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Thyrotropin Receptor Antibodies and Graves’ Disease, a Side-Effect of ¹³¹I Treatment in Patients with Nontoxic Goiter¹

Department of Internal Medicine and Endocrinology, Herlev Hospital (B.N., J.H.K., J.E.M.H.), Herlev; the Department of Internal Medicine and Endocrinology, Odense University Hospital (L.H.), Odense; and the Department of Clinical Physiology and Nuclear Medicine, Holbæk Hospital (A.V.C.S.), Holbæk, Denmark

Address all correspondence and requests for reprints to: Birte Nygaard, M.D., Department of Internal Medicine and Endocrinology F 112, Herlev Hospital, Herlev Ringvej, DK-2730 Herlev, Denmark.

The use of ¹³¹I treatment in patients with benign nontoxic goiter is increasing, and the described side-effects are few. In this paper we describe appearance of TSH receptor antibodies (TRAb) and concomitant development of hyperthyroidism as a side-effect of ¹³¹I treatment in patients with nontoxic goiter. In this retrospective study, 191 consecutive patients with ¹³¹I-treated nontoxic goiter are described. Nine patients (5%) developed hyperthyroidism 3 months after ¹³¹I treatment, and 5 patients (3%) developed radiation thyroiditis within the first month. Frozen sera were analyzed for thyroid peroxidase antibodies (anti-TPO) in 130 patients before ¹³¹I treatment. In 21% of these, serum levels of anti-TPO were over 200 U/mL. The complication frequency of Graves’-like hyperthyroidism and hypothyroidism was 51% in patients with elevated anti-TPO (n = 27) and 15% in patients with normal serum anti-TPO levels (P < 0.00005). TRAb, anti-TPO, and thyroglobulin were followed in patients developing hyperthyroidism or radiation thyroiditis and in 10 control patients remaining euthyroid. At the time of ¹³¹I treatment, all patients had serum TRAb values within the normal range. Three months after administration of ¹³¹I, the patients developing hyperthyroidism had a transient extensive rise in serum TRAb and anti-TPO levels parallel to a rise in the serum free T₄ index. In patients developing radiation thyroiditis, serum TRAb values were normal. In control patients, serum TRAb and anti-TPO values were both within the normal range throughout the observation period.

In conclusion, hyperthyroidism can be triggered by ¹³¹I in patients with nontoxic goiter, not only related to radiation thyroiditis but also as a Graves’-like hyperthyroidism induced by TRAb. Elevated anti-TPO pretreatment is a marker of an increased risk of side-effects to ¹³¹I treatment in nontoxic goiter.

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