Comparison of Sodium Ipodate (Oragrafin) and Propylthiouracil in Early Treatment of Hyperthyroidism*

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Abstract
To investigate further the usefulness of sodium ipodate (Oragrafin) in the management of hyperthyroidism, we studied the effects of a 21-day treatment of Graves’ disease patients with either ipodate (1 g/day) or propylthiouracil (PTU; 600 mg/day) on serum T3, T4, rT3) pulse rate, pulse pressure, and body weight. Baseline serum concentrations of immunoassayable T3, T4, and rT3 were (mean ± SEM) 405 ± 64 ng/dl, 20.9 ± 3.9 μg/dl, and 142 ± 20 ng/dl, respectively, in the ipodatetreated group (n = 6) and 504 ± 87 ng/dl, 23.0 ± 3.6 μg/dl, and 164 ± 29 ng/dl, respectively, in the PTU-treated group (n = 6). Within 24 h after the first does of ipodate, serum T3 decreased by 58% (P < 0.005), remained decreased thereafter (67-76%), and stayed within the normal range throughout treatment. The decreases in serum T3 concentration in the PTU-treated group of 23% at 24 h, 27% at 72 h, and 56% on day 21 were significantly less than the corresponding values in the ipodate group. At 24 h, the serum T4 concentration decreased by 20% (P < 0.05) in the ipodate group, while it did not change in the PTU group. Subsequently, the serum T4 concentration was 36 - 47% lower than baseline in the ipodate group. It decreased more slowly in PTU-treated patients to 25% below baseline on day 7 (P = NS), 35% on day 14 (P < 0.05), and 45% on day 17 (P < 0.05). The serum concentration of rT3 was markedly elevated (73-276% above baseline; P < 0.05) after treatment with ipodate, whereas it decreased significantly (35% below baseline; P < 0.05) on day 10 and thereafter in patients receiving PTU. When the percent changes in circulating thyroid hormone levels in the two groups were compared using the areas under the serum concentration curves, the fall in serum T3 and the rise in serum rT3 were significantly greater in the ipodate group than in the PTU group, but the decreases in the serum T4 levels were similar. Resting pulse rate and pulse pressure decreased and body weight increased in both groups, but statistically significant changes were observed earlier with ipodate than with PTU. The data suggest that 1) ipodate (1 g/day, orally) compares favorably with PTU (600 mg/day, orally) in reducing circulating T3 and T4 and clinical hyperthyroidism in patients with Graves’ disease; and 2) ipodate may serve as a useful adjunct in the early treatment of hyperthyroidism.

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