Doucet J, Evered DC, Ochoa R, Ochoa R, The use of radioactive iodine in the management of hyperthyroidism in children. Sheppard MC, Shimizu K, Trivalle C, Sheppard MC, 2000;90:161–5. Methimazole (Tapazole) and propylthiouracil (PTU) are the two agents available in the United States. Franklyn JA. The diagnostic workup begins with a thyroid-stimulating hormone level test. St. Louis: Mosby, 2002. Weight gain following treatment of hyperthyroidism. Shimada Y, When test results are uncertain, measuring radionuclide uptake helps distinguish among possible causes. Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. Radioactive iodine. The efficacy of thyroidectomy for Graves’ disease: a meta-analysis. Methimazole usually is the drug of choice in nonpregnant patients because of its lower cost, longer half-life, and lower incidence of hematologic side effects. Zhuang W, 34. Gayed I, Nedrebo BG, JERI R. REID, M.D., and STEPHEN F. WHEELER, M.D., University of Louisville School of Medicine, Louisville, Kentucky. Jansson S, 17. Murakami T, Arterial embolization: a novel approach to thyroid ablative therapy for Graves’ disease. Pijl H, Wang S, For the missing item, see the original print version of this publication. Akin P. Slatosky J, 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. In most cases, a dosage of 80 to 320 mg per day is sufficient.5 Calcium channel blockers such as diltiazem (Cardizem) can be used to reduce heart rate in patients who cannot tolerate beta blockers.17, Iodides block the peripheral conversion of thyroxine (T4) to triiodothyronine (T3) and inhibit hormone release. RAI is a common and long-used treatment for hyperthyroidism. 4th ed. Eide GE, The spectrum of thyroid disease in a community: the Whickham survey. 25. Skeie S, Several treatments for hyperthyroidism exist. J Clin Endocrinol Metab. In: Taylor RB. Marcocci C, J Community Hosp Intern Med Perspect. Immune, endocrine and metabolic disorders. 2001;86:3488–93. 15. Campenni A, There are 3 recognised modalities of treatment for hyperthyroidism: antithyroid drugs, surgery and radioiodine. 6th ed. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and … Has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions. Kitamura Y, The use of radioactive iodine in the management of hyperthyroidism in children. Rare causes of hyperthyroidism include metastatic thyroid cancer, ovarian tumors that produce thyroid hormone (struma ovarii), trophoblastic tumors that produce human chorionic gonadotrophin and activate highly sensitive TSH receptors, and TSH-secreting pituitary tumors.5, A diagnostic approach to patients who present with signs and symptoms of hyperthyroidism is summarized in Figure 2.5,13 Measurement of the TSH level is the only initial test necessary in a patient with a possible diagnosis of hyperthyroidism without evidence of pituitary disease. 8th ed. Patient information:A handout on treating hyperthyroidism, written by the authors of this article. 3: Has a potential for abuse less than those in schedules 1 and 2. However, antithyroid drugs will not 'cure' hyperthyroidism associated with a toxic nodular goitre. Beta blockers and iodides are used as treatment adjuncts. Solomon BL, Surgery, either subtotal or near-total thyroidectomy, has limited but specific roles to play in the treatment of hyperthyroidism: this approach is rarely used in patients with Graves' disease unless radioiodine has been refused or there is a large goitre causing symptoms of compression in the neck. Stenqvist O, Shimizu K, Menard JF, Trivalle C, N Engl J Med. 2001;233:60–4. Soyasal T, The effect of methimazole pretreatment on the efficacy of radioactive iodine therapy in Graves’ hyperthyroidism: one-year follow-up of a prospective, randomized study. This condition can be recurrent in some patients.11, Lymphocytic thyroiditis and postpartum (subacute lymphocytic) thyroiditis are transient inflammatory causes of hyperthyroidism that, in the acute stage, may be clinically indistinguishable from Graves’ disease. Murakami T, Fontanilla JC, Akasu H, Eur J Endocrinol. Howard R. Walpert N, Knudson PB. Allahabadia A, managing and monitoring of subclinical hypothyroidism. Monitoring and management of autoimmunity in multiple sclerosis patients treated with alemtuzumab: practical recommendations. Thyroid disease in the elderly. N Engl J Med. 2d ed. Management of a person with hyperthyroidism includes: Arranging emergency admission if a serious complication is suspected. Arch Intern Med. Arterial embolization: a novel approach to thyroid ablative therapy for Graves’ disease. COVID-19 is an emerging, rapidly evolving situation. Other common causes include thyroiditis, toxic multinodular goiter, toxic adenomas, and side effects of certain medications. Long-term follow-up study of radioiodine treatment of hyperthyroidism. 2001;11:153–60. Holm PA, 2000;214:143–8. Salmi J. et al. Jaatinen P, Ginsberg J. DRAFT FOR CONSULTATION Thyroid disease: assessment and management: NICE guideline DRAFT (June 2019) 6 of 49 1 Table 1 The possible benefits/advantages and risks/disadvantages of the 2 treatment options for thyrotoxicosis with hyperthyroidism (overactive thyroid) Radioactive iodine1 Surgery1 Antithyroid drugs1 Benefits/ advantages Graves’ hyperthyroidism: treatment with antithyroid drugs, surgery, or radioiodine—a prospective, randomized study. Islas S, It typically occurs in patients older than 40 years with a long-standing goiter, and has a more insidious onset than Graves’ disease.10, Toxic adenomas are autonomously functioning nodules that are found most commonly in younger patients and in iodine-deficient areas.10, Subacute thyroiditis produces an abrupt onset of thyrotoxic symptoms as hormone leaks from an inflamed gland. 24. Revilla C,
Oksala H, USA.gov. et al. Schneider AB, Dhekne R, / Vol. Graves’ disease. In: Carlson KJ, Eisenstat SA, eds. Endoscopic subtotal thyroidectomy for patients with Graves’ disease. Sarne DH. Pregnant patients: Levothyroxine should be dose titrated to achieve a TSH concentration within the … A gland-specific dosage based on the estimated weight of the gland and the 24-hour uptake may allow a lower dosage and result in a lower incidence of hypothyroidism but may have a higher recurrence rate.15 Higher-dose ablative therapy increases the chance of successful treatment and allows the early hypothyroidism that results from this regimen to be diagnosed and treated while the patient is undergoing close monitoring. It is common in middle-aged to older cats (> 95% of the cases occur in … Epub 2017 Feb 22. Vischer UM, If the thyroid-stimulating antibody level is elevated, continuation of therapy for another year should be considered. Giorgio A, The 10-minute diagnosis manual: symptoms and signs in the time-limited encounter. FAQs: Feline Hyperthyroidism and Radioiodine Treatment . Tisell LE. When thyroiditis is the cause, symptomatic treatment usually is sufficient because the associated hyperthyroidism is transient. Zhou M, 2002;56:65–8. Cigarette smoking is a risk factor for the development and progression of Graves’ ophthalmopathy.14,19, Using antithyroid drugs to achieve a euthyroid state before treatment with radioactive iodine is not recommended for most patients, but it may improve safety for patients with severe or complicated hyperthyroidism. Primary care of women. What is the normal reference range for serum TSH concentrations in each trimester of pregnancy? In: Carlson KJ, Eisenstat SA, eds. | 1996;44:50–3. N Engl J Med. St. Louis: Mosby, 2002:92. 1996;81:2986–93. A transient hypothyroidism often occurs before resolution (Figure 112).11. Lalezari S, et al. The effect of methimazole pretreatment on the efficacy of radioactive iodine therapy in Graves’ hyperthyroidism: one-year follow-up of a prospective, randomized study. Hypothyroidism commonly manifests as a slowing in physical and mental activity but may be asymptomatic. et al. Revilla C, Radio-iodine treatment of hyperthyroidism-prognostic factors for outcome. Thyroidectomy is an option when other treatments fail or are contraindicated, or when a goiter is causing compressive symptoms. Thyroid. 40. Torring O, Tene C, American Academy of Clinical Endocrinologists. 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. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Possible treatments include: 1. Maisonneuve P, Miltenburg DM. Also called radioiodine. Symptoms and signs are often subtle and neither sensitive nor specific.The following are symptoms of hypothyroidism: 1. Further testing is warranted if the TSH level is abnormal. Andrade VA, Walpert N, Percutaneous ethanol injection of large autonomous hyperfunctioning thyroid nodules. 32. An undetectable TSH level is diagnostic of hyperthyroidism. The spectrum of thyroid disease in a community: the Whickham survey. 44th ed. Levy EG. Lancet. Corvilain B, Dumont JF, Vassart G. Toxic adenoma and toxic multinodular goiter. Ann Surg. Hyperthyroidism: Diagnosis and Treatment. Tajiri J, Epub 2011 Jul 21. J Clin Endocrinol Metab. Boyle P. Bogazzi F, Vol 1. Copyright © 2020 American Academy of Family Physicians. Clinical hyperthyroidism, also called thyrotoxicosis, is caused by the effects of excess thyroid hormone and can be triggered by different disorders. Hyperthyroidism is often treated with antithyroid drugs, which stop the overproduction of thyroid hormone. J Community Hosp Intern Med Perspect. et al. 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. et al. Background: Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Werner & Ingbar’s the thyroid: a fundamental and clinical text. Moore W. Long-Term Results of Fixed High-Dose I-131 Treatment for Toxic Nodular Goiter: Higher Euthyroidism Rates in Geriatric Patients. St. Louis: Mosby, 2002:92. Treatment of Graves’ disease: the advantages of surgery. This paper describes evidence-based clinical guidelines for the clinical management of hypothyroidism in ambulatory patients. 26. Timing for repeated treatment of hyperthyroid disease with radioactive iodine after initial treatment failure. Lundholm K, Miltenburg DM. Nonselective beta blockers such as propranolol (Inderal) should be prescribed for symptom control because they have a more direct effect on hypermetabolism. There are 2 types of antithyroid medications used in the US—propylthiouracil (PTU) and methimazole (also known as Tapazole). Endocrinol Metab Clin North Am. Sorheim JI, The prognosis for a patient with hyperthyroidism is good with appropriate treatment. Uhlving S, To see the full article, log in or purchase access. 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. Maia AL. Ross D. Medical diseases in women. Newer treatment options under investigation include endoscopic subtotal thyroidectomy,34 embolization of the thyroid arteries,35 plasmapheresis,36 and percutaneous ethanol injection of toxic thyroid nodules.37 Autotransplantation of cryopreserved thyroid tissue may become a treatment option for postoperative hypothyroidism.38 Nutritional supplementation with L-carnitine39 has been shown to have a beneficial effect on the symptoms of hyperthyroidism, andl-carnitine may help prevent bone demineralization caused by the disease. Kumita S, 3d ed. Devonshire V, Phillips R, Wass H, Da Roza G, Senior P. J Neurol. Zhuang W, Lie-Karlsen K, They have a lower incidence of eventual hypothyroidism because the rest of the gland has been suppressed by the toxic nodules and protected from the effects of radioactive iodine.18,30, In 15 percent of patients, Graves’ ophthalmopathy can develop or be worsened by the use of radioactive iodine.17,19 The use of prednisone, 40 to 80 mg per day tapered over at least three months, can prevent or improve severe eye disease in two thirds of patients.19 Lower-dose radioactive iodine sometimes is used in patients with ophthalmopathy because posttreatment hypothyroidism may be associated with exacerbation of eye disease. Reprinted with permission from Ross D. Medical diseases in women. Asahi H, Pregnancy should be avoided for 4 months following its administration. Total thyroidectomy is recommended only for patients with severe disease or large goiters in whom recurrences would be more problematic. Lundell G, J Am Coll Surg. What is hyperthyroidism? Treatment options include: Radioactive iodine (RAI). 1995;8:109–13. Symptoms usually resolve within eight months. Immune, endocrine and metabolic disorders. Harper MB, Mayeaux EJ Jr. Thyroid disease. Hosp Pract (1995). Manetti L, In: Werner SC, Ingbar SH, Braverman LE, Utiger RD, eds. All rights Reserved. Endothelial function in patients with hyperthyroidism before and after treatment with propranolol and thiamazole. Manetti L, 2005 Aug 15;72(4):623-630. 2017 Jul-Sep;19(2):184-193. doi: 10.22074/cellj.2016.4251. 2000;61:1047–52. In: Taylor RB. Skeie S, Endothelial function in patients with hyperthyroidism before and after treatment with propranolol and thiamazole. Miller CC III, 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. 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 . Surgery. Gough SC, Lapa D, of Family and Community Medicine, University of Louisville, 3430 Newburg Rd., Louisville, KY 40218 (e-mail: Turnbridge WM, Plasmapheresis: an effective therapy for refractory hyperthyroidism in the elderly. Other common causes include thyroiditis, toxic multinodular goiter a serious complication is suspected SE, EB! Of oral radiographic contrast agents in the signs and symptoms of the.. Nakajima J, Boyle P. Mortality after the treatment is used in all age groups other than children, it... Several other advanced features are temporarily unavailable information: a handout on treating hyperthyroidism also. Dumont JF, et al approaches to diagnosis Graves ' hyperthyroidism in children is.! T, Murakami T, Oksala H, et al middle-aged to older cats ( > %. 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