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Antithyroid Drug

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161. Thyroid-associated ophthalmopathy; quality of life follow-up of patients randomized to treatment with antithyroid drugs or radioiodine. (Full text)

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 PubMed abstract

162. Antithyroid drug regimen for treating Graves' hyperthyroidism. (Full text)

Antithyroid drug regimen for treating Graves' hyperthyroidism. Antithyroid drugs are widely used in the therapy of hyperthyroidism. There are wide variations in the dose, regimen or duration of treatment used by health professionals.To assess the effects of dose, regimen and duration of antithyroid drug therapy for Graves' hyperthyroidism.We searched seven databases and reference lists.Randomised and quasi-randomised trials of antithyroid medication for Graves' hyperthyroidism.Two authors (...) higher in the block-replace group. Three studies considered the addition of thyroxine with continued low dose antithyroid therapy after initial therapy with antithyroid drugs. There was significant heterogeneity between the studies and the difference between the two groups was not significant (OR 0.58, 95% CI 0.05 to 6.21). Four studies considered the addition of thyroxine alone after initial therapy with antithyroid drugs. There was no significant difference in the relapse rates between the groups

2010 Cochrane database of systematic reviews (Online) PubMed abstract

163. Approach to the pediatric patient with graves' disease: when is definitive therapy warranted? (Full text)

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 PubMed abstract

164. 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

165. 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

166. 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

167. 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

168. 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

169. 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

170. 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

171. 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

172. 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

173. Side effects

of brand or generic labeling on medication effectiveness and side effects . 26462056 2016 02 03 2016 08 19 2016 02 03 1930-7810 35 2 2016 Feb Health psychology : official journal of the Division of Health Psychology, American Psychological Association Health Psychol Impact of brand or generic labeling on medication effectiveness and side effects . 187-90 10.1037/hea0000282 Branding medication with a known pharmaceutical company name or product name bestows on the drug an added assurance (...) on getting some today, under the headline “Statins ‘have no side effects '”. That’s not what found. But it was an interesting piece of work, with an odd result, looking 2014 7. Antithyroid Drug Side Effects in the Population and in Pregnancy. In a Danish population study using health registers, agranulocytosis caused by antithyroid drugs was 4 times more frequent than liver failure. Both were very rare in pregnancy, where birth defects were the dominant side effect . 2016 8. Management of opioid side

2018 Trip Latest and Greatest

174. Recommendation on screening adults for asymptomatic thyroid dysfunction in primary care

factors for thyroid dysfunction include medications that might affect thyroid hormone levels (e.g., lithium, amiodarone); other autoimmune diseases (e.g., type 1 diabetes mellitus, Addison disease); previous surgery or radiation therapy on the thyroid gland, head or neck area; and a family history of thyroid disease. , , , Thyroid hormone replacement medication is used to treat hypothyroidism, whereas treatments for hyperthyroidism include antithyroid medication, radioiodine ablation or thyroid gland (...) or thyroid surgery; exposure to medications known to affect thyroid function; exposure to thyroid radioiodine therapy, or radiotherapy to the head or neck area; or pituitary or hypothalamic diseases. Methods The task force is an independent panel of clinicians and methodologists that makes recommendations on primary and secondary prevention in primary care ( ). This recommendation was developed by a working group of 4 task force members (R.B., J.D., D.R. and B.T.) with scientific support from Public

2019 Canadian Task Force on Preventive Health Care

175. Carbimazole: increased risk of congenital malformations; strengthened advice on contraception

is needed to report – if in doubt, please complete a Yellow Card. For more about the importance of reporting suspected adverse drug reactions associated with medicines in pregnancy see . Healthcare professionals, patients, and caregivers can report suspected side effects via the or via the Yellow Card App. Download the app today via for iOS devices or via for Android devices. You can also use the app to access the latest safety information from the MHRA about medicines and medical devices (...) should be preserved for the situations in which a definitive therapy of the underlying disease (thyroidectomy or radioiodine treatment) was not suitable prior to pregnancy and in case of new occurrence or reoccurrence during pregnancy. If carbimazole is used during pregnancy, close maternal, foetal and neonatal monitoring is recommended. Report suspected adverse drug reactions via the Yellow Card Scheme Please continue to report any suspected adverse drug reactions via the . Remember only a suspicion

2019 MHRA Drug Safety Update

176. Carbimazole: risk of acute pancreatitis

-threatening acute pancreatitis with a decreased time to onset report suspected adverse drug reactions to the immediately Background Carbimazole is authorised for use in the management of hyperthyroidism, including preparation for thyroidectomy and treatment before and after radioiodine treatment. Around 45,000–50,000 prescriptions for carbimazole a month are dispensed across GP practices in NHS England (data from ). Carbimazole is a prodrug that undergoes rapid metabolism to the active metabolite (...) , thiamazole. Thiamazole (synonym methimazole) is an antithyroid agent that acts by blocking the production of thyroid hormones. Thiamazole is not authorised for use in the UK. Risk of acute pancreatitis An has found post-marketing reports of acute pancreatitis associated with the use of products containing carbimazole and thiamazole. In the UK, no Yellow Card reports of acute pancreatitis associated with carbimazole treatment have been received over a period of 55 years; however, a small number of reports

2019 MHRA Drug Safety Update

177. Diabetes insipidus

axis; and nephrogenic DI, due to renal insensitivity to AVP. Recognised risk factors for central DI include pituitary surgery, craniopharyngioma, infiltrative pituitary stalk lesions, traumatic brain injury, subarachnoid haemorrhage, congenital hypothalamo-pituitary defects, autoimmune disorders, and Wolfram's syndrome. Risk factors for nephrogenic DI include lithium therapy, chronic renal disease, and chronic hypercalcaemia or hypokalaemia. Genetic mutations are responsible for inherited forms (...) of both types. Both types of DI may be associated with hypernatraemia, and this may present as a medical emergency. Treatment goals are correction of any pre-existing water deficits and reduction in ongoing excessive urinary water losses. In central DI, desmopressin (DDAVP) is the treatment of choice. Nephrogenic DI is treated with an adequate fluid intake; salt restriction and diuretics may help reduce polyuria. Definition Diabetes insipidus (DI) is a metabolic disorder characterised by defective

2017 BMJ Best Practice

178. The role of immunotherapy in IVF: a guideline

; anti-nuclear antibodies; anti-nuclear antibody; antinuclear antibodies; antinuclear antibody; antiphospholipid antibody; antiphospholipid antibodies; antithyroid antibody; antithyroid antibodies; aspirin; assisted reproduction; autoantibodies; corticosteroid/s; corticotropin-releasinghormone;cost;cytokine;cytokines; dexamethasone; drug costs; embryo implantation; embryo transfer; Enbrel; estrogen/s; etanercept; fertility agents, fe- male/adverseeffects;fertilizationinvitro/methods;?lgras- tim; G (...) The role of immunotherapy in IVF: a guideline The role of immunotherapy in in vitro fertilization: a guideline Practice Committee of the American Society for Reproductive Medicine American Society for Reproductive Medicine, Birmingham, Alabama Adjuvant immunotherapy treatments in in vitro fertilization (IVF) aim to improve the outcome of assisted reproductive technology (ART) in both the general ART population as well as subgroups such as patients with recurrent miscarriage or implantation

2018 Society for Assisted Reproductive Technology

179. Pregnancy and Graves' disease: opt for treatments posing the lowest maternal and fetal risks

|   |   |   |  Spotlight Pregnancy and Graves' disease: opt for treatments posing the lowest maternal and fetal risks Treatment of pregnant women with Graves' disease (hyperthyroidism) is problematic since all drug therapies carry significant risks. Some synthetic antithyroid drugs are the treatment of choice. Graves' disease is one of the major causes of hyperthyroidism, which is due to an overactive thyroid gland. In cases of Graves' disease in pregnancy, poorly (...) for pregnant women. During pregnancy, synthetic antithyroid drugs are the treatment of choice, but they cross the placenta and hinder the functioning of the fetal thyroid, which means the minimum effective dose should be used. In the first trimester, propylthiouracil is the drug of choice because malformations appeared to be less severe and less common than with carbimazole or thiamazol. In the second and third trimesters, if it is not possible to halt antithyroid treatment, the risk of hepatic damage

2017 Prescrire

180. Atezolizumab (Tecentriq) - Non-Small-Cell Lung Carcinoma or Transitional Cell Carcinoma

symptoms are controlled by antithyroid medicinal product and thyroid function is improving Adrenal insufficiency Symptomatic Withhold Tecentriq Treatment may be resumed when the symptoms improve to Grade 0 or Grade 1 within 12 weeks and corticosteroids have been reduced to = 10 mg prednisone or equivalent per day and patient is stable on replacement therapy Hypophysitis Grade 2 or 3 Withhold Tecentriq Treatment may be resumed when the symptoms improve to Grade 0 or Grade 1 within 12 weeks (...) . Epidemiology 9 2.1.3. Biologic features, aetiology and pathogenesis 9 2.1.4. Clinical presentation, diagnosis 10 2.1.5. Management 10 2.2. Quality aspects 15 2.2.1. Introduction 15 2.2.2. Active Substance 15 2.2.3. Finished Medicinal Product 19 2.2.4. Discussion on chemical, pharmaceutical and biological aspects 21 2.2.5. Conclusions on the chemical, pharmaceutical and biological aspects 22 2.2.6. Recommendation(s) for future quality development 22 2.3. Non-clinical aspects 22 2.3.1. Introduction 22 2.3.2

2017 European Medicines Agency - EPARs

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