scholarly journals Current and Future Treatments for Graves’ Disease and Graves’ Ophthalmopathy

2018 ◽  
Vol 50 (12) ◽  
pp. 871-886 ◽  
Author(s):  
Anupam Kotwal ◽  
Marius Stan
Keyword(s):  
Clinical Care ◽  
Treatment Options ◽  
Geographic Location ◽  
Antithyroid Drugs ◽  
Term Therapy ◽  
Graves Disease ◽  
Graves Ophthalmopathy ◽  
Technological Advances ◽  
Potential Risks ◽  
Long Term Therapy

AbstractThe course and pathogenesis of Graves’ disease and Graves’ ophthalmopathy are interdependent, influencing each other’s therapeutic choices. Multiple factors including geographic location, access to medical services, patient and physician preferences influence the management of these conditions. Graves’ disease is classically managed with one of three treatment options – antithyroid drugs, radioactive iodine, and thyroidectomy. In recent years, there has been a shift towards antithyroid drugs, including long term therapy with these agents, given the advantage of avoiding hypothyroidism and the apparent safety of this approach. In addition, new therapies are (slowly) emerging, focusing on immunomodulation. Technological advances are opening doors to non-pharmaceutical interventions that aim to deal with both structural thyroid abnormalities as well as biochemical abnormalities of hyperthyroidism. Graves’ ophthalmopathy management is guided by its activity and severity status, with treatment options including smoking cessation, control of hyperthyroidism, local eye measures, glucocorticoids, selenium, orbital radiotherapy, and surgery. In addition to these established treatment choices, new immunotherapy-based approaches are being tested. Some of them (tocilizumab and teprotumumab) are very promising but further evaluation is needed before we can establish their role in clinical care. Agents identified as beneficial in Graves’ disease management will likely be tested in Graves’ ophthalmopathy as well. In the coming years, our main clinical responsibility will be to find the proper balance between the benefits and potential risks of these incoming therapies, and to identify the subgroups of patients where this ratio is most likely to favor a safe and successful therapeutic outcome.

EXAMINATION OF THYROID FUNCTION IN PATIENTS SUFFERING FROM GRAVES' DISEASE AFTER LONG-TERM THERAPY WITH ANTITHYROID DRUGS IN COMBINATION WITH THYROID HORMONES

1974 ◽  
Vol 77 (1_Suppl) ◽  
pp. S124
Author(s):  
W. Bindeballe ◽  
R. Gutekunst ◽  
Hg. Lahrtz ◽  
G. Rabenhorst ◽  
K. Schemmel ◽  
...  
Keyword(s):  
Thyroid Hormones ◽  
Thyroid Function ◽  
Antithyroid Drugs ◽  
Term Therapy ◽  
Graves Disease ◽  
Long Term Therapy

Urethral Sphincter Mechanism Incompetence in Dogs: An Update

2018 ◽  
Vol 54 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Rory Applegate ◽  
Shelly Olin ◽  
Bethany Sabatino
Keyword(s):  
Urinary Incontinence ◽  
Treatment Options ◽  
Term Therapy ◽  
Urethral Sphincter ◽  
Adrenergic Agents ◽  
Common Cause ◽  
Urethral Bulking ◽  
Long Term Therapy ◽  
Sphincter Mechanism

ABSTRACT Urethral sphincter mechanism incompetence (USMI) is the most common cause of acquired urinary incontinence in dogs. The pathogenesis of USMI is multifactorial and complex. Studies have shown variable results regarding the effects and timing of sterilization on the incidence of USMI. Diagnosis of USMI is often based on history, physical examination, and elimination of other differentials. Treatment options for USMI include medications, such as α-adrenergic agents and estrogen products, minimally-invasive urethral bulking procedures, surgical procedures (e.g., indwelling urethral occluders), or combination therapy. The overall prognosis for USMI is typically fair to good with long-term therapy.

Diagnosis and Treatment of Graves Disease

2003 ◽  
Vol 37 (7-8) ◽  
pp. 1100-1109 ◽  
Author(s):  
Darcie D Streetman ◽  
Ujjaini Khanderia
Keyword(s):  
Thyroid Gland ◽  
Radioactive Iodine ◽  
Radioiodine Therapy ◽  
Patient Adherence ◽  
Treatment Options ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Extensive Experience ◽  
Long Term Treatment ◽  
Β Blockers

OBJECTIVE: To review the etiology, diagnosis, and clinical presentation of Graves disease and provide an overview of the standard and adjunctive treatments. Specifically, antithyroid drugs, β-blockers, inorganic iodide, lithium, and radioactive iodine are discussed, focusing on current controversies. DATA SOURCES: Primary articles were identified through a MEDLINE search (1966–July 2000). Key word searches included β-blockers, Graves disease, inorganic iodide, lithium, methimazole, and propylthiouracil. Additional articles from these sources and endocrinology textbooks were also identified. We agreed to include articles that would highlight the most relevant points, as well as current areas of controversy. DATA SYNTHESIS: Graves disease is the most common cause of hyperthyroidism. The 3 main treatment options for patients with Graves hyperthyroidism include antithyroid drugs, radioactive iodine, and surgery. Although the antithyroid drugs propylthiouracil (PTU) and methimazole (MMI) have similar efficacy, there are situations when 1 agent is preferred. MMI has a longer half-life than PTU, allowing once-daily dosing that can improve patient adherence to treatment. PTU has historically been the drug of choice for treating pregnant and breast-feeding women because of its limited transfer into the placenta and breast milk. Adjuvant therapies for Graves disease include β-blockers, inorganic iodide, and lithium. β-Blockers are used to decrease the symptoms of hyperthyroidism. Inorganic iodide is primarily used to prepare patients for thyroid surgery because of its ability to decrease the vascularity of the thyroid gland. Lithium, which acts in a manner similar to iodine, is not routinely used due to its transient effect and the risk of potentially serious adverse effects. In the US, radioiodine therapy has become the preferred treatment for adults with Graves disease. It is easy to administer, safe, effective, and more affordable than long-term treatment with antithyroid drugs. Hypothyroidism is an inevitable consequence of radioiodine therapy. Radioiodine is contraindicated in pregnant women because it can damage the fetal thyroid gland, resulting in fetal hypothyroidism. Bilateral subtotal thyroidectomy, which was once the only treatment available, is now performed only in special circumstances. In addition to the normal risks associated with surgery, laryngeal nerve damage, hypoparathyroidism, and hypothyroidism can occur following that procedure. CONCLUSIONS: Despite extensive experience with medical management, controversy prevails regarding choosing among the various drugs for treatment of Graves disease. None of the treatment options, including antithyroid drugs, radioiodine, and surgery, is ideal. Each has risks and benefits, and selection should be tailored to the individual patient.

Correlation of orbital muscle changes evaluated by magnetic resonance imaging and thyroid-stimulating antibody in patients with Graves' ophthalmopathy

1993 ◽  
Vol 129 (3) ◽  
pp. 213-219 ◽  
Author(s):  
Mitsushige Nishikawa ◽  
Masayoshi Yoshimura ◽  
Nagaoki Toyoda ◽  
Hiroya Masaki ◽  
Toshinaga Yonemoto ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Resonance Imaging ◽  
Thyroid Stimulating Antibody ◽  
Graves Ophthalmopathy ◽  
Growth Activity ◽  
Muscle Changes ◽  
Rat Thyroid

To evaluate the relationship between eye changes and autoantibody to the thyrotropin receptor in patients with Graves' disease, we evaluated the eye changes using magnetic resonance imaging and the results were correlated with thyroid-stimulating antibody, thyrotropin binding inhibitor immunoglobulin and thyroid growth activity. Subjects were 15 patients with Graves' disease who had Graves' ophthalmopathy, including exophthalmos and other signs and symptoms, and nine patients without ophthalmopathy; all were maintained in a euthyroid state by antithyroid drugs. The thyrotropin-binding inhibitor imunoglobulin was measured by a kit, and thyroid-stimulating antibody and thyroid growth activity were evaluated by cyclic adenosine 3′,5′-monophosphate production and [3H]thymidine incorporation, respectively, by cultured functional rat thyroid lined cells. The sum of the swelling ratios (muscle thickness to the diameter of the optic nerve) of the four extraocular muscles correlated well with the degree of exophthalmos. The thyrotropin-binding inhibitor immunoglobulin was positive in nine out of 15 patients with ophthalmopathy; however, no correlation was observed between the activity and exophthalmos or muscle swelling. No significant correlation was observed between muscle changes and thyroid growth activity either. On the other hand, thyroid-stimulating antibody (642±91%) in Graves' patients with ophthalmopathy was significantly (p<0.02) higher than that (315±84%) in patients without ophthalmopathy. Moreover, the level of the stimulating activity in Graves' patients with ophthalmopathy showed a significant (p < 0.02) positive correlation with the sum of the swelling ratios of the individual eight eye muscles. These results suggest that thyroid-stimulating antibody has a close relation to Graves' ophthalmopathy.

scholarly journals RAI Therapy for Graves’ Hyperthyroidism

2021 ◽  
Author(s):  
Ioannis Iakovou ◽  
Evanthia Giannoula ◽  
Paraskevi Exadaktylou ◽  
Nikitas Papadopoulos
Keyword(s):  
Therapeutic Effect ◽  
Therapeutic Dose ◽  
Initial Treatment ◽  
Radioiodine Therapy ◽  
Treatment Options ◽  
Symptomatic Improvement ◽  
Therapeutic Management ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Common Cause

Graves’ Disease is the most common cause of hyperthyroidism. It has multiple manifestations and it requires appropriate diagnostic and therapeutic management. Once it has been established that the patient is hyperthyroid and the cause is GD, the patient and physician must choose between three effective and relatively safe initial treatment options: antithyroid drugs (ATDs), radioiodine (RAI) therapy, or thyroidectomy. RAI has been used to treat hyperthyroidism for more than seven decades. It is well tolerated and complications are rare, except for those related to orbitopathy. Most patients are effectively treated with one therapeutic dose of I-131. The patient usually notes symptomatic improvement within 3 weeks of therapy. However, the full therapeutic effect takes 3 to 6 months because stored hormone must first be released. Radioiodine therapy may not initially be effective in up to 10% of patients. They require repeat treatment, usually with a higher administered dose.

scholarly journals Rational treatment of patients with functional dyspepsia

2021 ◽  
Vol 93 (8) ◽  
pp. 982-985
Author(s):  
Alexander S. Kazakov ◽  
Sergey K. Zyryanov ◽  
Elena A. Ushkalova ◽  
Elena K. Nasretdinova
Keyword(s):  
Functional Dyspepsia ◽  
Motor Skills ◽  
Tricyclic Antidepressants ◽  
Treatment Options ◽  
Eradication Therapy ◽  
Term Therapy ◽  
Effective Treatment Option ◽  
Mucosal Permeability ◽  
Long Term Therapy

Functional dyspepsia is one of the most common functional disorders of the gastrointestinal tract, which resulted from impaired motor skills, visceral hypersensitivity, increased mucosal permeability, disorders of the autonomic nervous system, etc. There is no specific therapy for this disease, which often leads to the irrational use of various groups of drugs. Drug therapy is recommended only during periods of symptoms. The main options of pharmacotherapy include the use of proton pump inhibitors, phytotherapeutic drugs, eradication therapy of Helicobacter pylori. Against the background of possible motor disorders, prokinetics are also one of the possible treatment options, but cisapride has long been withdrawn from sale due to cardiotoxicity, the use of domperidone and metoclopramide is limited due to side effects, especially with long-term therapy, so currently the only prokinetic that can be used in everyday clinical practice is itopride. In refractory cases, tricyclic antidepressants and psychotherapeutic approaches are another effective treatment option.

scholarly journals Tuberculosis and Nanotechnology: Where shall the Twain meet?

2013 ◽  
Vol 47 (4) ◽  
pp. 188-192 ◽  
Author(s):  
Samir Malhotra ◽  
Ritika Kondel
Keyword(s):  
Treatment Options ◽  
Multidrug Resistant ◽  
Diagnostic Methods ◽  
New Drugs ◽  
Term Therapy ◽  
Antitubercular Drugs ◽  
Poor Patient Compliance ◽  
Current Area ◽  
Multiple Drugs ◽  
Long Term Therapy

ABSTRACT Tuberculosis remains among the commonest infectious diseases in the developing world and is a major source of morbidity and mortality. Conventional treatments typically consist of long-term therapy with multiple drugs which often leads to poor patient compliance as well as adverse effects. Poor compliance is in turn a major cause for the development of multidrug resistant (MDR) tuberculosis for which there are few treatment options. Therefore, there is an urgent need for improved and more effective therapies. There are very few new drugs for tuberculosis in the pipeline, and a major current area of research is development of novel formulations. Another key aspect is to prevent the spread of the disease by developing rapid diagnostic methods. Here, we describe advances in nanotechnology for improving the pharmacological profile of antitubercular drugs (substantial work in our institution) and microtechnology diagnostics for tuberculosis (TB). How to cite this article Shafiq N, Kondel R, Malhotra S. Tuberculosis and Nanotechnology: Where shall the Twain meet? J Postgrad Med Edu Res 2013;47(4):188-192.

scholarly journals 2022 European Thyroid Association Guideline for the management of pediatric Graves’ disease

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Christiaan F Mooij ◽  
Timothy D Cheetham ◽  
Frederik A Verburg ◽  
Anja Eckstein ◽  
Simon H Pearce ◽  
...  
Keyword(s):  
Treatment Options ◽  
Behavioral Changes ◽  
Definitive Treatment ◽  
Dose Titration ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Large Goiter ◽  
Management Recommendations ◽  
Receptor Antibodies ◽  
Serum Tsh

Hyperthyroidism caused by Graves’ disease (GD) is a relatively rare disease in children. Treatment options are the same as in adults – antithyroid drugs (ATD), radioactive iodine (RAI) or thyroid surgery, but the risks and benefits of each modality are different. The European Thyroid Association guideline provides new recommendations for the management of pediatric GD with and without orbitopathy. Clinicians should be alert that GD may present with behavioral changes or declining academic performance in children. Measurement of serum TSH receptor antibodies is recommended for all pediatric patients with hyperthyroidism. Management recommendations include the first-line use of a prolonged course of methimazole/carbimazole ATD treatment (3 years or more), a preference for dose titration instead of block and replace ATD, and to avoid propylthiouracil use. Where definitive treatment is required either total thyroidectomy or RAI is recommended, aiming for complete thyroid ablation with a personalized RAI activity. We recommend avoiding RAI in children under 10 years of age but favor surgery in patients with large goiter. Pediatric endocrinologists should be involved in all cases.

scholarly journals Graves’ Disease

2021 ◽  
Author(s):  
Vasudha Bakshi ◽  
Gollapalli Rajeev Kumar
Keyword(s):  
Thyroid Gland ◽  
Hormone Receptor ◽  
Treatment Options ◽  
Positive Family History ◽  
Current Treatment ◽  
Thyroid Stimulating Hormone ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Autoimmune Thyroid ◽  
Stimulating Hormone

Graves’ disease (GD) is an autoimmune thyroid disorder where autoantibodies are produced against TSH (Thyroid Stimulating Hormone) receptor causing thyrotoxicosis. It is characterized by goiter, ophthalmopathy, and occasionally pretibial myxedema. The autoimmune mechanism causing disease is not well understood and it is complex. It involves multifactorial etiology involving environmental and genetic factors. Smoking and positive family history contributing to the development of GD. GD can be diagnosed based on the clinical manifestation and demonstrating low concentration of TSHs, high TRab (Thyroid Stimulating Hormone receptor autoantibodies), and high FT4 (Free thyroxine) concentration. Current treatment options aimed at stable restoration of euthyroidism by following different modalities of suppressing thyroid gland using antithyroid drugs, removing/ablating thyroid gland by surgery, and radioactive iodine treatment with iodine- 131.

Patients’ and clinicians’ preferences for treatment for Graves’ disease: A discrete choice experiment

2021 ◽  
Author(s):  
Caroline M.j. van Kinschot ◽  
Vikas R. Soekhai ◽  
Esther W. de Bekker-Grob ◽  
W. Edward Visser ◽  
Robin P. Peeters ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Important Determinant ◽  
Remission Rate ◽  
Treatment Options ◽  
Treatment Choice ◽  
Preference Heterogeneity ◽  
Antithyroid Drugs ◽  
Graves Disease

Objective: Treatment options for Graves’ disease (GD) consist of antithyroid drugs (ATD), radioactive iodine (RAI) and total thyroidectomy (TT). Guidelines recommend to discuss these options with patients, taking into account patients’ preferences. This study aims to evaluate and compare patients’ and clinicians’ preferences and the trade-offs made in choosing treatment. Design and methods: A discrete choice experiment (DCE) was performed with GD patients with a first diagnosis or recurrence in the previous year, and with clinicians. Participants were offered hypothetical treatment options which differed in type of treatment, rates of remission, severe side effects, permanent voice changes and hypocalcemia. Preference heterogeneity was assessed by latent-class analysis. Results: 286 (82%) patients and 61 (18%) clinicians participated in the DCE. All treatment characteristics had a significant effect on treatment choice (p<0.05). Remission rate was the most important determinant and explained 37% and 35% of choices in patients and clinicians, respectively. Both patients and clinicians preferred ATD over surgery and RAI. A strong negative preference towards RAI treatment was observed in a subclass of patients, whereas clinicians preferred RAI over surgery. Conclusion: In both patients and clinicians, remission rate was the most important determinant of treatment choice and ATD was the most preferred treatment option. Patients had a negative preference towards RAI compared to alternatives, whereas clinicians preferred RAI over surgery. Clinicians should be aware that their personal attitude towards RAI differs from their patients. This study on patients’ and clinicians’ preferences can support shared decision making and thereby improve clinical treatment.

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