Ergebnisse der Radiojodtherapie der manifesten Hyperthyreose und der autonomen Struma mit Euthyreose

1990 ◽  
Vol 29 (04) ◽  
pp. 158-165 ◽  
Author(s):  
G. Berding ◽  
H. Schicha
Keyword(s):  
Thyroid Surgery ◽  
Dose Calculation ◽  
Additional Treatment ◽  
High Rate ◽  
Antithyroid Drugs ◽  
High Recurrence Rate ◽  
Graves Disease ◽  
Applied Dose ◽  
Immunogenic Hyperthyroidism ◽  
One Year

In 200 patients follow-up examinations were performed up to one year after radioiodine therapy (RITh) with individual dose calculation. The mean applied dose was significantly lower in patients with immunogenic hyperthyroidism (Graves’ disease) as compared to patients with non-immunogenic hyperthyroidism (disseminated/multifocal autonomy, HYDA). In Graves’ disease the rate of recurrent hyperthyroidism was significantly higher and that of posttreatment hypothyroidism lower. Considering the high recurrence rate in Graves’ disease a higher dose, e. g. 150 Gy, seems to be appropriate. In patients with HYDA who received antithyroid drugs during RITh, recurrence of hyperthyroidism appeared slightly more, and posttreatment hypothyroidism slightly less, frequent. The efficiency of RITh was not significantly reduced by additional treatment with antithyroid drugs. Posttreatment hypothyroidism in patients with euthyroid goiter and disseminated/multifocal autonomy (EUDA) occurred significantly more frequent if the basal TSH level was ≥0.5 µlE/ml before therapy. The goiter size was reduced independent of the basal TSH level. In this group protection by thyroxine could avoid posttreatment hypothyroidism without impairing the reduction of goiter. In HYDA patients after thyroid surgery recurrence appeared less, and in those with EUDA posttreatment hypothyroidism significantly more, frequent. A lower dose seems to be suitable in patients who underwent thyroid surgery before. In patients with focal autonomy after RITh no recurrence of hyperthyroidism was observed. In 9% a suppressed basal TSH level indicating persistent autonomy was seen. Posttreatment hypothyroidism in focal autonomy appeared only in patients without manifest hyperthyroidism before RITh and was significantly more frequent in this group as compared to the other groups of patients. In patients with focal autonomy who developed hypothyroidism the dose calculation was based on a significantly higher volume of the adenoma. In 3 cases cystic parts of the adenoma were not subtracted. This caused a higher radiation dose to the paranodular tissue, which might have been one reason for the high rate of posttreatment hypothyroidism in this group of patients.

scholarly journals Prediction of Relapse After Antithyroid Drugs Withdrawal: A Narrative Review

2020 ◽  
Vol 18 (Suppl) ◽  
Author(s):  
Pei-Wen Wang
Keyword(s):  
Risk Factors ◽  
Recurrence Rate ◽  
Prediction Models ◽  
Clinical Signs ◽  
Human Leukocyte ◽  
Baseline Risk ◽  
Antithyroid Drugs ◽  
Prior History ◽  
High Recurrence Rate ◽  
Graves Disease

Context: Antithyroid drugs (ATD) are the first-line treatment for Graves’ disease (GD); however, relapse following treatment is approximately 30% - 40% in the first year, and 50% - 60% in the long term. Identification of risk factors that predict relapse, after discontinuing ATD, plays an important role in guiding therapeutic options. Evidence Acquisition: PubMed was used to search for studies published in English between 1995 and 2019. The following search terms were used: Graves’ disease, antithyroid drugs, relapse, recurrence, and outcome. The reference lists from review articles were also included in the search in order to find older journals. Results: Factors associated with a high recurrence rate, as reported in most studies, were divided into phenotype and genotype predictors. Phenotype factors included large goiter size, persistence of high TSH receptor antibody (TRAb), severe hyperthyroidism, smoking, younger age, male sex, and prior history of recurrence. Genotype factors included human leukocyte antigen (HLA), CD40, CTLA-4, PTPN22, Tg, and TSHR genes. In a subgroup analysis by age, genetic factors were better predictors in the younger group, while clinical signs were more useful in the older group. The reliability of using individual baseline risk factors to predict subsequent relapse is poor; however, predictive scores calculated by grouping single risk factors might help to predict future outcomes. Conclusions: Longer normalization time of TRAb, the persistence of a palpable goiter, and harboring genetic risk factors in younger patients are associated with high recurrence rate of GD. Multi-marker prediction models have been proposed and validated to improve the predictive value of relapse after ATD withdrawal.

scholarly journals Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Jia Liu ◽  
Jing Fu ◽  
Yuan Xu ◽  
Guang Wang
Keyword(s):  
Recurrence Rate ◽  
Influencing Factors ◽  
Current Knowledge ◽  
Antithyroid Drug ◽  
Immunosuppressive Drugs ◽  
Antithyroid Drugs ◽  
High Recurrence Rate ◽  
Graves Disease ◽  
Immune Disorder ◽  
Modifiable Factors

Graves’ disease (GD) is the most common cause of hyperthyroidism worldwide. Current therapeutic options for GD include antithyroid drugs (ATD), radioactive iodine, and thyroidectomy. ATD treatment is generally well accepted by patients and clinicians due to some advantages including normalizing thyroid function in a short time, hardly causing hypothyroidism, and ameliorating immune disorder while avoiding radiation exposure and invasive procedures. However, the relatively high recurrence rate is a major concern for ATD treatment, which is associated with multiple influencing factors like clinical characteristics, treatment strategies, and genetic and environmental factors. Of these influencing factors, some are modifiable but some are nonmodifiable. The recurrence risk can be reduced by adjusting the modifiable factors as much as possible. The titration regimen for 12–18 months is the optimal strategy of ATD. Levothyroxine administration after successful ATD treatment was not recommended. The addition of immunosuppressive drugs might be helpful to decrease the recurrence rate of GD patients after ATD withdrawal, whereas further studies are needed to address the safety and efficacy. This paper reviewed the current knowledge of ATD treatment and mainly focused on influencing factors for recurrence in GD patients with ATD treatment.

Ergebnisse der Radiojod-Behandlung von Patienten mit immunogener und nicht-immunogener Hyperthyreose bei Anwendung unterschiedlicher Herddosen

1988 ◽  
Vol 27 (03) ◽  
pp. 98-104 ◽  
Author(s):  
C. R. Pickardt ◽  
K. Mann ◽  
D. Engelhardt ◽  
C. M. Kirsch ◽  
P. Knesewitsch ◽  
...  
Keyword(s):  
High Rate ◽  
Graves Disease ◽  
Normal Thyroid Function ◽  
Number Of Patients ◽  
Late Morbidity ◽  
Immunogenic Hyperthyroidism ◽  
Rate Of Success ◽  
High Degree ◽  
Recurrent Hyperthyroidism

The aim of this study was to check the efficacy of radioiodine (131I) therapy (RIT) in a large number of patients (n = 506) suffering from immunogenic or non-immunogenic hyperthyroidism (Graves’ disease, Plummer’s disease). Since there is no causal cure for immunogenic hyperthyroidism RIT provides, like all other modalities, only a moderate rate of success which is clearly dose-related. Applying 60 Gy, normal thyroid function can be achieved in only 54% of the cases. A dose of 150 Gy succeeds in 86% of the cases. The solitary decompensated autonomous adenoma (DAA) can be eliminated surgically as well as by RIT with a high degree of success (95%). Contrary to surgery, RIT does not have any noticeable early or late morbidity. The high rate of success of RIT in patients with DAA could be confirmed in two groups with different follow-up periods (16 and 65 months). As expected, the rate of hypothyroidism increased from 11 % in the early group to 23% in the late group. Multinodular autonomous adenomas can be eliminated successfully using RIT as well. The concept to apply a dose of 400 Gy to the total functional autonomous tissue as determined by ultrasound yields better results (95%) than 150 Gy to the whole thyroid gland as measured by ultrasound (88%). The rate of hypothyroidism as shown by these results (up to a maximum of 62% after RIT of Graves’ disease using 150 Gy) is the lesser evil compared to remaining or recurrent hyperthyroidism since these patients can be treated with thyroid hormones without problems.

What is the Significance of Raised Plasma TSH Levels after Thyroid Surgery?

1982 ◽  
Vol 27 (3) ◽  
pp. 216-219 ◽  
Author(s):  
A. D. Toft ◽  
H. A. Kellett ◽  
J. S. A. Sawers ◽  
I. S. R. Sinclair ◽  
G. J. Beckett ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
First Year ◽  
Graves Disease ◽  
Thyroid Status ◽  
The Third ◽  
Permanent Replacement ◽  
One Year ◽  
Recurrent Hyperthyroidism ◽  
Regular Review ◽  
Tsh Levels

Thyroid function was assessed prospectively for five years in 73 patients treated surgically for Graves' disease. No patient developed hypothyroidism after the sixth postoperative month, despite the presence of raised plasma TSH levels in 70 per cent of euthyroid patients at the end of the first year. Indeed, in those with evidence of temporary hypothyroidism (low T4, raised TSH at 3 months but normalisation of T4 at 6 months) plasma TSH continued to fall for up to three years. The majority (6) of patients developing recurrent hyperthyroidism did so within the first year, but in one of three patients who relapsed subsequently, plasma TSH had been elevated at one year. Plasma TSH cannot be used to predict thyroid status following surgery for Graves' disease. Although regular review remains necessary, it should not include measurement of TSH unless this is needed to confirm the validity of a low thyroxine level after the third postoperative month and before starting permanent replacement therapy.

scholarly journals A questionnaire survey concerning the most favourable treatment for Graves' disease in children and adolescents

2004 ◽  
pp. 155-156 ◽  
Author(s):  
GE Krassas ◽  
Z Laron
Keyword(s):  
Children And Adolescents ◽  
Radioactive Iodine ◽  
High Rate ◽  
Treatment Modalities ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Toxic Adenoma ◽  
Or Groups ◽  
The Usa ◽  
Toxic Goiter

Graves' disease (GD) is the most common cause of juvenile thyrotoxicosis in children and adolescents (1, 2). Three treatment modalities are now available for the treatment of Graves' thyrotoxicosis in childhood: antithyroid drugs (ATD), surgery and radioactive iodine (RAI). However, none of these treatments has been shown to be ideal or clearly superior to the others. Physicians in different countries have different approaches concerning the optimal treatment of juvenile GD.In a European questionnaire study (3), which was conducted by the European Thyroid Association in 1993 and in which 99 individuals or groups from 22 countries participated, it was found that 22 out of 99 physicians from nine countries would consider RAI treatment as the treatment of choice for children with recurrent thyrotoxicosis after surgery, or with recurrent thyrotoxicosis 2 years after ATD. However, RAI is preferred by only a small percentage of physicians for this group of patients in Europe. Hardly any of the respondents chose RAI for the patients with a toxic adenoma or a multinodular toxic goiter (3). On the other hand, in view of the difficulties with medical therapy in children and adolescents, including poor compliance, a high rate of relapse, drug toxicity and continued thyroid enlargement, some eminent American physicians emphasize the safety, simplicity and economic advantages of (131)I ablation which should be considered more commonly in children (4, 5).We had the opportunity to conduct a similar study during a pediatric thyroidology symposium, which was organized by Professors Buyugkebiz and Laron in Izmir (Smyrna) Turkey from 30 October to 1 November 2003. During the congress a questionnaire with the following four questions was circulated among the 120 participants from eight countries who were mainly paediatric endocrinologists. Most of them were from Turkey and the rest, except for one who came from the USA, were Europeans. Sixty-one out of the 120 physicians responded.

scholarly journals Graves’ disease thyrotoxicosis and propylthiouracil related agranulocytosis successfully treated with therapeutic plasma exchange and g-csf followed by total thyroidectomy.

2017 ◽  
Vol 9 (1) ◽  
pp. e2017058 ◽  
Author(s):  
Anna Candoni
Keyword(s):  
Post Partum ◽  
Hormone Replacement ◽  
Antithyroid Drug ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Antithyroid Drug Therapy ◽  
Thyroid Hormone Replacement Therapy ◽  
One Year ◽  
Toxic Goiter ◽  
Receptor Antibodies

Antithyroid drugs can be a rare cause of agranulocytosis (0.5% of treated patients). Suspension of these drugs is mandatory in these patients and may result in worsening hyperthyroidism. We report the case of a 27-year-old woman who is 3 months post-partum, breastfeeding, and suffering from Graves’ disease hyperthyroidism treated first with methimazole and then with propylthiouracil due to a methimazole allergy. She was admitted for urosepsis and agranulocytosis. The patient was diagnosed with propylthiouracil related agranulocytosis, diffuse toxic goiter, and thyro-gastric syndrome. Antithyroid drug therapy was stopped resulting in a worsening of thyrotoxicosis. Agranulocytosis was treated with 8 doses of G-CSF with full recovery. To rapidly restore euthyroidism and to perform a thyroidectomy, the patient received 6 plasmapheresis procedures, to clear thyroid hormones and anti-TSH receptor antibodies from the blood, resulting in a pre-surgical euthyroid state without antithyroid drugs. One year after thyroidectomy, the patient is well on thyroid hormone replacement therapy. Key Words: Plasmapheresis; Hyperthyroidism, Agranulocytosis; Propylthiouracil.

Evaluation of TSH-receptor antibodies as prognostic markers after cessation of antithyroid drug treatment in patients with Graves' disease

1988 ◽  
Vol 117 (2) ◽  
pp. 173-180 ◽  
Author(s):  
Kanji Kasagi ◽  
Yasuhiro Iida ◽  
Hiroto Hatabu ◽  
Yasutaka Tokuda ◽  
Keisuke Arai ◽  
...  
Keyword(s):  
Drug Treatment ◽  
Antithyroid Drug ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Transverse Diameter ◽  
Group 3 ◽  
Group 2 ◽  
Antithyroid Drug Treatment ◽  
One Year ◽  
Group 1

Abstract. Clinical usefulness of thyroid-stimulating antibodies (TSab) and TSH-binding inhibitor immunoglobulins (TBII) for predicting the prognosis in patients with Graves' disease after cessation of antithyroid drug treatment was evaluated, and compared with that of T3 suppression test and goitre size. Among 46 patients who had been euthyroid on a maintenance dose of antithyroid drugs for at least one year and had discontinued taking medicine, 16 relapsed within one year (group 1), 7 relapsed later than 1 year (group 2), and 23 patients remained in remission for more than 1 year (group 3). Incidence of TSab, TBII, T3 nonsuppressibility and large goitre (transverse diameter longer than means of the values for the 46 patients: ≥ 4.36 cm in females; ≥ 4.74 cm in males) determined at the time of discontinuation of treatment was 87.5% (14/16), 56.3% (9/16), 78.6% (11/14) and 81.3% (13/16) in group 1; 66.7% (4/6), 28.6% (2/7), 50.0% (3/6), and 57.1% (4/7) in group 2, and 56.5% (13/23), 24.1% (5/23), 35.7% (8/23), and 26.1% (6/23) in group 3, respectively. All relapsed patients showed remarkable increases in both TSab and TBII activities at the time of relapse. High incidence of TSab in patients remaining in remission suggests that a reduced functional reserve of the thyroid, probably owing to destructive changes and/or shrinkage of the gland, may cause impaired responses to TSab and is involved in the cause of remission. Development of blocking type of TBII was not considered to be a cause of remission. Remission was predictable in all patients with any two of the indices such as negative TSab, positive T3 suppressibility, and small goitre.

Guideline for radioiodine therapy for benign thyroid diseases (version 3)

2004 ◽  
Vol 43 (06) ◽  
pp. 217-220 ◽  
Author(s):  
J. Dressler ◽  
F. Grünwald ◽  
B. Leisner ◽  
E. Moser ◽  
Chr. Reiners ◽  
...  
Keyword(s):  
Radioiodine Therapy ◽  
Thyroid Volume ◽  
Thyroid Diseases ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Co Morbidity ◽  
History Of ◽  
Individual Decisions ◽  
Prophylactic Use ◽  
Benign Thyroid

SummaryThe version 3 of the guideline for radioiodine therapy for benign thyroid diseases presents first of all a revision of the version 2. The chapter indication for radioiodine therapy, surgical treatment or antithyroid drugs bases on an interdisciplinary consensus. The manifold criteria for decision making consider the entity of thyroid disease (autonomy, Graves’ disease, goitre, goitre recurrence), the thyroid volume, suspicion of malignancy, cystic nodules, risk of surgery and co-morbidity, history of subtotal thyroidectomy, persistent or recurrent thyrotoxicosis caused by Graves’ disease including known risk factors for relapse, compression of the trachea caused by goitre, requirement of direct therapeutic effect as well as the patient’s preference. Because often some of these criteria are relevant, the guideline offers the necessary flexibility for individual decisions. Further topics are patients’ preparation, counseling, dosage concepts, procedural details, results, side effects and follow-up care. The prophylactic use of glucocorticoids during radioiodine therapy in patients without preexisting ophthalmopathy as well as dosage and duration of glucocorticoid medication in patients with preexisting ophthalmopathy need to be clarified in further studies. The pragmatic recommendations for the combined use of radioiodine and glucocorticoids remained unchanged in the 3rd version.

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