Comparative Efficacy of Radioiodine Therapy With Adjunctive Thionamides vs Either Treatment Alone in the Management of Graves Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors' conclusion
ATDs do not significantly affect the success or failure rates of RAI therapy, particularly in long-term follow-up, but they may improve euthyroid outcomes and reduce hypothyroidism. Long-term ATD monotherapy showed no significant difference compared with RAI in resolving hyperthyroidism; however, additional long-term trials are needed to confirm these findings. Management of Graves disease requires individualized physician-patient decisions.
Study context
- Population
- Adults with Graves disease; Randomized controlled trials (RCTs) from PubMed, CENTRAL, Scopus and Web of Science to December 2023
- Participants
- 1,914 adults21 RCTs
- Comparison
- Radioactive iodine (RAI) with adjunctive antithyroid drugs (ATDs) vs RAI alone; ATD monotherapy vs RAI with adjunctive ATDs
- Outcome
- Success (hypothyroidism/euthyroid) and failure (hyperthyroidism/relapse)
Methodological detailsrandom-effects model, GRADE certainty assessment
- Random-effects model
- GRADE certainty assessment
Pooled result
As reported in the abstract
Moderate GRADE
Each group vs RAIEstimate (95% CI)
RAI + adjunctive ATDs
RR (success) 0.96(0.91–1.01)
RAI + adjunctive ATDs
RR (failure) 1.17(0.97–1.42)
Further pooled results
| Outcome | Estimate | |
|---|---|---|
| HypothyroidismRAI + ATDvs RAI | RR for hypothyroidism 0.67 (95% CI 0.50–0.90) | |
| Resolving hyperthyroidism, ATD monotherapyvs RAI with adjunctive ATDs | RR for resolving hyperthyroidism 0.93 (95% CI 0.84–1.02) | |
| 0.512Ratio (log scale) |
Success with propylthiouracil plus RAI
| RR for success (hypothyroidism/euthyroid) (95% CI) | ||
|---|---|---|
| Propylthiouracil + RAIReduced likelihood of success | 0.81 (0.69–0.96) | |
| 0.512RR for success (hypothyroidism/euthyroid) (log scale) |
Hypothyroidism
- Adjunctive ATDs increased the chance of euthyroid state vs RAI
Original publication
Comparative Efficacy of Radioiodine Therapy With Adjunctive Thionamides vs Either Treatment Alone in the Management of Graves Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Endocrinol Metab. Published 1 December 2025. doi:10.
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