Iodine for the Outpatient Management of Graves' Disease: A Case Series of 7 Patients.

Background/Objective: Methimazole (MMI) and propylthiouracil are common treatments for Graves' disease (GD), but few options exist for patients who cannot tolerate these drugs or prefer to avoid radioactive iodine or surgery. Iodine is an alternative treatment but is infrequently used due to concerns of transient effectiveness. Case Description: Seven patients (ages 24-77, mean 53.7 years) with GD previously on thionamides received iodine (saturated solution of potassium iodide or Lugol's 5% solution) for periods ranging from 3 weeks to over a year. Four patients started iodine for MMI-associated transaminitis, one for neutropenia on MMI and methotrexate, one for chemotherapy-induced pancytopenia, and one for uncontrolled hyperthyroidism on high-dose propylthiouracil. Doses of iodine ranged 60-750 mg/d; mean treatment duration: 134 ± 135 days. Five patients eventually underwent thyroidectomy, one patient with leukemia entered hospice, and one remains controlled on iodine monotherapy. Of the 7 patients, 71% maintained normal thyroid hormone levels and 29% had recurrence of hormone elevations. Discussion: Iodine monotherapy can effectively control GD for as long as 1 year. Compared to thionamides, iodine has a more favorable safety profile and may be a suitable option for patients who are unable or unwilling to undergo radioactive iodine or surgery, or for those who cannot tolerate thionamides. In select patients, iodine may serve as a bridging therapy to definitive treatments such as surgery. Conclusion: Iodine may offer a viable alternative for treating GD, particularly for situations where patients cannot tolerate thionamides or have a contraindication, prefer alternative nonthionamide therapy, or as a bridge to surgery.