Graves' disease hyperthyroidism medical therapy: Difference between revisions
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* Low risk of hypothyroidism | * Low risk of hypothyroidism | ||
* No radiation hazard or surgical risk | * No radiation hazard or surgical risk | ||
* Remission rate 40–50% | * Remission rate 40–50% | ||
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* High recurrence rate | * High recurrence rate | ||
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* Agranulocytosis in <0.2% of patients | * Agranulocytosis in <0.2% of patients | ||
* Hepatotoxicity in ≤0.1% | * Hepatotoxicity in ≤0.1% | ||
* | * Cholestasis for the thionamides and hepatocellular necrosis for propylthiouracil | ||
* Antineutrophil cytoplasmic antibody–associated vasculitis in ≤0.1% of patients | * Antineutrophil cytoplasmic antibody–associated vasculitis in ≤0.1% of patients | ||
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|Oral; activity either fixed (e.g., 15 mCi [555 MBq]) or calculated on the basis of goiter size and uptake and turnover investigations | |Oral; activity either fixed (e.g., 15 mCi [555 MBq]) or calculated on the basis of goiter size and uptake and turnover investigations | ||
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* Normally outpatient procedure | * Normally outpatient procedure | ||
* Definitive therapy | * Definitive therapy | ||
* Low cost | * Low cost | ||
* Few side effects | * Few side effects | ||
* Effectively reduces goiter size | * Effectively reduces goiter size | ||
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* Potential radiation hazards | * Potential radiation hazards | ||
* Adherence to a country’s particular radiation regulations | * Adherence to a country’s particular radiation regulations | ||
* Radiation thyroiditis | * Radiation thyroiditis | ||
* Decreasing efficacy with increasing goiter size | * Decreasing efficacy with increasing goiter size | ||
* Eventual hypothyroidism in most patients | * Eventual hypothyroidism in most patients | ||
| Line 93: | Line 93: | ||
| ----- | | ----- | ||
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* Rapid euthyroidism | * Rapid euthyroidism | ||
* Recurrence extremely rare | * Recurrence extremely rare | ||
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* Most expensive therapy | * Most expensive therapy | ||
* Hypothyroidism is the aim | * Hypothyroidism is the aim | ||
* Risks associated with surgery and anesthesiology | * Risks associated with surgery and anesthesiology | ||
* Minor complications in 1–2% of patients (bleeding, infection, scarring), | * Minor complications in 1–2% of patients (bleeding, infection, scarring), | ||
* Major complications in 1–4% (hypoparathyroidism, recurrent laryngeal-nerve damage) | * Major complications in 1–4% (hypoparathyroidism, recurrent laryngeal-nerve damage) | ||
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* Does not influence course of Graves’ ophthalmopathy during pregnancy | * Does not influence course of Graves’ ophthalmopathy during pregnancy | ||
* Is best performed during the second trimester | * Is best performed during the second trimester | ||
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Revision as of 19:08, 5 April 2017
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Graves' disease hyperthyroidism medical therapy On the Web |
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Risk calculators and risk factors for Graves' disease hyperthyroidism medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
Antithyroid drugs are the first line treatment in Europe but ablation therapy either by thyroidectomy or radioactive iodine is more accepted in North America.
Hyperthyroidism Therapy
Genreral aspects
- In a small proportion of patients, spontaneous remission occurs.
- Smoking cessation is one of the mainstay of treatment.
- Antithyroid drugs are the first line treatment in Europe.
- Ablation therapy either by thyroidectomy or radioactive iodine is more accepted in North America.
- Each treatment approach has advantages and drawbacks. The patient’s preference after receiving adequate counseling, remains a critical factor in therapy decisions.
The following table summarizes the medical therapy and surgical option for treatment.
| Treatment | Mechanism | Route of administration | Advantages | Disadvantages | Special considerations |
|---|---|---|---|---|---|
| Beta-blockers |
|
Oral; may be administered
intravenously in acute cases |
Ameliorates sweating, anxiety, tremulousness, palpitations, and tachycardia |
|
|
| Antithyroid drugs (methimazole,
carbimazole, and propylthiouracil) |
|
Given as either a single, high fixed dose (e.g., 10–30 mg of methimazole or 200–600 mg of propylthiouracil daily)
and adjusted as euthyroidism is achieved or combined with thyroxine to prevent hypothyroidism (“block–replace” regimen) |
|
|
Major side effect usually within first 3 mo of therapy
|
| Radioactive iodine
(iodine-131) |
|
Oral; activity either fixed (e.g., 15 mCi [555 MBq]) or calculated on the basis of goiter size and uptake and turnover investigations |
|
|
|
| Thyroidectomy | Most or all thyroid tissue is removed surgically | ----- |
|
|
|
Antithyroid Drugs
- Methimazole, carbimazole and propylthiouracil are the available anti thyroid drugs.
- Methimazole is preferred for initial therapy in both Europe and North America because of its favorable side-effect profile.[1][2]
- Durable remission occurs in 40 to 50% of patients which is defined as euthroidism for at least 12 months following 1-2 years of treatment.
- Patients may be switched from one drug to another when necessitated by minor side effects.
- Monitoring by means of liver-function tests and white-cell counts before and during antithyroid drug therapy is advocated by some experts but is not currently supported by consensus opinion.
Radioactive Iodine
- Radioactive iodine therapy offers relief from symptoms of hyperthyroidism within weeks.
- Radioiodine is not associated with an increased risk of cancer.[3]
- It can provoke or worsen ophthalmopathy.[4]
References
- ↑ Burch HB, Burman KD, Cooper DS (2012). "A 2011 survey of clinical practice patterns in the management of Graves' disease". J. Clin. Endocrinol. Metab. 97 (12): 4549–58. doi:10.1210/jc.2012-2802. PMID 23043191.
- ↑ Bartalena L, Burch HB, Burman KD, Kahaly GJ (2016). "A 2013 European survey of clinical practice patterns in the management of Graves' disease". Clin. Endocrinol. (Oxf). 84 (1): 115–20. doi:10.1111/cen.12688. PMID 25581877.
- ↑ Ron E, Doody MM, Becker DV, Brill AB, Curtis RE, Goldman MB, Harris BS, Hoffman DA, McConahey WM, Maxon HR, Preston-Martin S, Warshauer ME, Wong FL, Boice JD (1998). "Cancer mortality following treatment for adult hyperthyroidism. Cooperative Thyrotoxicosis Therapy Follow-up Study Group". JAMA. 280 (4): 347–55. PMID 9686552.
- ↑ Bartalena L, Tanda ML (2009). "Clinical practice. Graves' ophthalmopathy". N. Engl. J. Med. 360 (10): 994–1001. doi:10.1056/NEJMcp0806317. PMID 19264688.