scholarly journals Clinical usage recommendations and analytic performance goals for total and free triiodothyronine measurements

1996 ◽  
Vol 42 (1) ◽  
pp. 155-159 ◽  
Author(s):  
G G Klee
Keyword(s):  
Heart Function ◽  
Hormone Replacement ◽  
Antithyroid Drug ◽  
Cross Reactivity ◽  
Free Triiodothyronine ◽  
Clinical Role ◽  
Reverse T3 ◽  
Antithyroid Drug Therapy ◽  
Total Triiodothyronine ◽  
Thyroid Hormone Replacement Therapy

Abstract The major clinical role for total triiodothyronine (TT3) and (or) free T3 (FT3) is the assessment of hyperthyroidism in patients with suppressed sensitive thyrotropin (sTSH) concentrations. The assays are particularly important in hyperthyroid patients with normal free thyroxine (FT4) concentrations to assess potential T3 thyrotoxicosis. Other specialized uses for T3 and FT3 measurements are monitoring thyroid hormone replacement therapy, the evaluation of amiodarone-induced thyrotoxicosis, and predicting outcome of antithyroid drug therapy in patients with Graves hyperthyroidism. The roles of these tests in assessing heart function in cardiopulmonary bypass surgery, evaluation of patients with neuropsychiatric disorders, and monitoring of patients on anticonvulsant therapy are not well defined. These assays are not recommended for diagnosis of hypothyroidism. Analytic recommendations include CV < 5.2% for T3 and < 3.8% for FT3; < 0.2% cross-reactivity with L-T4; and < 1.0% cross-reactivity with D-T4, D-T3, and reverse T3.

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.

scholarly journals Antithyroid drug therapy: 70 years later

2018 ◽  
Vol 179 (5) ◽  
pp. R261-R274 ◽  
Author(s):  
Henry B Burch ◽  
David S Cooper
Keyword(s):  
Adverse Reactions ◽  
Antithyroid Drug ◽  
Ease Of Use ◽  
Antithyroid Drugs ◽  
Clinical Role ◽  
Antithyroid Drug Therapy ◽  
Prediction And Prevention ◽  
Life Threatening ◽  
History Of ◽  
Toxic Drugs

The thionamide antithyroid drugs were discovered in large part following serendipitous observations by a number of investigators in the 1940s who found that sulfhydryl-containing compounds were goitrogenic in animals. This prompted Prof. Edwin B Astwood to pioneer the use of these compounds to treat hyperthyroidism in the early 1940s and to develop the more potent and less toxic drugs that are used today. Despite their simple molecular structure and ease of use, many uncertainties remain, including their mechanism(s) of action, clinical role, optimal use in pregnancy and the prediction and prevention of rare but potentially life-threatening adverse reactions. In this review, we summarize the history of the development of these drugs and outline their current role in the clinical management of patients with hyperthyroidism.

Role of Subclinical Iatrogenic Hyperthyroidism in the Setting of Heart Disease and Arrhythmic Burden

2020 ◽  
Vol 20 (6) ◽  
pp. 959-962 ◽  
Author(s):  
Sandra Mastroianno ◽  
Giuseppe Di Stolfo ◽  
Angela Maggio ◽  
Michele Pacilli ◽  
Domenico Rosario Potenza ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Hormone Replacement ◽  
The Elderly ◽  
Subclinical Hyperthyroidism ◽  
Free Triiodothyronine ◽  
Thyroid Hormone Replacement ◽  
Ventricular Extrasystoles ◽  
Cardiovascular Involvement ◽  
Thyroid Hormone Replacement Therapy

Background: Subclinical hyperthyroidism is defined by a subnormal serum thyroidstimulating hormone (TSH) level with normal free thyroxine (FT4) and free triiodothyronine (FT3) levels. Its prevalence varies from 0.6% to 16% in the elderly and can increase to 20% in patients receiving thyroid hormone replacement therapy. Thyroid disease and/or replacement therapy are frequently associated with cardiovascular involvement. Cases Presentation: We report three clinical cases of patients with initial subclinical hyperthyroidism and cardiological manifestations, including supraventricular and ventricular extrasystoles, prolapse of the mitral valve with severe regurgitation, higher mean heart rate and deterioration of the arrhythmias on arrhythmogenic dysplasia substrate. Conclusion: We discuss the role of appropriate and early correction of thyroid dysfunction in improving cardiological manifestations.

A second course of antithyroid drug therapy is effective in patients with relapsed Graves' disease

2018 ◽  
Author(s):  
Khyatisha Seejore ◽  
Fozia Nawaz ◽  
Katherine Kelleher ◽  
Julie Kyaw-Tun ◽  
Julie Lynch ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Antithyroid Drug ◽  
Graves Disease ◽  
Antithyroid Drug Therapy

scholarly journals Control of Graves’ hyperthyroidism with very long-term methimazole treatment: a clinical trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fereidoun Azizi ◽  
Hengameh Abdi ◽  
Atieh Amouzegar
Keyword(s):  
Low Dose ◽  
Reference Range ◽  
Antithyroid Drug ◽  
Therapeutic Modality ◽  
Thyroid Status ◽  
Antithyroid Drug Therapy ◽  
Daily Dose ◽  
Prevention Of Relapse

Abstract Background Long-term antithyroid drug therapy has become one of the options for treatment of Graves’ hyperthyroidism. The aim of this study was to compare thyroid status in those who discontinued methimazole (MMI) treatment after 12.8 years with those who continued MMI as long as 24 years. Methods Fifty nine patients with Graves’ disease on long-term MMI for 14.2 ± 2.9 years were recruited; 32 patients (54%) decided to discontinue MMI and 27 (46%) preferred additional years of MMI treatment. All patients were followed for a mean of 6 additional years. Results Of 27 patients who continued MMI up to 24 years, suppressed serum thyrotropin (TSH) was not observed in any patient after the seventh year of treatment. Serum free thyroxine, triiodothyronine, TSH and TSH receptor antibody concentrations remained normal up to the length of the study. Mean daily dose of MMI to maintain TSH in the reference range decreased gradually and reached to 2.8 ± 1.7 mg by 24 years of MMI treatment. No adverse reaction related to MMI occured during additional years of therapy. In 32 patients who discontinued MMI, hyperthyroidism relapsed in 6 patients (19%), one left follow-up and 25 (78%) remained euthyroid during the study. Conclusions Long-term low dose MMI treatment may be a lifelong effective and safe therapeutic modality in patients with Graves’ hyperthyroidism for prevention of relapse, if studies from other centers confirm findings of this research. Trial registration IRCT201009224794N1, 2010-10-25. Retrospectively registered. https://www.irct.ir/trial/5143.

Successful Treatment of Graves Disease in Pregnancy with Lugol's Iodine

2000 ◽  
Vol 45 (1) ◽  
pp. 20-21 ◽  
Author(s):  
A. Jamieson ◽  
C.G. Semple
Keyword(s):  
Drug Therapy ◽  
Successful Treatment ◽  
Surgical Intervention ◽  
Antithyroid Drug ◽  
Primary Treatment ◽  
Graves Disease ◽  
Lugol’S Iodine ◽  
Organic Iodine ◽  
Antithyroid Drug Therapy ◽  
In Pregnancy

We report a case of Grave's disease in pregnancy complicated by intolerance of standard antithyroid drug therapy. We describe the success of prolonged use of organic iodine as a primary treatment prior to surgical intervention.

Enzyme-linked immunosorbent assay of autoantibodies reacting with thyroid plasma membrane antigens in sera of patients with autoimmune thyroid diseases

1986 ◽  
Vol 113 (2) ◽  
pp. 255-260 ◽  
Author(s):  
Andrzej Gardas ◽  
Kathleen L. Rives
Keyword(s):  
Plasma Membrane ◽  
Immunosorbent Assay ◽  
Lupus Erythematosus ◽  
Antithyroid Drug ◽  
Cross Reactivity ◽  
Enzyme Linked Immunosorbent Assay ◽  
Autoimmune Thyroid Diseases ◽  
Nodular Goitre ◽  
Membrane Antigens ◽  
Toxic Nodular Goitre

Abstract. A sensitive and specific enzyme-linked immunosorbent assay (ELISA) for the detection of autoantibodies reacting with thyroid plasma membrane antigens has been established. Autoantibodies reacting with thyroid plasma membrane antigens were detected by the ELISA in 95% of untreated hyperthyroid Graves', 68% of antithyroid drug-treated Graves' up to four months of the therapy, in 62% of Hashimoto's thyroiditis and in 8.9% of toxic nodular goitre. The ELISA was negative in 100% healthy blood donors, 100% non-toxic nodular goitre, in 12 patients with rheumatoid arthritis, 18 patients with scleroderma and 94% of patients with systemic lupus erythematosus. The mean value of autoantibodies titre was higher in untreated hyperthyroid Graves' (1:84 000) and lowest in positive patients with autoimmune disease of non-thyroid origin (1:4000). The cross-reactivity of antimicrosomal antigen antibodies was below 10%; there was no influence of antithyroglobulin antibodies on the ELISA; and most of the autoantibodies react with plasma membrane antigens different from the TSH binding sites.

Lithium treatment and thyroid dysfunction – data from an inpatient psychiatric department

2016 ◽  
Vol 33 (S1) ◽  
pp. S545-S545
Author(s):  
M. Lázaro ◽  
A. Mota ◽  
A. Moreira ◽  
R. Alves ◽  
M.A. Nobre
Keyword(s):  
Thyroid Dysfunction ◽  
Lithium Treatment ◽  
Hormone Replacement ◽  
Thyroid Hormone Replacement ◽  
High Prevalence ◽  
Thyroid Hormone Replacement Therapy ◽  
Competing Interest ◽  
Psychiatric Department ◽  
Term Monitoring

IntroductionLithium is among the most effective therapies for bipolar disorder. Lithium treatment may cause hypothyroidism, goiter or to a lesser extent hyperthyroidism, since it can affect several aspects of thyroid functioning. The prevalence of lithium-associated hypothyroidism varies extensively between studies, reaching up to 47%, and affecting more females than males (5:1).ObjectiveDetermine the prevalence of thyroid dysfunction in an acute inpatient psychiatric department dedicated to affective disorders and its association with lithium therapy.AimsTo review the relation between lithium treatment and thyroid dysfunction.MethodsObservational, descriptive and retrospective study with clinical and laboratorial data concerning all inpatient episodes of 2015 in our Psychiatric Department. A non-systematic literature search was performed in PubMed.ResultsThe present study documented a high prevalence of thyroid dysfunction, particularly in women. Most cases were due to either hypothyroidism or subclinical hypothyroidism. Patients treated with lithium were more often under thyroid hormone replacement therapy (levothyroxine).ConclusionsThe evidence that lithium treatment is associated with hypothyroidism is well established and this condition is easily treatable with levothyroxine. This study highlights the importance of baseline screening of thyroid function and regular long-term monitoring in patients treated with lithium.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Erratum

1989 ◽  
Vol 121 (2) ◽  
pp. 304
Author(s):  
H. Schleusener ◽  
J. Schwander ◽  
C. Fischer ◽  
R. Holle ◽  
G. Holl ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Relapse Rate ◽  
Clinical Course ◽  
Antithyroid Drug ◽  
Graves Disease ◽  
Trh Test ◽  
Prospective Multicentre Study ◽  
Antithyroid Drug Therapy ◽  
Significant Difference ◽  
The Individual

Abstract. Graves' disease is an autoimmune disease characterized by a course of remission and relapse. Since the introduction of antithyroid drug treatment, various parameters have been tested for their ability to predict the clinical course of a patient with Graves' disease after drug withdrawal. Nearly all these studies were retrospective and often yielded conflicting results. In a prospective multicentre study with a total of 451 patients, we investigated the significance of a variety of routine laboratory and clinical parameters for predicting a patient's clinical course. Patients who had positive TSH receptor antibodies activity at the end of therapy showed a significantly higher relapse rate than those without (P < 0.001). However, the individual clinical course cannot be predicted exactly (sensitivity 0.49, specificity 0.73, N = 391). The measurement of microsomal (P = 0.99, sensitivity 0.37, specificity 0.63, N = 275) or thyroglobulin antibodies (P = 0.76, sensitivity 0.18, specificity 0.84, N = 304) at the end of antithyroid drug therapy did not show a statistically significant difference in the antibody titre between the patients of the relapse and those of the remission group. Additionally, HLA-DR typing (HLA-DR3: P = 0.37, sensitivity 0.36, specificity 0.58, N = 253) was proven to be unsuitable for predicting a patient's clinical course. Patients with abnormal suppression or an abnormal TRH test at the end of antithyroid drug therapy relapse significantly more often (P< 0.001) than patients with normal suppression or normal TRH test. Patients with a large goitre also have a significantly (P< 0.001) higher relapse rate than those with only a small enlargement. The sensitivity and specificity values of all these parameters, however, were too low to be useful for daily clinical decisions in the treatment of an individual patient. This is also true for the combinations of different parameters. Though the highest sensitivity value (0.94) was found for a combination of the suppression and the TRH test at the end of therapy, the very low specificity value (0.13) for this combination reduced its clinical usefulness.

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