131I-Induced Graves’ disease in patients treated for toxic multinodular goitre: systematic review and descriptive analysis

Background Graves’ disease (GD) arising after the treatment of toxic multinodular goitre (TMNG) with radioiodine has long been described but it remained unclear whether GD was in fact iodine induced, its incidence, risk factors, natural history and treatment outcomes. Methods: A systematic search using The Cochrane Library, Medline and PubMed Central allowed the pooling of data from 3633 patients with thyroid autonomy, 1340 patients with TMNG, to fill gaps in knowledge, regarding the clinical expression of iodine-induced GD ( 131 I-IGD) in adults. Results 131 I-IGD developed in 0–5.3% of those with thyroid autonomy (first year) and in 5–5.4% of those with TMNG, 3–6 months after treatment. Patients with toxic adenoma were less affected. 131 I-IGD was more common in patients with pre-treatment direct or indirect signs of autoimmunity: positive anti-TPO ( p