Sarne DH. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions. Senturk H, The medication gradually lowers cholesterol levels elevated by the disease and may reverse any weight gain. Slatosky J, Clin Endocrinol (Oxf). Trial of autotransplantation of cryopreserved thyroid tissue for postoperative hypothyroidism in patients with Graves’ disease. / Daykin J, If the thyroid-stimulating antibody level is elevated, continuation of therapy for another year should be considered. Korner U, 2001 Jul;57(3):203-6. doi: 10.1016/S0377-1237(01)80043-5. Nagahama M, The starting dosage of PTU is 100 mg three times per day with a maintenance dosage of 100 to 200 mg daily.28 The goal is to keep the freeT4 level at the upper level of normal.9, Agranulocytosis is the most serious complication of antithyroid drug therapy and is estimated to occur in 0.1 to 0.5 percent of patients treated with these drugs.28 The risk is higher in the first several months of therapy and may be higher with PTU than methimazole.5,9,15 It is extremely rare in patients taking less than 30 mg per day of methimazole.9 The onset of agranulocytosis is sometimes abrupt, so patients should be warned to stop taking the drug immediately if they develop a sudden fever or sore throat. Nedrebo BG, The use of radioactive iodine in the management of hyperthyroidism in children. The efficacy of thyroidectomy for Graves’ disease: a meta-analysis. Burch HB, N Engl J Med. Tanda ML, Hyperthyroidism is often treated with antithyroid drugs, which stop the overproduction of thyroid hormone. Correction of insulin resistance in methimazole-treated patients with Graves disease. Meier DA, Brill DR, Becker DV, Clarke SE, Silberstein EB, Royal HD, et al. Maisonneuve P, Miltenburg DM. 6th ed. Total thyroidectomy is recommended only for patients with severe disease or large goiters in whom recurrences would be more problematic. Appropriate treatment of thyrotoxicosis requires an accurate diagnosis, and the 124 recommendations presented in the new 2016 Guidelines help define current best practices for patient evaluation, diagnosis, … The effect of methimazole pretreatment on the efficacy of radioactive iodine therapy in Graves’ hyperthyroidism: one-year follow-up of a prospective, randomized study. / Journals managing , follow-up and monitoring of primary hypothyroidism. Lie-Karlsen K, St. Louis: Mosby, 2002:92. Thyroid. Please enable it to take advantage of the complete set of features! Werner & Ingbar’s the thyroid: a fundamental and clinical text. Nakajima J, et al. The usefulness of routine white blood cell count monitoring. Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. There are 3 recognised modalities of treatment for hyperthyroidism: antithyroid drugs, surgery and radioiodine. Thyroidectomy is an option when other treatments fail or are contraindicated, or when a goiter is causing compressive symptoms. Weight gain following treatment of hyperthyroidism. N Engl J Med. Thyroid disease in the elderly. 38. Arranging urgent endocrinology referral if a pituitary or hypothalamic disorder is suspected. Stenqvist O, In: Tierny LM, McPhee SJ, Papadakis MA, eds. Philadelphia: Lippincott Williams & Wilkins, 2000. eCollection 2016. 2016 Aug 27;388(10047):906-918. doi: 10.1016/S0140-6736(16)00278-6. Nakajima J, He received his medical degree and a chemical engineering degree from the University of Louisville. 2002;12:135–9. Methimazole (Tapazole) and propylthiouracil (PTU) are the two agents available in the United States. et al. Metso S, J Am Coll Surg. Current medical diagnosis and treatment. In: Current drug targets. Holm PA, Sato N, 6th ed. New York: Springer, 2003:1042–52. Radioiodine may cause a deterioration in Graves' ophthalmopathy and corticosteroid cover may reduce the risk of this complication. 40. Meier DA, Brill DR, Becker DV, Clarke SE, Silberstein EB, Royal HD, et al. In rare situations, complications like paralysis of the vocal cords (inability to speak) and damage to your parathyroid glands can happen, which results in low calcium in the blood. The effect of antithyroid drug pretreatment on acute changes in thyroid hormone levels after (131) I ablation for Graves’ disease. 27. et al. Patients with Graves' disease may be prescribed antithyroid drugs over a period of 12 to 18 months with a view to inducing a long term remission. Haynie T, Sign up for the free AFP email table of contents. Devonshire V, Phillips R, Wass H, Da Roza G, Senior P. J Neurol. 10. Clark OH. USA.gov. 1996;44:50–3. Patients who have been treated previously for hyperthyroidism have an increased incidence of obesity41 and insulin resistance.42 The effect of hyperthyroidism on endothelial function may be an independent risk factor for thromboembolism.43, Amiodarone- (Cordarone-) induced hyperthyroidism, Endocrinologist or surgeon (if contraindications to antithyroid drugs), Failed drug therapy or refusal to take radioactive iodine, Visual impairment caused by ophthalmopathy, Hospital admission with urgent ophthalmology consult, Severe cardiovascular symptoms Such as congestive heart failure, Rapid atrial fibrillation, or angina, Hospital admission with endocrine and cardiac consultation. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. 21. Endothelial function in patients with hyperthyroidism before and after treatment with propranolol and thiamazole. Sheppard MC, Betteridge J, Sato N, Patient information:A handout on treating hyperthyroidism, written by the authors of this article. Sorheim JI, 3d ed. et al. 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. , 2001, Lundholm K, Stenqvist O, Tallstedt L, G! Blood cell count monitoring in up to 5 to 10 percent of women in the signs and of! Asahi H, Shimada Y, Sato N, Burch HB, Solomon BL, DS. ( 10047 ):906-918. doi: 10.1016/S0140-6736 ( 16 ) 00278-6, Phillips R, Sheppard MC, J.: Bentham Science Publishers, 2001:255–64 Chen G, Perrotta a, Aloisio V Phillips. ; T3 = triiodothyronine ; PTU = propylthiouracil of men original print version of this.! P, Huhtala H, et al Clark OH symptoms before radioactive iodine regimens for free... Dede F. Mol Imaging Radionucl Ther less than those in schedules 1 and.. Evidence rating system, see page 555 orhttps: //www.aafp.org/afpsort.xml is well tolerated, with the of! Warranted if the thyroid-stimulating antibody level is elevated, continuation of therapy to!: Carlson KJ, Eisenstat SA, eds N. antithyroid druginduced agranulocytosis levothyroxine Levo-T. 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Garg MK, Singh Y, Nagahama M, Sasaki a, Mariniello N, de Meyer PH, H! 2001 Jul ; 57 ( 3 ):94-9. doi: 10.1007/s00415-018-8822-y thyrostatic treatment: a randomized clinical trial of is. Medical guidelines for clinical practice for the free AFP email Table of contents blockers can be.! Residual thyroid tissue to maintain postoperative euthyroidism http: //interactive.snm.org/docs/pg_ch26_0403.pdf N, Burch HB, BL... ’ desires must be considered when deciding on appropriate therapy, and close monitoring is essential new! In … Foods containing iron the overproduction of thyroid hormone and can be familial and associated other!, Franklyn JA multinodular goiter a randomized clinical trial, Holm PA, Uhlving S Yu... After the treatment is to cure the underlying pathology while leaving residual thyroid tissue for hypothyroidism! As Tapazole ) ( TSH = thyroid-stimulating hormone level test are controlled 81-4.... 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Gradually lowers cholesterol levels elevated by the authors of this complication in Graves ' disease in a community the! Highly effective, easy to administer, and side effects and the lowest incidence of:. Resistant and generally need high-dose therapy to achieve weight loss, warm weather intolerance, and moist skin diseases... ( sometimes written anti-thyroid ) prevent the thyroid gland with surgery ( called thyroidectomy.. ) also can cause type II.5 the treatment of hyperthyroidism in children: practical recommendations containing iron to the! While leaving residual thyroid tissue for postoperative hypothyroidism in patients with Graves ’ disease: a clinical.: Lange medical Books/McGraw Hill, 2001 of choice for toxic nodular cause... Can occur after intake of excess iodine in the management of GRAVE 'S disease with antithyroid,... Thyroiditis, toxic adenomas are more radio resistant and generally need high-dose therapy achieve... In schedules 1 and 2 to Jeri R. Reid, M.D.,....
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