Endocrine research · 2026
Impact of antithyroid drug duration on radioactive iodine therapy efficacy in Graves' disease in Japan: a propensity score-matched analysis using thyroid weight-based outcomes.
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Tachibana Seigo, Ohara Tomoyuki, Nagayama Yuji, Fukuda Takashi, Tatsushima Daisuke, Mori Yusuke, Shindo Hisakazu, Takahashi Hiroshi, Sato Shinya, Yamashita Hiroyuki
Аннотация
INTRODUCTION: Antithyroid drugs (ATDs) are commonly administered prior to radioactive iodine therapy (RAIT) for Graves' disease (GD), but their impact on RAIT efficacy remains unclear, largely due to insufficient adjustment for confounding factors in previous studies.
METHODS: This retrospective study evaluated the impact of ATD treatment duration on RAIT outcomes using propensity score matching (PSM) to control for key covariates. Eighty patients with GD who underwent RAIT between 2015 and 2023 were classified into short-term (S group, <3 months) and long-term (L group, ≥3 months) ATD treatment cohorts (pre-PSM cohorts). After matching for age, thyroid weight, and 131I absorbed dose, 48 patients (24 per group) were enrolled in the PSM. Treatment efficacy was assessed using thyroid weight and percent thyroid weight reduction at 1 year post-RAIT (TW-1y and %TW-1y, respectively).
RESULTS: The S group demonstrated significantly lower TW-1y (4.9 ± 2.6 g vs. 7.7 ± 5.1 g, p = 0.033) and greater %TW-1y (78.6 ± 8.3% vs. 68.0 ± 14.2%, p = 0.005) than the L group, despite higher TRAb and TSAb levels, which are typically associated with reduced treatment response. Standardized mean difference analysis confirmed adequate covariate balance, and doubly robust sensitivity analysis supported the reliability of these findings.
CONCLUSION: These results suggest that prolonged ATD administration before RAIT is associated with reduced therapeutic efficacy, providing stronger evidence than prior observational reports.
METHODS: This retrospective study evaluated the impact of ATD treatment duration on RAIT outcomes using propensity score matching (PSM) to control for key covariates. Eighty patients with GD who underwent RAIT between 2015 and 2023 were classified into short-term (S group, <3 months) and long-term (L group, ≥3 months) ATD treatment cohorts (pre-PSM cohorts). After matching for age, thyroid weight, and 131I absorbed dose, 48 patients (24 per group) were enrolled in the PSM. Treatment efficacy was assessed using thyroid weight and percent thyroid weight reduction at 1 year post-RAIT (TW-1y and %TW-1y, respectively).
RESULTS: The S group demonstrated significantly lower TW-1y (4.9 ± 2.6 g vs. 7.7 ± 5.1 g, p = 0.033) and greater %TW-1y (78.6 ± 8.3% vs. 68.0 ± 14.2%, p = 0.005) than the L group, despite higher TRAb and TSAb levels, which are typically associated with reduced treatment response. Standardized mean difference analysis confirmed adequate covariate balance, and doubly robust sensitivity analysis supported the reliability of these findings.
CONCLUSION: These results suggest that prolonged ATD administration before RAIT is associated with reduced therapeutic efficacy, providing stronger evidence than prior observational reports.