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Antithyroid Drug

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141. Thyroid Dysfunction Induced by Amiodarone Therapy (Follow-up)

does not alter the basic approach to the medical management of thyrotoxicosis, but it reduces the chances of a successful outcome. In type 1 thyrotoxicosis, the persistently raised levels of intrathyroidal and circulating iodide reduce the effectiveness of treatment with antithyroid drugs. Mild AIT subsides spontaneously in up to 20% of cases upon discontinuation of amiodarone therapy. Many patients with type 2 AIT become euthyroid within 3-5 months after the discontinuation of amiodarone therapy (...) of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) James Burks, MD, FACP, FACE Professor of Medicine, Program Director, Department of Medicine, Texas Tech University Health Sciences Center James Burks, MD, FACP, FACE is a member of the following medical societies: , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug

2014 eMedicine.com

142. Thyroid Dysfunction Induced by Amiodarone Therapy (Diagnosis)

Instruct patients about the adverse effects of amiodarone therapy. Give them a list of potential symptom manifestations. Because the development of thyrotoxicosis is sudden and explosive, instruct patients to watch for symptoms and to seek treatment promptly. Patients should also be aware of the potential side effects of antithyroid medications. Instruct patients to watch for signs such as fever, sore throat, jaundice, or oral ulcers. Previous References Tsadok MA, Jackevicius CA, Rahme E, Essebag V (...) of Medicine, Program Director, Department of Medicine, Texas Tech University Health Sciences Center James Burks, MD, FACP, FACE is a member of the following medical societies: , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Arthur B Chausmer, MD, PhD, FACP, FACE

2014 eMedicine.com

143. Thyroid Dysfunction Induced by Amiodarone Therapy (Treatment)

does not alter the basic approach to the medical management of thyrotoxicosis, but it reduces the chances of a successful outcome. In type 1 thyrotoxicosis, the persistently raised levels of intrathyroidal and circulating iodide reduce the effectiveness of treatment with antithyroid drugs. Mild AIT subsides spontaneously in up to 20% of cases upon discontinuation of amiodarone therapy. Many patients with type 2 AIT become euthyroid within 3-5 months after the discontinuation of amiodarone therapy (...) of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) James Burks, MD, FACP, FACE Professor of Medicine, Program Director, Department of Medicine, Texas Tech University Health Sciences Center James Burks, MD, FACP, FACE is a member of the following medical societies: , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug

2014 eMedicine.com

144. Thyroid Dysfunction Induced by Amiodarone Therapy (Overview)

Instruct patients about the adverse effects of amiodarone therapy. Give them a list of potential symptom manifestations. Because the development of thyrotoxicosis is sudden and explosive, instruct patients to watch for symptoms and to seek treatment promptly. Patients should also be aware of the potential side effects of antithyroid medications. Instruct patients to watch for signs such as fever, sore throat, jaundice, or oral ulcers. Previous References Tsadok MA, Jackevicius CA, Rahme E, Essebag V (...) of Medicine, Program Director, Department of Medicine, Texas Tech University Health Sciences Center James Burks, MD, FACP, FACE is a member of the following medical societies: , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Arthur B Chausmer, MD, PhD, FACP, FACE

2014 eMedicine.com

145. Anaplastic Thyroid Carcinoma Following Radioactive Iodine Therapy for Graves' Disease Full Text available with Trip Pro

been diagnosed with Graves' disease and although she was treated with an antithyroid drug, she remained in a hyperthyroid state, which led to two RAI treatments. More than 10 years later, the patient revisited our clinic due to hoarseness, dysphagia, and dyspnea, which had lasted for 2 months. Neck computed tomography suggested thyroid carcinoma and a lymph node biopsy showed metastatic papillary carcinoma. The patient underwent total thyroidectomy and was finally diagnosed as having an ATC (...) Anaplastic Thyroid Carcinoma Following Radioactive Iodine Therapy for Graves' Disease Radioactive iodine (RAI) therapy has been used as a treatment option for Graves' disease, and it has been widely accepted to be safe. On the other hand, some evidence suggests that RAI therapy is possibly associated with a small increased risk of thyroid cancer. Herein, we report a rare case of anaplastic thyroid carcinoma (ATC) associated with Graves' disease, following RAI treatment. A 42-year-old woman had

2013 Endocrinology and Metabolism

146. Thyrotoxicosis and radioiodine therapy: Does the dose matter? Full Text available with Trip Pro

Thyrotoxicosis and radioiodine therapy: Does the dose matter? There are 3 treatment options for thyrotoxicosis: Antithyroid drugs, Surgery and radioiodine. The choice of treatment varies geographically. Radioiodine therapy is preferred in the United States. The aim of radioiodine is to destroy sufficient thyroid tissue to cure the hyperthyroidism. There is a lack of consensus towards what dose of radioiodine should be used. Several methods are used to determine the dose. In our practice we

2012 Indian journal of endocrinology and metabolism

147. EANM procedure guidelines for therapy of benign thyroid disease

for hyperthyroidism and nontoxic goitre Antithyroid drugs (ATDs) and radioiodine therapy are both useful options for treatment of hyperthyroidism. Surgery is preferably performed in selected patients with nodular goitre or recurrent Graves’ disease, in those with a suspicion of malignancy, and when there is a severe compression of neighbouring structures or a necessity for immediate effec- tiveness, e.g. in those with severe adverse effects of ATDs. Although ATDs – propylthiouracil and methimazole or its (...) instances, agranulocytosis and hepatitis; success of this therapy depends to a high degree on patient compliance with physician recommendations. Radioiodine is in most cases the first-line treatment for solitary hyperfunctioning thyroid nodules, or it can be administered if hyperthyroidism is not controlled or recurs after initial antithyroid drug treatment, such as in Graves’ disease. The main indications for radioiodine treatment of NTG are to reduce the size of a goitre that is causing cosmetic

2010 European Association of Nuclear Medicine

148. Elevated thyroid stimulating hormone in a neonate: Drug induced or disease? Full Text available with Trip Pro

) day of life with reports of elevated TSH and increased tracer uptake in 99mTc thyroid scan. Disproportionately high TSH in comparison to low maternal antithyroid drug dosage and further elevation of TSH after stopping mother's antithyroid drugs ruled out maternal antithyroid drug-induced congenital hypothyroidism in the baby. Early institution of therapy in these patients can prevent mental retardation and other features of hypothyroidism. (...) Elevated thyroid stimulating hormone in a neonate: Drug induced or disease? Dyshormonogenesis is an uncommon cause of congenital hypothyroidism. The most common abnormality is absent or insufficient thyroid peroxidase enzyme. Maternal intake of antithyroid drug can also lead to elevated thyroid stimulating hormone (TSH) in a neonate, albeit the scenario is temporary. We report one such interesting case where a clinically euthyroid neonate borne to a mother on antithyroid drug presents on 12(th

2011 Indian journal of endocrinology and metabolism

149. Benefit of short-term iodide supplementation to antithyroid drug treatment of thyrotoxicosis due to Graves' disease. (Abstract)

Benefit of short-term iodide supplementation to antithyroid drug treatment of thyrotoxicosis due to Graves' disease. Combined treatment with anti-thyroid drugs (ATDs) and potassium iodide (KI) has been used only for severe thyrotoxicosis or as a pretreatment before urgent thyroidectomy in patients with Graves' disease. We compared methimazole (MMI) treatment with MMI + KI treatment in terms of rapid normalization of thyroid hormones during the early phase and examined the later induction (...) of the patients showed an increase in thyroid hormones or aggravation of disease during combined treatment with MMI and KI. The remission rates in Groups 1, 2, 3 and 4 were 34%, 44%, 33% and 51%, respectively, and were higher in the groups receiving combined therapy but differences among four groups did not reach significance.Combined treatment with MMI and KI improved the short-term control of Graves' hyperthyroidism and was not associated with worsening hyperthyroidism or induction of thionamide resistance.

2010 Clinical endocrinology Controlled trial quality: uncertain

150. Thyroid-associated ophthalmopathy; quality of life follow-up of patients randomized to treatment with antithyroid drugs or radioiodine. Full Text available with Trip Pro

Thyroid-associated ophthalmopathy; quality of life follow-up of patients randomized to treatment with antithyroid drugs or radioiodine. The objective of this study was to investigate quality of life (QoL) in patients with Graves' disease treated with radioiodine or antithyroid drugs.The design of the study consists of an open, prospective, randomized multicenter trial between radioiodine and medical treatment. A total of 308 patients were included in the study group: 145 patients in the medical (...) with TAO in 40 medically treated patients (P<0.0009). Comparisons between the group of patients who have had TAO versus the group without TAO, in relation to treatments and time, showed significantly decreased QoL scores for the TAO groups at several time points during the study. In patients without TAO, there were no differences in QoL related to mode of treatment.The QoL in patients with Graves' ophthalmopathy was similar in radioiodine and medically treated patients, but patients who developed

2010 European journal of endocrinology / European Federation of Endocrine Societies Controlled trial quality: uncertain

151. Approach to the pediatric patient with graves' disease: when is definitive therapy warranted? Full Text available with Trip Pro

by the findings of an increased heart rate and goiter in the setting of a suppressed TSH and elevated T(3) and/or T(4). The majority of pediatric patients are initially placed on antithyroid medications and maintained on these medications for prolonged periods of time in hopes of achieving remission. Unfortunately, for many children and adolescents remission is unattainable, ultimately occurring in only 15-30% of patients. Several recent studies have suggested that the age of the patient, the degree (...) of thyrotoxicosis at diagnosis, the initial response to therapy, and the level of TSH receptor antibodies serve as reasonable predictors of remission and relapse. However, a consensus on the utility of these markers has not been reached. The present clinical case describes an adolescent with Graves' disease and highlights the negative impact that prolonged medical therapy can have on quality of life and school performance; it reviews pertinent data on the diagnosis, comorbidities, and treatment options

2011 Journal of Clinical Endocrinology and Metabolism

152. A randomized trial evaluating a block-replacement regimen during radioiodine therapy. (Abstract)

A randomized trial evaluating a block-replacement regimen during radioiodine therapy. Lack of consensus regarding the antithyroid drug regimen in relation to radioiodine ((131) I) therapy of hyperthyroidism prompted this randomized trial comparing two strategies.Patients with Graves' disease (GD, n = 51) or toxic nodular goitre (TNG, n = 49) were randomized to (131) I either 8 days following discontinuation of methimazole (-BRT, n = 52, median dose: 5 mg) or while on a continuous block (...) on the type of disease. In GD, treatment failure in the +BRT group correlated positively with the 24-h thyroid (131) I uptake (P = 0·017), while no correlations existed in the -BRT group. In addition to +BRT allocation, patients with TNG were at higher risk of treatment failure with lower thyroid radiation doses (P = 0·048), higher doses of methimazole (P = 0·026) and lower levels of serum TSH (P = 0·009).A continuous block-replacement regimen results in a stable thyroid function during (131) I therapy

2011 European journal of clinical investigation Controlled trial quality: uncertain

153. Thyroid disease: assessment and management

Monitoring after r Monitoring after radioactiv adioactive iodine treatment e iodine treatment 1.7.1 Consider measuring TSH, FT4 and FT3 levels in adults, children and young people every 6 weeks for the first 6 months after radioactive iodine treatment until TSH is within the reference range. 1.7.2 For adults, children and young people who have hypothyroidism after radioactive iodine treatment and are not on antithyroid drugs, offer levothyroxine replacement therapy and follow recommendations 1.3.6 (...) with Graves' disease or toxic nodular goitre 42 Antithyroid drugs for people with hyperthyroidism 43 Follow-up and monitoring of hyperthyroidism 45 Managing and monitoring subclinical hyperthyroidism 46 Investigating non-malignant thyroid enlargement with normal thyroid function 47 Managing non-malignant thyroid enlargement 49 Context 51 Key facts and figures 51 Current practice 52 Finding more information and resources 53 Thyroid disease: assessment and management (NG145) © NICE 2019. All rights reserved

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

154. Joint statement from the Society for Endocrinology and the British Thyroid Association regarding ‘Association of Radioactive Iodine Treatment with cancer mortality in patients with hyperthyroidism’

and the British Thyroid Association regarding ‘Association of Radioactive Iodine Treatment with cancer mortality in patients with hyperthyroidism’ We are aware of the substantial interest shown in the recent publica - tion in JAMA internal medicine by Kitahara et al 1 This retrospective analysis of data from the large multicentre co-operative thyrotoxico- sis therapy follow-up study (CTTFUS) suggests a modest increase in potential risk of death from cancer in people who receive radioiodine therapy (...) - roidism is keeping the highest risk from antithyroid drugs in the blind spot. Clin Nucl Med. 2019;44(10):789-791. 4. Melo DR, Brill AB, Zanzonico P, et al. Organ dose estimates for hy- perthyroid patients treated with (131)I: an update of the thyrotoxi- cosis follow-up study. Radiat Res. 2015;184(6):595-610. 5. Greenspan BS, Siegel JA, Hassan A, Silberstein EB. There is no as- sociation of radioactive iodine treatment with cancer mortality in patients with hyperthyroidism. J Nucl Med. 2019;60(11):1500

2020 British Thyroid Association

155. BTA/SFE statement regarding issues specific to thyroid dysfunction during the COVID -19 pandemic

with thyroid disease continue taking their thyroid medication(s) to reduce this risk. Are individuals taking antithyroid drugs at higher risk of infection? Antithyroid drugs (ATDs) are not known to increase the risk of infection, unless they result in neutropenia, which is very rare. We do not consider patients on ATDs to be at higher risk of contracting COVID-19 or of developing more severe disease in the event of contracting the infection. A patient infected with COVID-19 can continue ATDs unless (...) . If symptoms worsen during the period off ATDs or recur after recommencing the drug, the patient should seek urgent medical attention; in such situations performing a FBC is essential. How should we advise patients on steroid treatment for thyroid eye disease? Some patients with thyroid eye disease will be on steroid therapy at immunosuppressive dosage or other immunosuppressive agents such as mycophenolate. These patients are included in the group of people who are extremely vulnerable and at very high

2020 British Thyroid Association

156. Turner's syndrome

karyotype audiology testing bone age echocardiogram cardiac MRI serum FSH and anti-Müllerian hormone (AMH) skeletal survey pelvic ultrasound renal ultrasound TFTs antithyroid antibodies LFTs/gamma GT fasting glucose and HbA1c serum lipids IgA level and tissue transglutaminase IgA Treatment algorithm ACUTE ONGOING Contributors Authors Medical Director Disorders of Sex Development Program Seattle Children’s Hospital Associate Professor of Pediatrics University of Washington Seattle WA Disclosures PYF

2018 BMJ Best Practice

157. Urticaria and angio-oedema

ESR C-reactive protein anti-IgE receptor antibody and related tests thyroid-stimulating hormone (TSH) antithyroid antibodies antinuclear antibodies (ANA) skin biopsy C4 level C1-esterase inhibitor level C1-esterase inhibitor function C1q levels Treatment algorithm ACUTE ONGOING Contributors Authors Allergy and Clinical Immunology Rochester Regional Health Clinical Assistant Professor of Medicine University of Rochester School of Medicine & Dentistry Rochester NY Disclosures SSM is on the speakers (...) and has a complex aetiology. Diagnosis of acute and chronic urticaria is based on history and physical examination; diagnosis of chronic urticaria may involve additional laboratory testing, depending on the history. Referral to a specialist may be appropriate, especially in cases of chronic urticaria. Antihistamines are the mainstay of therapy for both acute and chronic urticaria. For patients who do not respond to antihistamines, additional treatment options include omalizumab and immunomodulatory

2018 BMJ Best Practice

158. Subacute granulomatous thyroiditis

therapy is generally necessary. Non-steroidal anti-inflammatory drugs and beta-blockers may be used for symptoms. Some patients with severe symptoms may also require corticosteroids, opioid analgesics, or potassium iodide or iopanoic acid to reduce the conversion of T4 to the more biologically active form of thyroid hormone, T3. Definition Subacute granulomatous thyroiditis is a self-limited inflammation of the thyroid gland. It is associated with a triphasic clinical course that lasts for a few weeks (...) of Endocrinology, Diabetes and Nutrition Boston Medical Center Associate Professor of Medicine Boston University School of Medicine Boston MA Disclosures SLL declares that she has no competing interests. Peer reviewers Professor of Medicine and Endocrinology Medical Center Spijkenisse The Hague The Netherlands Disclosures Not disclosed. Professor of Surgery Virginia Commonwealth University Richmond VA Disclosures RM declares that he has no competing interests. Consultant Endocrinologist Epworth and Alfred

2018 BMJ Best Practice

159. Primary hypothyroidism

antithyroid peroxidase antibodies Treatment algorithm ONGOING Contributors Authors Adjunct Clinical Professor Department of Family Medicine University of North Carolina Chapel Hill NC Disclosures WM declares that he has no competing interests. Peer reviewers Professor of Medicine Chair of Family Medicine University of Chicago Medical Center Chicago IL Disclosures BE declares that he has no competing interests. Consultant Endocrinologist Queen Elizabeth Hospital Gateshead UK Disclosures SR declares that he (...) and low free T4. Treatment is levothyroxine at a starting dose of 1.6 micrograms/kg daily or 25 micrograms daily in older patients or those with CAD. Over-treatment is uncommon but can lead to iatrogenic hyperthyroidism. Definition Hypothyroidism is a clinical state resulting from underproduction of the thyroid hormones T4 and T3. Franklyn JA. Hypothyroidism. Medicine. 2005;33:27-29. Most cases (95%) are due to primary hypothyroidism, a failure of the thyroid gland to produce thyroid hormones

2018 BMJ Best Practice

160. Graves' disease

of hyperthyroidism. Diagnostic tests are suppressed serum TSH, elevated levels of circulating thyroid hormones, detectable TSH receptor antibodies, and high thyroid uptake of radioactive iodine (or technetium 99). Treatment options are antithyroid drugs, radioactive iodine therapy, and thyroid surgery. Untreated hyperthyroidism, particularly in older people, may result in cardiac arrhythmias, high-output cardiac failure, bone mineral loss, and, rarely, thyroid storm. Unusual complications include vision loss (...) , Thyroid Eye Disease Amsterdam Declaration Implementation, and European Group on Graves' Orbitopathy. PP is an author of a number of references cited in this monograph. Dr Salman Razvi and Dr Petros Perros would like to gratefully acknowledge Dr Douglas S. Ross, Dr George Hennemann, and Dr Vahab Fatourechi, previous contributors to this topic. Peer reviewers Associate Professor of Medicine Boston University Medical Center Boston MA Disclosures ENP is a consultant for Scientific Consulting Company GmbH

2018 BMJ Best Practice

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