Exp. Clin. Endocrinol. Vol. 97, No. 2/3, 1991, pp. 308-311
J. A. Barth, Leipzig
Treatment of Hyperthyroidism with Potassium Iodide G. PHILIPP0u, G. PIPERINGOS, A. SOUVATZOGLOU, D. A. KOTJTRAS and
S. D. MouI.oPouLos
Summary. Potassium iodide was given to 17 cases of Basedow's disease in comparison to 12 normal controls for 5 weeks. In the thyrotoxic patients, the maximum decrease in serum T3 and T4 levels was observed 2 and 3 weeks, respectively, but in some cases remained normal even at 5 weeks. The euthyroid persons showed a small decrease in T4 and T3 and an increase in serum TSH.
Introduction Plummer (1923) first used iodide in the preoperative preparation of hyperthyroid patients. Subsequently, Thompson et al. (1930 a, b, c) found that 1.5 mg of iodide daily was enough to reduce the basal metabolic rate in half of the cases, whereas 6 mg/day were effective in 15 out of 17 patients. However, because of the wide therapeutic margins, usually greater doses are used. The maximum effect occurs usually on the 10th day (Means, 1948). This therapeutic effect is, however, only transient. Harden et al. (1964) observed a decrease in the serum PBI 14 days after starting treatment, but this increased again at 28 days, in spite of continuous administration. The use of inorganic iodine for the preoperative preparation arid for thyrotoxic crisis is now firmly established, but, surprisingly, this treatment has not been studied adequately with modern techniques, in spite of a few studies, either short or with limited
number of cases (Emerson et al., 1975; Roti et al., 1985; Tan et al., 1989). In the present work we studied with a battery of thyroid function tests 17 thyrotoxic patients for 5 weeks in comparison to 12 controls, as described below.
Material and Methods 17 patients with Graves-Basedow's disease (6 males, 11 females, x ± SE, age 41 ± 3.4 years) were studied in comparison to 12 normal controls (1 male, 11 females, age 37.1 ± 3.4 years). All the subjects were diagnosed in our Department using standard clinical and laboratory methods. All the subjects were treated with potassium iodide, as a 10% solution, 10 drops three times daily, corresponding to about 100 mg of iodide. In all the cases blood was obtained before and 3 and 7 days after treatment and then every week, for 5 weeks. Thyrotoxic patients showing signs of relapse were withdrawn from the study, hence the smaller number of cases studied at 35 days.
Downloaded by: Collections and Technical Services Department. Copyrighted material.
Athens University, Department of Clinical Therapeutics (Head: Prof. S. D. Moulopoulos), Alexandra General Hospital, Athens, Greece
309
G. PHILIPPOU et. al., freatment of Hyperthyroidism with Kl
The following laboratory parameters were obtained each time: Serum total thyroxine (T4) was measured by fluorescence polarization immunoassay (Abbott Laboratories), normal range: 53-180 nmol/l; Serum triiodothyronine (T3) was measured by fluorescence polarization immunoassay (Abbot Laboratories), normal range: 0.45-3.20 nmol/l;
Serum TSH was measured by enzyme immunometric assay (Abbott), normal range: 0.%-35 U/m1; Serum reverse triiodothyronine (ff3) was measured by Ria (Biodata), normal range; 0.25-2 ng/ml; Serum Thyroxine Binding Capacity (TBC) was measured by ELISA-principie (Boehringer Mann-
heim Immunodiagnostics Enzymur-test TBK), normal range: 0.85-1.35. The paired Wilcoxon test was used for comparing the values during treatment with those obtained before.
Results
The results in the 17 patients with Graves'-Basedow's are summarized in Täble 1. It can be seen that serum T4 and T3 decreased significantly during treatment, whereas TBC and TBG increased. Serum TSH was undetectable throughout the entire study. The decrease in the serum levels was more uniform for T4 than T3. At 14 and 21 days all the thyrotoxic patients had normal serum T4 values (läble ), and even at 28 days this was true for 16 of the 17 cases. However, serum T3 never became normal in all the cases studied. At 14 days it was normal in only 14 of the 17 cases, and the proportion was even smaller in the other time points. Table 3 shows the effects of Kl in the 12 normal subjects. There was a small decrease in serum T4 (p < 0.05 at 7, 14 and 21 days), T3 (p
J. A. Barth, Leipzig
Treatment of Hyperthyroidism with Potassium Iodide G. PHILIPP0u, G. PIPERINGOS, A. SOUVATZOGLOU, D. A. KOTJTRAS and
S. D. MouI.oPouLos
Summary. Potassium iodide was given to 17 cases of Basedow's disease in comparison to 12 normal controls for 5 weeks. In the thyrotoxic patients, the maximum decrease in serum T3 and T4 levels was observed 2 and 3 weeks, respectively, but in some cases remained normal even at 5 weeks. The euthyroid persons showed a small decrease in T4 and T3 and an increase in serum TSH.
Introduction Plummer (1923) first used iodide in the preoperative preparation of hyperthyroid patients. Subsequently, Thompson et al. (1930 a, b, c) found that 1.5 mg of iodide daily was enough to reduce the basal metabolic rate in half of the cases, whereas 6 mg/day were effective in 15 out of 17 patients. However, because of the wide therapeutic margins, usually greater doses are used. The maximum effect occurs usually on the 10th day (Means, 1948). This therapeutic effect is, however, only transient. Harden et al. (1964) observed a decrease in the serum PBI 14 days after starting treatment, but this increased again at 28 days, in spite of continuous administration. The use of inorganic iodine for the preoperative preparation arid for thyrotoxic crisis is now firmly established, but, surprisingly, this treatment has not been studied adequately with modern techniques, in spite of a few studies, either short or with limited
number of cases (Emerson et al., 1975; Roti et al., 1985; Tan et al., 1989). In the present work we studied with a battery of thyroid function tests 17 thyrotoxic patients for 5 weeks in comparison to 12 controls, as described below.
Material and Methods 17 patients with Graves-Basedow's disease (6 males, 11 females, x ± SE, age 41 ± 3.4 years) were studied in comparison to 12 normal controls (1 male, 11 females, age 37.1 ± 3.4 years). All the subjects were diagnosed in our Department using standard clinical and laboratory methods. All the subjects were treated with potassium iodide, as a 10% solution, 10 drops three times daily, corresponding to about 100 mg of iodide. In all the cases blood was obtained before and 3 and 7 days after treatment and then every week, for 5 weeks. Thyrotoxic patients showing signs of relapse were withdrawn from the study, hence the smaller number of cases studied at 35 days.
Downloaded by: Collections and Technical Services Department. Copyrighted material.
Athens University, Department of Clinical Therapeutics (Head: Prof. S. D. Moulopoulos), Alexandra General Hospital, Athens, Greece
309
G. PHILIPPOU et. al., freatment of Hyperthyroidism with Kl
The following laboratory parameters were obtained each time: Serum total thyroxine (T4) was measured by fluorescence polarization immunoassay (Abbott Laboratories), normal range: 53-180 nmol/l; Serum triiodothyronine (T3) was measured by fluorescence polarization immunoassay (Abbot Laboratories), normal range: 0.45-3.20 nmol/l;
Serum TSH was measured by enzyme immunometric assay (Abbott), normal range: 0.%-35 U/m1; Serum reverse triiodothyronine (ff3) was measured by Ria (Biodata), normal range; 0.25-2 ng/ml; Serum Thyroxine Binding Capacity (TBC) was measured by ELISA-principie (Boehringer Mann-
heim Immunodiagnostics Enzymur-test TBK), normal range: 0.85-1.35. The paired Wilcoxon test was used for comparing the values during treatment with those obtained before.
Results
The results in the 17 patients with Graves'-Basedow's are summarized in Täble 1. It can be seen that serum T4 and T3 decreased significantly during treatment, whereas TBC and TBG increased. Serum TSH was undetectable throughout the entire study. The decrease in the serum levels was more uniform for T4 than T3. At 14 and 21 days all the thyrotoxic patients had normal serum T4 values (läble ), and even at 28 days this was true for 16 of the 17 cases. However, serum T3 never became normal in all the cases studied. At 14 days it was normal in only 14 of the 17 cases, and the proportion was even smaller in the other time points. Table 3 shows the effects of Kl in the 12 normal subjects. There was a small decrease in serum T4 (p < 0.05 at 7, 14 and 21 days), T3 (p
