three days, he says,
may cause a worsening of the
hyperthyroidism. "In our practice, we
usually discontinue methimazole for 48
hours before radioiodine use with good
results," he says.
or two. The other group followed their
regular diet. The researchers found no
differences in how well the RIT worked six
months later. That study is published online
September 25 in Archives of Endocrinology
and Metabolism.
Low-iodine diets are not generally advised
for Graves' patients before RIT, agree Drs.
Wexler and Mezitis. They are, however,
often recommended before and during
treatment for thyroid cancer, Dr. Wexler
says. Graves' patients can be assured, Dr.
Wexler says, that they would not get
enough iodine from a typical, regular diet to
interfere with RIT treatment.
Last updated on 11/13/2015
First published on 10/20/2015

The researchers, from Imam Reza Hospital

and other facilities in Mashhad, Iran,
evaluated 151 patients with Graves'
disease, ranging from 18 to 65 years old.
Before their RIT, the patients were assigned
to one of three groups. They discontinued
the medication one to two days before, or
just over two days to three days, or just
over three days to a week before.

The researchers assessed the responses to

In Graves' disease, the thyroid gland makes
excess amounts of thyroid hormones,
resulting in hyperthyroidism. The
medication methimazole works by
preventing the thyroid gland from making
too much thyroid hormone. But sometimes,
it doesn't work well enough and RIT is
suggested. In RIT, the thyroid gland tissue is
shrunk or destroyed. The methimazole is
stopped before the RIT, ideally at a ''sweet
spot"the medication-free interval that
will help the treatment work best but not
make the hyperthyroidism even worse.
Now, researchers from Iran report that
responses to the RIT were the same
regardless of whether patients stopped
their medication one to two days before or
for a longer period, even up to four days
before.
RIT a month later, then again three months,
six months and a year later. They found that
the response to treatment was not different
regardless of time before, up to four days
before the RIT. The researchers conclude
that "Shorter discontinuation of
methimazole before RIT may be preferable
in most patients."
Although the study provides some
important information, the study follow up
is brief, Dr. Wexler pointed out. "What
happens after the year would be important
to look at,'' he says. That way, the
researchers could be sure the success of the
RIT held.
In another recent study evaluating
preparation for RIT for Graves' disease
patients, Brazilian researchers evaluated 55
the use of a low-iodine diet. A low-iodine
diet is often recommended for those with