{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:14:31Z","timestamp":1771546471316,"version":"3.50.1"},"reference-count":46,"publisher":"The Endocrine Society","issue":"3","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,20]]},"abstract":"Abstract<\/jats:title>\n \n Context<\/jats:title>\n Antithyroid drugs (ATDs) and radioactive iodine (RAI) are the main nonsurgical modalities for Graves disease, but there is no agreement on the optimal approach for utilizing these 2 alternatives, either individually or in combination.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the success (hypothyroidism\/euthyroid) and failure (hyperthyroidism\/relapse) of adjunctive (pre-RAI\/post-RAI\/both) and monotherapy with ATDs in Graves disease.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n PubMed, CENTRAL, Scopus, and Web of Science were searched to December 2023 for RCTs on adjunctive ATDs with RAI or ATDs monotherapy in adults. Pooled relative risks were estimated using a random-effects model. Certainty of findings was assessed with GRADE.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n We included 21 RCTs (1914 participants). Adjunctive ATDs showed no significant effect on success (RR: 0.96, 95% CI: 0.91-1.01) or failure (RR: 1.17, 95% CI: 0.97-1.42) rate (moderate GRADE) but increased the chance of euthyroid state and reduced hypothyroidism (RR: 0.67, 95% CI: 0.50-0.90) compared to RAI. ATDs monotherapy vs RAI with adjunctive ATDs showed no significant difference in resolving hyperthyroidism (RR: 0.93, 95% CI: 0.84-1.02). Propylthiouracil with RAI was associated with reduced likelihood of success (RR: 0.81, 95% CI: 0.69-0.96).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf580","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T13:04:12Z","timestamp":1764248652000},"page":"892-903","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1210","volume":"111","author":[{"given":"Seyed Reza","family":"Mirjalili","sequence":"first","affiliation":[{"name":"Yazd Cardiovascular Research Center, Non-Communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences , Yazd 8917945556 ,","place":["Iran"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elham","family":"Razmpoosh","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence and Impact (HEI), McMaster University , Hamilton, ON L8P 1H6 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reza","family":"Eshraghi","sequence":"additional","affiliation":[{"name":"Social Determinants of Health Research Center, Isfahan University of Medical Sciences , Isfahan 8174673461 ,","place":["Iran"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marziyeh","family":"Ashoori","sequence":"additional","affiliation":[{"name":"Rasool Akram Medical Complex Clinical Research Development Center, Iran University of Medical Sciences, Tehran 1449614535 ,","place":["Iran"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1591-2569","authenticated-orcid":false,"given":"Sepideh","family":"Soltani","sequence":"additional","affiliation":[{"name":"Yazd Cardiovascular Research Center, Non-Communicable Diseases Research Institute, Shahid Sadoughi University of 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