Epub 2011 Jul 21. Rev Invest Clin. Kadioglu P, 2016. These drugs are also often given for a short period to render the patient euthyroid before definitive therapy with radioiodine or thyroidectomy. 37. Dale J, et al. Once antithyroid drug therapy is discontinued, the patient should be monitored every three months for the first year, because relapse is more likely to occur during this time, and then annually, because relapse can occur years later. Ruggeri RM, Update on the management of hyperthyroidism and hypothyroidism. The spectrum of thyroid disease in a community: the Whickham survey. 2002;8:457–69. Braga M,  |  Goroll AH, Mulley AG Jr. Primary care medicine: office evaluation and management of the adult patient. Home Correction of insulin resistance in methimazole-treated patients with Graves disease. Kitagawa W, 2000;343:1236–48. 2005 Aug 15;72(4):623-630. USA.gov. Brewis M, 2004;61:641–8. Islas S, The choice of radioactive iodine, antithyroid medication, or surgery for hyperthyroidism should be based on the cause and severity of the disease as well as on the patient’s age, goiter size, comorbid conditions, and treatment desires. Aktaş GE, Turoğlu HT, Erdil TY, İnanır S, Dede F. Mol Imaging Radionucl Ther. An undetectable TSH level is diagnostic of hyperthyroidism. Wallin G, Some studies8,18 have shown that the eventual incidence of hypothyroidism is similar regardless of the radioactive iodine dosage. Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. Graves’ hyperthyroidism: treatment with antithyroid drugs, surgery, or radioiodine—a prospective, randomized study. The effect of antithyroid drug pretreatment on acute changes in thyroid hormone levels after (131) I ablation for Graves’ disease. In: Current drug targets. Landrin I, 4(August 15, 2005) Emeis JJ, However, antithyroid medications are not effective in thyrotoxicosis in which scintigraphy shows low uptake of iodine-123 (123I), as in patients with subacute thyroiditis, because these cases result from release of preformed thyroid hormone. Zhou M, Sorheim JI, Slatosky J, Further testing is warranted if the TSH level is abnormal. et al. Iodine-induced hyperthyroidism can occur after intake of excess iodine in the diet, exposure to radiographic contrast media, or medications. 1991;75:151–67. Kumita S, Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) Jonklaas, Bianco, et al., Thyroid 24(12): 1670-1751, 2014 . Evered DC, Correction of insulin resistance in methimazole-treated patients with Graves disease. 2017 Jul-Sep;19(2):184-193. doi: 10.22074/cellj.2016.4251. The antithyroid drug is continued for three months after radioactive iodine, then tapered. et al. Trial of autotransplantation of cryopreserved thyroid tissue for postoperative hypothyroidism in patients with Graves’ disease. SUBTOTAL THYROIDECTOMY IN THE MANAGEMENT OF GRAVE'S DISEASE. Metso S, et al. 25. Zhuang W, Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. 32. Percutaneous ethanol injection of large autonomous hyperfunctioning thyroid nodules. Burch HB, A … Andrade VA, 23. The effect of methimazole pretreatment on the efficacy of radioactive iodine therapy in Graves’ hyperthyroidism: one-year follow-up of a prospective, randomized study. Walpert N, Address correspondence to Jeri R. Reid, M.D., Dept. Hypothyroidism has multiple etiologies and manifestations. Because amiodarone contains 37 percent iodine, type I is an iodine-induced hyperthyroidism (see above). Tanda ML, Skeie S, Aloisio V, The causes of hyperthyroidism, and key clinical features that differentiate each condition, are outlined in Table 2.6,7, Lymphocytic thyroiditis, postpartum thyroiditis, medication-induced thyroiditis, Graves’ disease (thyroid-stimulating antibody), Increased glandular stimulation (substance causing stimulation), Iodine-induced hyperfunctioning of thyroid gland (iodide ingestion, radiographic contrast, amiodarone [Cordarone]), Functioning pituitary adenoma (thyroid-stimulating hormone); trophoplastic tumors (human chorionic gonadotropin), Graves’ disease is the most common cause of hyperthyroidism, accounting for 60 to 80 percent of all cases.8 It is an autoimmune disease caused by an antibody, active against the thyroid-stimulating hormone (TSH) receptor, which stimulates the gland to synthesize and secrete excess thyroid hormone. Murakami T, N Engl J Med. 3: Has a potential for abuse less than those in schedules 1 and 2. Patients’ desires must be considered when deciding on appropriate therapy, and close monitoring is essential. Vischer UM, 2001;11:153–60. 2001 Jul;57(3):203-6. doi: 10.1016/S0377-1237(01)80043-5. Radioiodine may cause a deterioration in Graves' ophthalmopathy and corticosteroid cover may reduce the risk of this complication. J Clin Endocrinol Metab. Nakajima J, Hosp Pract (1995). Arranging urgent endocrinology referral if a pituitary or hypothalamic disorder is suspected. Graves’ disease, toxic multinodular goiter, and toxic adenoma can be treated with radioactive iodine, antithyroid drugs, or surgery, but in the United States, radioactive iodine is the treatment of choice in patients without contraindications. Kadioglu P, Ozdemir S, Trimarchi F. Endocr Pract 2002 Nov-Dec;8(6):457-69. He received his medical degree and a chemical engineering degree from the University of Louisville. et al. The most common cause of hyperthyroidism is Graves' disease, an autoimmune disorder associated with circulating immunoglobulins that bind to and stimulate the thyrotropin (TSH) receptor, resulting in sustained thyroid overactivity. Maia AL. In: Current drug targets. In this study, patients had white cell counts every two weeks for the first two months, then monthly. The effect of methimazole pretreatment on the efficacy of radioactive iodine therapy in Graves’ hyperthyroidism: one-year follow-up of a prospective, randomized study. Tajiri J, Routine monitoring of white cell counts remains controversial, but results of one study29 showed that close monitoring of white cell counts allowed for earlier detection of agranulocytosis. New Rochelle, NY, August 17, 2016 —New evidence-based recommendations from the American Thyroid Association (ATA) provide guidance to clinicians in the management of patients with all forms of thyrotoxicosis (excessively high thyroid hormone activity), including hyperthyroidism. Long-term follow-up of patients has not validated these concerns.14,15 The treatment of hyperthyroidism in children remains controversial, but radioactive iodine is becoming more acceptable in this group.30, The treatment dosage of radioactive iodine has been a topic of much debate. Sasaki A, Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. Radioactive Iodine Therapy and Glucose Tolerance. Torring O, Some new therapies are under investigation. Benvenga S, Soyasal T, Trivalle C, Arterial embolization: a novel approach to thyroid ablative therapy for Graves’ disease. Members of various family medicine departments develop articles for “Practical Therapeutics.” This article is one in a series coordinated by the Department of Family and Geriatric Medicine at the University of Louisville School of Medicine, Louisville, Ky. Haynie T, Kadri N, Family medicine: principles and practice. Epub 2018 Mar 10. Burch HB, 2000;29:321–37. Fitzgerald PA. Endocrinology. et al. Kumita S, Zhuang W, Korner U, T4 = thyroxine; T3 = triiodothyronine; PTU = propylthiouracil. Organic iodide radiographic contrast agents (e.g., iopanoic acid or ipodate sodium) are used more commonly than the inorganic iodides (e.g., potassium iodide). Franklyn JA. This guideline includes recommendations on: information for people with thyroid disease. AACE Thyroid Task Force. et al. 2d ed. Burch HB, New York: McGraw-Hill, 2005:1102–10. 16. Sheppard MC, This surgery preserves some of the thyroid tissue and reduces the incidence of hypothyroidism to 25 percent, but persistent or recurrent hyperthyroidism occurs in 8 percent of patients.22 Total thyroidectomy is reserved for patients with severe disease or large goiters in whom recurrences would be highly problematic, but carries an increased risk of hyperparathyroidism and laryngeal nerve damage.22,23. Arch Intern Med. Howard R. 2001;86:3579–94. Symptoms usually resolve within eight months. Campenni A, Nonspecific laboratory findings can occur in hyperthyroidism, including anemia, granulocytosis, lymphocytosis, hypercalcemia, transaminase elevations, and alkaline phosphatase elevation.5, Algorithm for diagnosing hyperthyroidism. The medication gradually lowers cholesterol levels elevated by the disease and may reverse any weight gain. New York: Lange Medical Books/McGraw Hill, 2001. Fitzgerald PA. Endocrinology. An infiltrative ophthalmopathy accompanies Graves’ disease in about 50 percent of patients.9, Toxic multinodular goiter causes 5 percent of the cases of hyperthyroidism in the United States and can be 10 times more common in iodine-deficient areas. 20. Russo A, Toxic nodular goitres cause hyperthyroidism due to autonomous hyperfunctioning of localised areas of the thyroid. et al. Chassagne P, of Family and Community Medicine, University of Louisville, 3430 Newburg Rd., Louisville, KY 40218 (e-mail:jrreid01@gwise.louisville.edu). et al. Arranging endocrinology referral or advice for … Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions. Menard JF, Some patients may take thyroid preparations to achieve weight loss. Antithyroid drugs, radioactive iodine, and surgery are the main treatment options for persistent hyperthyroidism (Table 3).5,8,9,14–24 Each therapy can produce satisfactory outcomes if properly used.16, Prompt control of symptoms; treatment of choice for thyroiditis; first-line therapy before surgery, radioactive iodine, and antithyroid drugs; short-term therapy in pregnancy, Use with caution in older patients and in patients with pre-existing heart disease, chronic obstructive pulmonary disease, or asthma, Block the conversion of T4 to T3 and inhibit hormone release, Rapid decrease in thyroid hormone levels; preoperatively when other medications are ineffective or contraindicated; during pregnancy when antithyroid drugs are not tolerated; with antithyroid drugs to treat amiodarone- (Cordarone-) induced hyperthyroidism, Paradoxical increases in hormone release with prolonged use; common side effects of sialadenitis, conjunctivitis, or acneform rash; interferes with the response to radioactive iodine; prolongs the time to achieve euthyroidism with antithyroid drugs, Antithyroid drugs (methimazole [Tapazole] and PTU), Interferes with the organification of iodine; PTU can block peripheral conversion of T4 toT3 in large doses, Long-term treatment of Graves’ disease (preferred first-line treatment in Europe, Japan, and Australia); PTU is treatment of choice in patients who are pregnant and those with severe Graves’ disease; preferred treatment by many endocrinologists for children and for adults who refuse radioactive iodine; pretreatment of older and cardiac patients before radioactive iodine or surgery; both medications considered safe for use while breastfeeding, High relapse rate; relapse more likely in smokers, patients with large goiters, and patients with positive thyroid-stimulating antibody levels at end of therapy; major side effects include polyarthritis (1 to 2 percent), agranulocytosis (0.1 to 0.5 percent); PTU can cause elevated liver enzymes (30 percent), and immunoallergic hepatitis (0.1 to 0.2 percent); methimazole can cause rare cholestasis and rare congenital abnormalities; minor side effects (less than 5 percent) include rash, fever, gastrointestinal effects, and arthralgia, Concentrates in the thyroid gland and destroys thyroid tissue, High cure rates with singledose treatment (80 percent); treatment of choice for Graves’ disease in the United States, multinodular goiter, toxic nodules in patients older than 40 years, and relapses from antithyroid drugs, Delayed control of symptoms; posttreatment hypothyroidism in majority of patients with Graves’ disease regardless of dosage (82 percent after 25 years); contraindicated in patients who are pregnant or breastfeeding; can cause transient neck soreness, flushing, and decreased taste; radiation thyroiditis in 1 percent of patients; may exacerbate Graves’ ophthalmopathy; may require pretreatment with antithyroid drugs in older or cardiac patients, Treatment of choice for patients who are pregnant and children who have had major adverse reactions to antithyroid drugs, toxic nodules in patients younger than 40 years, and large goiters with compressive symptoms; can be used for patients who are noncompliant, refuse radioactive iodine, or fail antithyroid drugs, and in patients with severe disease who could not tolerate recurrence; may be done for cosmetic reasons, Risk of hypothyroidism (25 percent) or hyperthyroid relapse (8 percent); temporary or permanent hypoparathyroidism orlaryngeal paralysis (less than 1 percent); higher morbidity and cost than radioactive iodine; requires patient to be euthyroid preoperatively with antithyroid drugs or iodides to avoid thyrotoxic crisis. Foods containing iron. Regardless of the cause of hyperthyroidism, the adrenergic symptoms are controlled by beta blockers (Table 5).2528 Propranolol has the theoretical advantage of also inhibiting 5-monodeiodinase, thus blocking peripheral conversion of T4 to T3.25 The choice of treatment modality for hyperthyroidism caused by overproduction of thyroid hormones depends on the patient's age, symptoms, comorbidities, and preference.25,26 Graves disease requires one of the three treatment options: an antithyroid medica… ) a hypermetabolic syndrome caused by the american Academy of Family Physicians Datta Med! İnanır S, Jaatinen P, Sheppard MC, Gough SC, Franklyn JA, Maisonneuve,. Also called Thyrotoxicosis, is caused by the disease and may reverse weight... Other common causes include thyroiditis, toxic adenomas, and safe younger patients:2494-2505.. First-Line therapy for Graves ’ disease may cause a deterioration in Graves ' hyperthyroidism in adults... 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