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Antithyroid Drug

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841. Evaluation of a coated-tube assay for antithyrotropin receptor antibodies in patients with Graves' disease and other thyroid disorders. (Abstract)

Evaluation of a coated-tube assay for antithyrotropin receptor antibodies in patients with Graves' disease and other thyroid disorders. The detection of autoantibodies to the thyrotropin-receptor antibody (TRAb) is commonly used in clinical practice for the diagnostic assessment of Graves' disease (GD) and its differential diagnosis from toxic multinodular goiter (MNG) and autonomous adenoma. Additionally, TRAb assays can be useful during antithyroid drug treatment of GD to evaluate the risk

2004 Thyroid

842. A case of hypersensitivity syndrome induced by methimazole for Graves' disease. (Abstract)

hypersensitivity syndrome caused by the antithyroid drug methimazole (MMI). After treatment with MMI 30 mg three times daily for 1(1/2) months, the patient developed generalized exfoliative erythematous eruption and high fever. Cessation of treatment with the drug improved his condition. Readministration of MMI worsened his clinical features. Treatment with high-dose methylprednisolone for 6 days and subsequent administration of prednisolone 20 mg twice daily improved his clinical manifestations. Elevated (...) A case of hypersensitivity syndrome induced by methimazole for Graves' disease. Drug-induced hypersensitivity syndrome is one of the most severe forms of drug eruption and is characterized by high fever and multiorgan involvement. Reactivation of human herpesvirus-6 (HHV-6) or cytomegalovirus (CMV) has been suggested to be involved in this syndrome, although the exact role of these viruses remains elusive. We report the case of a 50-year-old Japanese male with Graves' disease who developed

2005 Thyroid

843. Pancytopenia in untreated patients with Graves' disease. (Abstract)

reached normal values after radioiodinetherapy and standard immunosuppressive treatment with antithymocyte globulin (700 mg/d, intravenous infusion for 5 days), oral cyclosporin (400 mg/d), prednisone (30-60 mg/d), and granulocyte colony-stimulating factor (150 microg subcutaneous injection, 3 times per week). We conclude that: (1) a hematologic evaluation of all patients with Graves' disease should be performed before administering antithyroid drugs, (2) antithyroid drugs may be administered (...) to patients with pancytopenia and bone marrow hypercellularity but a reevaluation of the bone marrow must be done if there is no recovery of the peripheral blood cell count when euthyroidism state is achieved, (3) standard immunosuppressive treatment of aplastic anemia caused by antithyroid drugs restores normal hematopoiesis, and (4) a thyroid evaluation of patients with pancytopenia should be done, even though no related symptoms are found.

2006 Thyroid

844. Should total thyroidectomy become the preferred procedure for surgical management of Graves' disease? (Abstract)

and by contacting treating physicians or patients. The most common surgical indications were patient preference (26%), cold nodule (24%), eye symptoms (20%), large goiter size (18%), allergy to antithyroidal medications (15%), and age younger than 16 years (14%). Thyroidectomies performed included 45 (total or near-total), 57 subtotal, and 1 lobectomy. Transient complications included hypocalcemia in 42 patients, and recurrent laryngeal nerve palsy in 5 patients. There was no difference in the frequency (...) Should total thyroidectomy become the preferred procedure for surgical management of Graves' disease? This study aims to evaluate our institution's experience with thyroidectomy for Graves' disease, with an emphasis on indications and long-term outcomes. The study cohort consisted of 103 patients (mean age 34.3 [+/-13.9] years), who underwent thyroidectomy for Graves' disease between 1991 and 2002. Clinical and follow-up data were obtained by retrospective review of medical records

2005 Thyroid

845. Intravenous methimazole in the treatment of refractory hyperthyroidism. (Abstract)

Intravenous methimazole in the treatment of refractory hyperthyroidism. Management of a hyperthyroid patient unable to take oral or rectal medication is a difficult clinical problem. The need for an alternative parenteral route of antithyroid medication administration in thyrotoxic patients occurs in certain rare cases, such as emergent gastrointestinal surgery, bowel ileus or obstruction, or severe vomiting and diarrhea. We report a simple and successful protocol for the preparation and use (...) of intravenous methimazole (MMI) for treatment of hyperthyroidism in patients intolerant of orally and rectally administered thionamides.Five hundred milligrams of methimazole USP powder was reconstituted with pH-neutral 0.9% sodium chloride solution to a final volume of 50 mL using aseptic technique, then filtered through a 0.22-microm filter. MMI injection was administered as a slow intravenous push over 2 minutes and followed by a saline flush.A 76-year-old man, intolerant of oral and rectal medications

2006 Thyroid

846. Prevalence of postpartum thyroid dysfunction: a quantitative review. (Full text)

Prevalence of postpartum thyroid dysfunction: a quantitative review. Estimates of the prevalence of postpartum thyroid dysfunction (PPTD) vary widely because of variations in study design, populations, and duration of screening. Our objective was to estimate the prevalence of PPTD among general and high-risk women, across geographical regions and in women with antithyroid peroxidase antibodies (TPOAbs). We conducted a systematic review and pooled analysis of the published literature (1975-2004 (...) screening TPOAbs, but the benefits, cost, and risks related to subsequent therapy must be weighed.

2006 Thyroid PubMed abstract

847. Central nervous system vasculitis after starting methimazole in a woman with Graves' disease. (Full text)

Central nervous system vasculitis after starting methimazole in a woman with Graves' disease. Graves' disease (GD), a prototypical autoimmune disorder, is associated with other autoimmune diseases, including vasculitis. Antithyroid drugs, despite their postulated immunosuppressive effects, may cause several autoimmune disorders. Here we describe the first patient with central nervous system (CNS) vasculitis that developed shortly after the start of methimazole (MMI) treatment for GD.CNS (...) in the brain, with a reduced perfusion on the left side of the frontotemporal and parietal regions, and on the right side of the frontotemporal area. MMI was stopped before total thyroidectomy, and symptoms resolved in the next 5 weeks. Six months after MMI was stopped, the brain MRI and SPECT had become normal.To our knowledge, this is the first report of CNS vasculitis related to MMI therapy.

2008 Thyroid PubMed abstract

848. Treatment for childhood-onset Graves' disease in Japan: results of a nationwide questionnaire survey of pediatric endocrinologists and thyroidologists. (Abstract)

%. Methimazole was selected for first-line initial antithyroid drug therapy by 92% of respondents. Antithyroid drugs tended to be given at larger initial doses and over longer periods of time to childhood-onset patients than to adult patients, and these tendencies were more pronounced for pediatric endocrinologists. Combination therapy with an antithyroid drug and thyroxine was used more frequently by pediatric endocrinologists. Thyroidologists had more experience with radioiodine therapy than pediatric

2007 Thyroid

849. Serial changes in liver function tests in patients with thyrotoxicosis induced by Graves' disease and painless thyroiditis. (Full text)

Serial changes in liver function tests in patients with thyrotoxicosis induced by Graves' disease and painless thyroiditis. When the liver function tests are aggravated after starting antithyroid drugs (ATDs) in Graves' hyperthyroidism, discontinuation of ATDs is generally considered. However, a question arises whether such aggravation constitutes an adverse effect of the drugs or not.The aim of this study was to clarify the influence of thyrotoxicosis on liver function tests, comparing (...) the results with those in thyrotoxicosis induced by painless thyroiditis.We prospectively studied liver biochemical tests in 30 patients with Graves' disease and in 27 patients with painless thyroiditis.Twenty-three (76.7%) untreated Graves' disease patients and 14 (51.9%) untreated painless thyroiditis patients were found to have at least one liver function test abnormality. One month after starting ATD therapy in patients with Graves' disease, aspartate aminotransferase (AST) and alanine

2008 Thyroid PubMed abstract

850. Graves' disease with intractable diarrhea, chylous ascites, and chylothorax: a case report. (Abstract)

antithyroid medication because of improvement of her symptoms. On admission, a thyroid swelling, exophthalmos, a pleural effusion, and ascites were observed. The results of thyroid function tests (free triiodothyronine: 21.5 pg/mL; free thyroxine: 7.17 ng/dL; thyroid-stimulating hormone (TSH): <0.01 microIU/mL; TSH receptor antibodies: 95.9%) were consistent with Graves' disease. Biochemical analysis of pleural and ascitic fluid was consistent with chylothorax and chylous ascites, respectively. Serum

2007 Thyroid

851. Clinical studies of exposure to perchlorate in the United States. (Full text)

Clinical studies of exposure to perchlorate in the United States. Perchlorate is a competitive inhibitor of the sodium/iodine symporter, decreasing the active transport of iodine into the thyroid. It was used as an antithyroid drug in the treatment of hyperthyroidism in the 1950s and 1960s but was discontinued because of the occasional occurrence of aplastic anemia. More recently, lower doses of perchlorate have been used successfully in the treatment of iodine-induced hyperthyroidism

2007 Thyroid PubMed abstract

852. Preoperative embolization of thyroid arteries in a patient with a large cervicomediastinal hyperfunctioning goiter. (Abstract)

perfusion. After embolization, the patient was treated with antithyroid agents and corticosteroid drug therapy. At the same time, severe leukocytosis developed, thyroid hormone values increased, and a CT scan obtained 7 days after embolization showed the thyroid unchanged in volume. We therefore discharged the patient and were waiting for his laboratory blood chemical findings to return to normal. Thirty days later the patient was readmitted to hospital, and a new CT scan showed that the thyroid mass

2007 Thyroid

853. Continued suppression of serum TSH level may be attributed to TSH receptor antibody activity as well as the severity of thyrotoxicosis and the time to recovery of thyroid hormone in treated euthyroid Graves' patients. (Abstract)

in the pituitary gland. The purpose of this study is to verify the relation between TRAb or other clinical parameters and the continued suppression of serum TSH level during antithyroid drug therapy in patients with Graves' disease. We reviewed the medical records of patients with Graves' disease between 1995 and 2002 at Samsung Medical Center. We selected 167 Graves' patients who had been euthyroid for at least 12 months after recovery of serum T3 and T4 levels during the antithyroid drug therapy. We analyzed (...) Continued suppression of serum TSH level may be attributed to TSH receptor antibody activity as well as the severity of thyrotoxicosis and the time to recovery of thyroid hormone in treated euthyroid Graves' patients. The cause of continued suppression of serum thyroid-stimulating hormone (TSH) levels during antithyroid drug therapy in some Graves' patients is unclear. Recently, there has been a notable explanation involving the direct inhibition of TSH receptor antibody (TRAb) on TSH secretion

2006 Thyroid

854. Hyperthyroidism-associated coronary vasospasm with myocardial infarction and subsequent euthyroid angina. (Abstract)

Hyperthyroidism-associated coronary vasospasm with myocardial infarction and subsequent euthyroid angina. A 40-year-old African-American woman presented with atypical chest pain, an acute non-ST segment elevation myocardial infarction, and angiographic evidence for severe ostial vasospasm of the left main and right coronary arteries. Subsequently, she was diagnosed with hyperthyroidism and treated with antithyroid therapy and oral nitrates. Repeat angiography revealed resolution

2008 Thyroid

855. A questionnaire survey concerning the most favourable treatment for Graves' disease in children and adolescents. (Abstract)

is preferred by only a small percentage of physicians for this group of patients in Europe. Hardly any of the respondents chose RAI for the patients with a toxic adenoma or a multinodular toxic goiter (3). On the other hand, in view of the difficulties with medical therapy in children and adolescents, including poor compliance, a high rate of relapse, drug toxicity and continued thyroid enlargement, some eminent American physicians emphasize the safety, simplicity and economic advantages of (131)I ablation (...) A questionnaire survey concerning the most favourable treatment for Graves' disease in children and adolescents. Graves' disease (GD) is the most common cause of juvenile thyrotoxicosis in children and adolescents (1, 2). Three treatment modalities are now available for the treatment of Graves' thyrotoxicosis in childhood: antithyroid drugs (ATD), surgery and radioactive iodine (RAI). However, none of these treatments has been shown to be ideal or clearly superior to the others. Physicians

2004 European Journal of Endocrinology

856. Treatment of juvenile Graves' disease and its ophthalmic complication: the 'European way'. (Abstract)

Treatment of juvenile Graves' disease and its ophthalmic complication: the 'European way'. Three treatment modalities are available for Graves' disease: antithyroid drugs, surgery and radioactive iodine (RAI). None has been shown to be ideal or superior to the others. There are wide differences between individual physicians and between the physicians in different countries on the optional treatment for childhood hyperthyroidism. While antithyroid drugs remain the initial treatment of choice (...) in almost all the medical centers in Europe, with surgery being used mainly to deal with antithyroid failures, radioiodine is preferred by only a small percentage of physicians for this group of patients. In the USA, on the contrary, radioiodine treatment of thyrotoxicosis in children has strong advocates, who emphasize the safety, simplicity and economic advantages of iodine-131 ablation, which should be considered more commonly in children. Until now, the available data have shown no significant

2004 European Journal of Endocrinology

857. Impaired health-related quality of life in Graves' disease. A prospective study. (Abstract)

Impaired health-related quality of life in Graves' disease. A prospective study. In the acute, thyrotoxic phase, patients with Graves' disease often have both thyrotoxic and neuropsychiatric symptoms. The purpose of this prospective study was to examine health-related quality of life (HRQOL) in newly diagnosed and untreated Graves' patients and the effect of antithyroid medical treatment on HRQOL. In addition, we examined the potential influence of thyroid hormones and psychiatric symptoms (...) on the impairment of HRQOL in the thyrotoxic phase.A total of 30 consecutively referred patients with newly diagnosed and untreated Graves' disease and 34 age-, sex- and education-matched healthy volunteers were included in the study. HRQOL was assessed with the Medical Outcome Study 36-item Short-Form Health Status Survey (SF-36) before treatment, after reaching euthyroidism and 1 year after initiation of treatment.In the thyrotoxic phase of Graves' disease, HRQOL was significantly impaired, in physical

2004 European Journal of Endocrinology

858. Resistin levels in hyperthyroid patients before and after restoration of thyroid function: relationship with body weight and body composition. (Full text)

before and after restoration of euthyroidism and to correlate the results with body weight, body fat, waist circumference and body mass index (BMI).A total of 43 hyperthyroid patients (12 men and 31 women) were investigated, in addition to 23 controls. Anthropometric parameters and resistin concentrations were measured. All the patients commenced taking antithyroid drugs and 3-4 months later the same investigations were performed in 36 of the 43 individuals.Hyperthyroid patients exhibited increased

2005 European Journal of Endocrinology PubMed abstract

859. Childhood Graves' ophthalmopathy: results of a European questionnaire study. (Full text)

%). Antithyroid drugs were the treatment of choice for 94% of respondents; 70% recommended a wait-and-see policy and 28% corticosteroids for the co-existing GO. In variants of the standard case, a younger age did not affect therapeutic approach very much. Recurrent hyperthyroidism would still be treated with antithyroid drugs by 66%, and with (131)I by 25%. Worsening of GO or active GO when euthyroid would convince about two-thirds of respondents to initiate treatment of GO, preferably with steroids.GO occurs (...) in 33% of patients with juvenile Graves' hyperthyroidism; its prevalence is higher in countries with a higher prevalence of smoking among teenagers. The diagnostic approach to the standard case of a 13-year-old with Graves' hyperthyroidism and moderately severe active GO involves on average five biochemical tests; thyroid as well as orbital imaging is done in 84% of cases. Antithyroid drugs remain the treatment of choice for 94% of respondents, and even so in case of recurrences (66%). For GO, 70

2005 European Journal of Endocrinology PubMed abstract

860. Treatment of Graves' disease and associated ophthalmopathy with the anti-CD20 monoclonal antibody rituximab: an open study. (Full text)

with mild lid signs) were studied. The trial was only approved as an open pilot study; thus we compared the effect of RTX therapy to that of i.v. glucocorticoids (IVGC) in 20 consecutive patients. Patients were treated with RTX (1000 mg i.v. twice at 2-week interval) or with IVGC (500 mg i.v. for 16 weeks). TAO was assessed by the clinical activity score (CAS) and severity was classified using NOSPECS (No signs or symptoms; Only signs (lid); Soft tissue involvement; Proptosis, Extraocular muscle (...) involvement; Corneal involvement; Sight loss). Thyroid function and lymphocyte count were measured by standardized methods.All patients attained peripheral B-cell depletion with the first RTX infusion. Minor side effects were reported in three patients. Thyroid function was not affected by RTX therapy and hyperthyroid patients required therapy with methimazole. After RTX, the changes in the levels of thyroglobulin antibodies, thyroperoxidase antibodies and TRAb were neither significant nor correlated

2007 European Journal of Endocrinology PubMed abstract

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