Resistant hyperthyroidism induced by sodium iopodate used as treatment for Graves' disease.

Sodium iopodate has recently been advocated for long-term control of hyperthyroidism in Graves' disease. Its advantages over conventional therapy are a rapid fall in thyroid hormones and control of symptoms with a simple dosage regime. We report a case in which severe resistant hyperthyroidism developed during treatment of Graves' disease with sodium iopodate. Sodium iopodate may not be suitable for long-term use in all patients with Graves' disease.

Sodium ipodate in the preparation of Graves' hyperthyroid patients for thyroidectomy.

Sodium ipodate (SI) is an oral cholecystographic agent that also affects thyroid hormone metabolism. It inhibits the peripheral T4 to T3 conversion and the thyroidal hormone release. We investigated the safety and efficacy of SI (500 mg daily during 5 days) in the preparation for subtotal thyroidectomy of 7 Graves' hyperthyroid patients in whom treatment with thionamides was unsuccessful due to allergy or noncompliance. Plasma T3 levels (mean +/- SD) decreased from 4.90 +/- 1.80 nmol/l on day 0 to 1.70 +/- 0.30 nmol/l on day 4 of treatment. Thyroidectomy performed on day 5 of treatment was uneventful. In comparison with 14 Graves' hyperthyroid patients who underwent thyroidectomy during the same period after conventional preparation with thionamides and potassium iodide, the therapeutic outcome 1 year postoperatively was similar in both groups. However, in the mildly hypothyroid patients prepared with SI, the plasma thyroid-stimulating hormone level was transiently higher 3 and 6 months postoperatively. It is concluded (1) that SI is a safe and efficacious drug in the preparation of Graves' hyperthyroid patients for thyroidectomy; (2) the therapeutic outcome 12 months postoperatively is similar in SI and in conventionally prepared Graves' hyperthyroid patients, and (3) postoperative mild or subclinical hypothyroidism is more pronounced in SI than in conventionally prepared patients.

Euthyroid hyperthyroxinemia.

An increasing number of disorders that may cause hyperthyroxinemia without thyrotoxicosis have been recognized in recent years. These include acquired and inherited abnormalities of serum thyroid-hormone-binding proteins, peripheral resistance to thyroid hormones, acute nonthyroidal illness, acute psychiatric illness, and some drug-induced conditions associated with nonthyrotoxic elevations of serum thyroxine. In addition to the laboratory finding of elevated serum thyroxine levels, many of these syndromes are also accompanied by abnormalities in triiodothyronine and free thyroid hormone levels, as well as unresponsiveness of thyroid-stimulating hormone to thyrotropin-releasing hormone, all of which further erroneously indicate a diagnosis of thyrotoxicosis. An awareness of these syndromes and alterations in the results of thyroid function tests that accompany them is important to prevent a misdiagnosis of hyperthyroidism and inappropriate therapy.

Fractionated dose cholecystography: a comparison between iopanoic acid and sodium ipodate.

Two randomised groups of 100 subjects each, undergoing oral cholecystography, were given either a 6 g fractionated dose of iopanoic acid (Telepaque) or sodium ipodate (Biloptin) to determine the relative merits of this dose schedule. Exclusions to the study were pregnancy and iodine sensitivity. Calculi or abnormal gallbladder opacification were present in 45% of subjects. Both agents were equally effective in demonstrating abnormalities, although bile duct visualisation was better using iopanoic acid (P less than 0.05). Of 46 subjects with abnormal cholecystograms subsequently undergoing surgery, all had the diagnosis confirmed. Side effects occurred in 63% of all subjects, being twice as common in those taking iopanoic acid (P less than 0.01). Sodium ipodate in a large fractionated dose is favoured because of the lower occurrence of side effects without loss of diagnostic accuracy.

Clinical comparison of locetamic acid (cholebrine) and ipodate sodium (Orgrafin).

Locetamic acid (Cholebrine) and ipodate sodium (Oragrafin) were compared in a double blind study of 503 patients. The radiographs were evaluated for contrast density, visualization of common duct, gallstones, residual in the intestinal tract, and side effects. Cholebrine demonstrated better opacification, fewer repeat examinations, slightly greater common duct opacification, and more frequent visualization of gallstones. Oragrafin had less residue. Side effects were minimal with both contrast agents.

Comparative study of iocetamic acid and calcium ipodate in the visualisation of the gallbladder and common bile duct.

Iocetamic acid (Cholebrin) and calcium ipodate (Solubiloptin) were randomly allocated to two groups of 50 patients. Each patient completed a detailed questionnaire for side effects. There was no significant difference between the contrast media in their ability to opacify the gallbladder. Cholebrin was superior to Solubiloptin in opacifying the common bile duct in the presence of abnormal liver function, but there was no difference when liver function was normal. Palpitations were significantly higher with Solubiloptin (P = 0.01) but the incidences of other side effects showed no significant differences. Unabsorbed contrast residues were noted in similar frequency with both media. A high incidence of chronic cholecystitis was found in patients with non-opacified gallbladders and in those with gallstones.

A comparison of iocetamic acid and sodium iopodate in cholecystography.

Cholecystography was carried out on 456 consecutive patients using varying dosage schedules of cholebrine (iocetamic acid) tablets and biloptin (sodium iopodate) tablets. The density of gall-bladder gave the impression of a slightly greater opacification with cholebrin tablets. Quality of common duct demonstration was equally good with both media, with those patients having a morning dose of contrast giving the best demonstration.