Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Iodinated radiocontrast agents in the treatment of hyperthyroidism

Douglas S Ross, MD
Section Editor
David S Cooper, MD
Deputy Editor
Jean E Mulder, MD


As of this writing, neither iopanoic acid nor ipodate are available in the United States. It is unclear when, or even whether, they will ever again be marketed in the United States.

Ipodate and iopanoic acid, two oral iodine-containing drugs marketed as oral cholecystographic agents, have been used in the treatment of hyperthyroidism. These drugs are the most potent inhibitors of 5'-monodeiodinase, thereby impairing the extrathyroidal conversion of thyroxine (T4) to the more potent triiodothyronine (T3). The release of iodine in pharmacologic quantities from these agents has the additional benefits of blocking thyroid hormone release and interfering with its synthesis in some patients. (See "Iodine in the treatment of hyperthyroidism".)

These agents are more potent than propylthiouracil in blocking the conversion of T4 to T3, and they result in a rapid reduction in serum T4 and T3 concentrations (figure 1) [1,2]. Doses in most studies have ranged from 500 mg to 1000 mg as a single daily dose.


Ipodate and iopanoic acid have been used as monotherapy for the treatment of hyperthyroidism caused by Graves' disease [3]. However, they are not as effective as methimazole or propylthiouracil in controlling the hyperthyroidism, and the relapse rate after therapy is discontinued is higher [4].

There are also several additional problems with the use of these agents:


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jan 18, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Wu SY, Shyh TP, Chopra IJ, et al. Comparison sodium ipodate (oragrafin) and propylthiouracil in early treatment of hyperthyroidism. J Clin Endocrinol Metab 1982; 54:630.
  2. Robuschi G, Manfredi A, Salvi M, et al. Effect of sodium ipodate and iodide on free T4 and free T3 concentrations in patients with Graves' disease. J Endocrinol Invest 1986; 9:287.
  3. Shen DC, Wu SY, Chopra IJ, et al. Long term treatment of Graves' hyperthyroidism with sodium ipodate. J Clin Endocrinol Metab 1985; 61:723.
  4. Martino E, Balzano S, Bartalena L, et al. Therapy of Graves' disease with sodium ipodate is associated with a high recurrence rate of hyperthyroidism. J Endocrinol Invest 1991; 14:847.
  5. Caldwell G, Errington M, Toft AD. Resistant hyperthyroidism induced by sodium iopodate used as treatment for Graves' disease. Acta Endocrinol (Copenh) 1989; 120:215.
  6. Roti E, Robuschi G, Gardini E, et al. Comparison of methimazole, methimazole and sodium ipodate, and methimazole and saturated solution of potassium iodide in the early treatment of hyperthyroid Graves' disease. Clin Endocrinol (Oxf) 1988; 28:305.
  7. Baeza A, Aguayo J, Barria M, Pineda G. Rapid preoperative preparation in hyperthyroidism. Clin Endocrinol (Oxf) 1991; 35:439.
  8. Panzer C, Beazley R, Braverman L. Rapid preoperative preparation for severe hyperthyroid Graves' disease. J Clin Endocrinol Metab 2004; 89:2142.
  9. Bogazzi F, Miccoli P, Berti P, et al. Preparation with iopanoic acid rapidly controls thyrotoxicosis in patients with amiodarone-induced thyrotoxicosis before thyroidectomy. Surgery 2002; 132:1114.
  10. Chopra IJ, van Herle AJ, Korenman SG, et al. Use of sodium ipodate in management of hyperthyroidism in subacute thyroiditis. J Clin Endocrinol Metab 1995; 80:2178.
  11. Arem R, Munipalli B. Ipodate therapy in patients with severe destruction-induced thyrotoxicosis. Arch Intern Med 1996; 156:1752.
  12. Berkner PD, Starkman H, Person N. Acute L-thyroxine overdose; therapy with sodium ipodate: evaluation of clinical and physiologic parameters. J Emerg Med 1991; 9:129.
  13. Brown RS, Cohen JH 3rd, Braverman LE. Successful treatment of massive acute thyroid hormone poisoning with iopanoic acid. J Pediatr 1998; 132:903.
  14. Braga M, Cooper DS. Clinical review 129: Oral cholecystographic agents and the thyroid. J Clin Endocrinol Metab 2001; 86:1853.
  15. Bal CS, Kumar A, Chandra P. Effect of iopanoic acid on radioiodine therapy of hyperthyroidism: long-term outcome of a randomized controlled trial. J Clin Endocrinol Metab 2005; 90:6536.