scholarly journals Treatment of juvenile Graves' disease and its ophthalmic complication: the 'European way'

2004 ◽  
pp. 407-414 ◽  
Author(s):  
GE Krassas
Keyword(s):  
Thyroid Cancer ◽  
Young Children ◽  
Treatment Modalities ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Older Children ◽  
Medical Centers ◽  
The Usa ◽  
Ophthalmic Complication ◽  
Almost All

Three treatment modalities are available for Graves' disease: antithyroid drugs, surgery and radioactive iodine (RAI). None has been shown to be ideal or superior to the others. There are wide differences between individual physicians and between the physicians in different countries on the optional treatment for childhood hyperthyroidism. While antithyroid drugs remain the initial treatment of choice in almost all the medical centers in Europe, with surgery being used mainly to deal with antithyroid failures, radioiodine is preferred by only a small percentage of physicians for this group of patients. In the USA, on the contrary, radioiodine treatment of thyrotoxicosis in children has strong advocates, who emphasize the safety, simplicity and economic advantages of iodine-131 ablation, which should be considered more commonly in children. Until now, the available data have shown no significant increase in thyroid neoplasia, gonadal injury or congenital abnormalities in the offspring of older children and adults receiving RAI for thyrotoxicosis. Given the considerable increase in the risk of thyroid cancer in young children exposed to external radiation, it has been hypothesized that there may be a small increase in the risk of thyroid cancer in young children treated with RAI. Until long-term data on safety are available, specifically for young children, differences between the physicians in different countries will remain.

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.

Management of Graves’ hyperthyroidism

2011 ◽  
pp. 489-494
Author(s):  
Jacques Orgiazzi ◽  
Claire Bournaud
Keyword(s):  
Treatment Strategy ◽  
Multidisciplinary Approach ◽  
Symptomatic Treatment ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Therapeutic Approaches ◽  
Severity Of The Disease ◽  
Selection Of

The treatment strategy for the hyperthyroidism of Graves’ disease remains a matter of controversy for several reasons. Treatment modalities available so far are symptomatic rather than pathophysiological, patients are heterogeneous in the severity and prognosis of the disease, and, in many patients, the disease is lifelong. Even symptomatic treatment should be adapted to the severity of the disease, both in terms of intensity of hyperthyroidism and degree of immunological derangement, an elusive goal so far. Current treatment modalities are medical/conservative with antithyroid drugs, often marred by relapse, and radical/destructive with radio-iodine or surgery with subsequent hypothyroidism. Being controversial, the selection of the treatment strategy also requires the patient’s informed cooperation. Finally, another peculiarity of the management of Graves’ disease is the frequent requirement of a multidisciplinary approach. This chapter will discuss general and specific therapeutic approaches of hyperthyroid Graves’ disease.

Surgery for thyrotoxicosis

2011 ◽  
pp. 484-489
Author(s):  
Mauricio Moreno ◽  
Nancy D. Perrier ◽  
Orlo Clark
Keyword(s):  
Radioactive Iodine ◽  
Critical Role ◽  
Antithyroid Drug ◽  
Thyroid Storm ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Cardiac Morbidity ◽  
The Usa ◽  
Antithyroid Drug Treatment ◽  
Needle Aspiration Cytology

Surgical intervention plays a critical role in the management of thyrotoxicosis. Despite this, radioactive iodine is still the most popular treatment modality in the USA. Thyrotoxicosis, the condition of hyperthyroidism, is due to the increased secretion of thyroid hormone, and may be caused by toxic solitary nodules, toxic multinodular goitre (Plummer’s disease), or diffuse toxic goitre (Graves’ disease). Graves’ disease is the condition of goitre and associated clinical features of tachycardia and bulging eyes described by Dr Robert James Graves (1797–1853) in 1835 (1). Understanding the pathophysiology of the condition of thyrotoxicosis is essential in the appropriate selection of surgical candidates and planning the most suitable technique. Generally, accepted indications for thyroidectomy for thyrotoxicosis include: suspicion of malignancy by physical examination (firmness, irregularity, or attachment to local structures) or by fine-needle aspiration cytology of nodules; pregnancy; women desiring pregnancy within 6–12 months of treatment; lactation; medical necessity for rapid control of symptoms (patients with cardiac morbidity); local compression (pain, dysphagia); recurrence after antithyroid drug treatment; fear of radioactive iodine treatment; resistance to 131I or antithyroid drugs; or thyroid storm unresponsive to medical therapy. Other more relative indications for thyroidectomy also include: large goitres greater than 100 g that are less likely to respond to radioactive treatment and require a large treatment dose of 131I; severe Graves’ ophthalmopathy; poor compliance with antithyroid drugs; children and adolescents; a large, bothersome, and unsightly goitre; amiodarone-induced thyrotoxicosis, in cases when medical treatment is ineffective and amiodarone is necessary to treat cardiac disease; or hypersensitivity to iodine.

Thyroiditis, Goiter, Thyroid Nodules, and Thyroid Cancer

2020 ◽  
Author(s):  
Paul W. Ladenson
Keyword(s):  
Differential Diagnosis ◽  
Thyroid Cancer ◽  
Celiac Disease ◽  
Thyroid Nodules ◽  
Graves Disease ◽  
Thyroid Disorders ◽  
Munchausen Syndrome ◽  
Life Threatening ◽  
Almost All ◽  
Key Words Hypothyroidism

Thyroid disorders are the most common endocrine conditions encountered in clinical practice. Persons of either sex and any age can be affected, although almost all forms of thyroid disease are more frequent in women than in men, and many thyroid ailments increase in incidence with age. The presentation of thyroid conditions can range from clinically obvious to clinically silent. Their consequences can be widespread and serious, even life-threatening. With proper testing, the diagnosis and differential diagnosis can be established with certainty, and effective treatments can be instituted for almost all patients. This review contains 1 figure, 7 tables, and 31 references. Key Words: Hypothyroidism, Thyrotoxicosis, Thyrotropin, celiac disease, vitiligo, pernicious anemia, Sjögren syndrome, Graves disease, Munchausen syndrome

Thyroiditis, Goiter, Thyroid Nodules, and Thyroid Cancer

2020 ◽  
Author(s):  
Paul W. Ladenson
Keyword(s):  
Differential Diagnosis ◽  
Thyroid Cancer ◽  
Celiac Disease ◽  
Thyroid Nodules ◽  
Graves Disease ◽  
Thyroid Disorders ◽  
Munchausen Syndrome ◽  
Life Threatening ◽  
Almost All ◽  
Key Words Hypothyroidism

Thyroid disorders are the most common endocrine conditions encountered in clinical practice. Persons of either sex and any age can be affected, although almost all forms of thyroid disease are more frequent in women than in men, and many thyroid ailments increase in incidence with age. The presentation of thyroid conditions can range from clinically obvious to clinically silent. Their consequences can be widespread and serious, even life-threatening. With proper testing, the diagnosis and differential diagnosis can be established with certainty, and effective treatments can be instituted for almost all patients. This review contains 1 figure, 7 tables, and 31 references. Key Words: Hypothyroidism, Thyrotoxicosis, Thyrotropin, celiac disease, vitiligo, pernicious anemia, Sjögren syndrome, Graves disease, Munchausen syndrome

Orofacial myofunctional therapy with children ages 0-4 and individuals with special needs

2020 ◽  
Vol 46 (1) ◽  
pp. 22-36
Author(s):  
Robyn Merkel-Walsh
Keyword(s):  
Social Media ◽  
Young Children ◽  
Special Needs ◽  
Cognitive Status ◽  
Treatment Modalities ◽  
Children With Special Needs ◽  
Clinical Expertise ◽  
Older Children ◽  
Self Monitoring ◽  
Myofunctional Therapy

Purpose: The purposes of this paper are to 1) define variations in terminology and treatment methodology for orofacial myofunctional disorders (OMDs) in children 0-4 years of age and in special populations, and 2) compare and contrast service delivery models for children ages 0-4 and individuals with special needs versus older children and children who are neurotypical. Method: A literature review of scholarly articles, professional presentations, poster presentations, blogs, and social media were analyzed using three tiers of evidence-based practice to include: 1) clinical expertise/expert opinion; 2) external and internal evidence and 3) client/patient/caregiver perspectives. Results: Professional texts and publications used consistent language when discussing treatment of OMDs in young children and children with special needs. Terminology and treatment approaches for young children and/or children with special needs who present with OMDs were inconsistent in social media and professional presentations. Discussion: The treatment modalities used in orofacial myofunctional therapy to stimulate oral motor responses depend upon age and cognitive status. OMDs should certainly be treated in infants, young children and individuals with special needs according to the methods of the pediatric feeding specialist. Orofacial myofunctional therapy requires volitional control and self-monitoring; as such, it is contraindicated for infants and toddlers as well as those individuals who cannot actively engage in therapeutic techniques.

scholarly journals Epidemiologic patterns of human Salmonella serotype diversity in the USA, 1996–2016

2019 ◽  
Vol 147 ◽  
Author(s):  
M. C. Judd ◽  
R. M. Hoekstra ◽  
B. E. Mahon ◽  
P. I. Fields ◽  
K. K. Wong
Keyword(s):  
Older Adults ◽  
Young Children ◽  
Human Populations ◽  
Source Attribution ◽  
Older Children ◽  
Seasonal Characteristics ◽  
The Usa ◽  
Common Serotypes ◽  
Salmonella Serotype ◽  
Transmission Pathways

AbstractAlthough researchers have described numerous risk factors for salmonellosis and for infection with specific common serotypes, the drivers of Salmonella serotype diversity among human populations remain poorly understood. In this retrospective observational study, we partition records of serotyped non-typhoidal Salmonella isolates from human clinical specimens reported to CDC national surveillance by demographic, geographic and seasonal characteristics and adapt sample-based rarefaction methods from the field of community ecology to study how Salmonella serotype diversity varied within and among these populations in the USA during 1996–2016. We observed substantially higher serotype richness in children <2 years old than in older children and adults and steadily increasing richness with age among older adults. Whereas seasonal and regional variation in serotype diversity was highest among infants and young children, variation by specimen source was highest in adults. Our findings suggest that the risk for infection from uncommon serotypes is associated with host and environmental factors, particularly among infants, young children and older adults. These populations may have a higher proportion of illness acquired through environmental transmission pathways than published source attribution models estimate.

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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