scholarly journals Planning and diagnostic nursing strategy in the clinical management of the patient with hyperthroidism

2022 ◽  
Vol 7 (1) ◽  
pp. 5-9
Author(s):  
Astasio Picado Álvaro
Keyword(s):  
Risk Factors ◽  
Radioactive Iodine ◽  
Antithyroid Drug ◽  
Therapeutic Failure ◽  
Antithyroid Drugs ◽  
Common Disease ◽  
Inclusion Criteria ◽  
Iodine Treatment ◽  
Antithyroid Drug Treatment ◽  
Negative Factors

Hyperthyroidism is a common disease that affects 0.8% of the population in Europe. It occurs when the thyroid gland produces more thyroid hormones than your body needs. There are several types of treatment, such as antithyroid drugs, treatment with radioactive iodine (131I) and finally surgery, in addition to these treatments, reference is made to a good hygienic-dietary orientation. Objective: to assess from the nursing field the safest and most effective type of hyperthyroidism treatment, including the risk factors to take into account when carrying out these. Methodology: systematic searches were carried out in bibliographic sources of trials and articles published between 2015 and 2021. Including studies that contained data on risk factors for hyperthyroidism. Results: of 426 related articles found, 13 met the inclusion criteria. Total thyroidectomy surgery induced a 26% therapeutic failure rate and 95% radioactive iodine treatment compared to the 19.1% therapeutic failure in antithyroid drug treatment. Conclusion: Despite the verification of the efficacy of all existing hyperthyroidism treatments, antithyroid drugs have greater efficacy and safety than the rest of the treatments studied, in relation to the time and rate of remission. On the other hand, risk factors such as tobacco and female sex are evidenced, which are negative factors when carrying out treatment for hyperthyroidism.

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.

scholarly journals Remission Rate of Graves' Disease and the Trend of Changes in Serum TSH Receptor Antibodies in Prolonged Antithyroid Drug Treatment

2020 ◽  
Vol 18 (Suppl) ◽  
Author(s):  
Danilo Villagelin ◽  
Roberto Bernardo Santos ◽  
João Hamilton Romaldini
Keyword(s):  
Drug Treatment ◽  
Remission Rate ◽  
Antithyroid Drug ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Remission Rates ◽  
Thyrotropin Receptor Antibodies ◽  
Antithyroid Drug Treatment ◽  
The Impact ◽  
Receptor Antibodies

Context: Graves’ disease is an autoimmune disease caused by thyrotropin receptor antibodies (TRAb). These antibodies can be measured and used for the diagnosis, prediction of remission, and risk of Graves’ orbitopathy development. There are three treatments for Graves’ disease that have remained unchanged for the last 75 years: Antithyroid drugs, radioiodine, and surgery. Antithyroid drugs are the first treatment option worldwide and are usually used for 12 - 18 months. Recent reports suggest the use of antithyroid drugs for more than 18 months with better outcomes. This review focuses on two aspects of treatment with antithyroid drugs: The impact of using antithyroid drugs for more than 12 - 18 months on remission rates and the trend of TRAb during prolonged antithyroid drug treatment. Evidence Acquisition: A review was performed in Medline on the published work regarding the duration of ATD treatment and remission of Graves' disease and also ATD treatment and TRAb status during the 1990 - 2019 period. Results: Remission rates are variable (30% - 80%), and many clinical and genetic factors serve as predictors. The long-term use of antithyroid drugs appears to increase remission rates. TRAb values usually decline during ATD treatment, but the trend could occur in two ways: Becoming negative or showing a fluctuating pattern. However, approximately 10% of the patients will remain TRAb-positive after five years of treatment with antithyroid drugs. Conclusions: Antithyroid drugs can be used for long periods with an increase in remission rates, and a gradual decrease in TRAb levels, with the disappearance of TRAb in 90% of the patients after 60 months.

Antithyroid drug treatment for thyrotoxicosis

2011 ◽  
pp. 476-481
Author(s):  
Anthony Toft
Keyword(s):  
Adverse Reaction ◽  
Active Metabolite ◽  
Antithyroid Drug ◽  
Good Evidence ◽  
Antithyroid Drugs ◽  
Thyroid Peroxidase ◽  
Immunosuppressive Action ◽  
Antithyroid Drug Treatment ◽  
The Uk

The most effective and commonly used antithyroid drugs are the thionamides, including carbimazole and its active metabolite methimazole (not available in the UK). These act by inhibiting the synthesis of thyroid hormones, principally by interfering with the iodination of tyrosine by serving as preferential substrates for the iodinating intermediate of thyroid peroxidase. Oxidized iodine is thus diverted from potential iodination sites in thyroglobulin. The iodinated antithyroid drugs are desulfurated and further oxidized to inactive metabolites. There is also some evidence for an immunosuppressive action which is of doubtful clinical significance as most patients relapse after drug withdrawal. Another thionamide, propylthiouracil, is, in addition, a potent inhibitor of type 1 outer ring deiodinase and acutely inhibits thyroxine (T4) to triiodothyronine (T3) conversion, but there is no good evidence to suggest that this effect is of any clinical relevance. Propylthiouracil tends to be reserved for those patients who have developed an adverse reaction to carbimazole or methimazole.

INCREASED RISK OF RADIOIODINE TREATMENT FAILURE ASSOCIATED WITH GRAVES DISEASE REFRACTORY TO METHIMAZOLE

2020 ◽  
Vol 26 (11) ◽  
pp. 1312-1319
Author(s):  
Jennifer J. Kwak ◽  
Rola Altoos ◽  
Alexandria Jensen ◽  
Basel Altoos ◽  
Michael T. McDermott
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Potential Risk ◽  
Radioactive Iodine ◽  
Antithyroid Drug ◽  
Graves Disease ◽  
First Line ◽  
Line Therapy ◽  
Potential Risk Factors ◽  
Iodine 131

Objective: Iodine 131 (I-131) radioactive iodine (RAI) therapy has been the preferred treatment for Graves disease in the United States; however, trends show a shift toward antithyroid drug (ATD) therapy as first-line therapy. Consequently, this would favor RAI as second-line therapy, presumably for ATD refractory disease. Outcomes of RAI treatment after first-line ATD therapy are unclear. The purpose of this study was to investigate treatment failure rates and potential risk factors for treatment failure, including ATD use prior to RAI treatment. Methods: A retrospective case control study of Graves disease patients (n = 200) after I-131 RAI therapy was conducted. Treatment failure was defined as recurrence or persistence of hyperthyroidism in the follow-up time after therapy (mean 2.3 years). Multivariable regression models were used to evaluate potential risk factors associated with treatment failure. Results: RAI treatment failure rate was 16.5%. A majority of patients (70.5%) used ATD prior to RAI therapy, predominantly methimazole (MMI) (91.9%), and approximately two-thirds of patients used MMI for >3 months prior to RAI therapy. Use of ATD prior to RAI therapy ( P = .003) and higher 6-hour I-123 thyroid uptake prior to I-131 RAI therapy ( P<.001) were associated with treatment failure. MMI use >3 months was also associated with treatment failure ( P = .002). Conclusion: More patients may be presenting for RAI therapy after failing first-line ATD therapy. MMI use >3 months was associated with RAI treatment failure. Further studies are needed to investigate the association between long-term first-line ATD use and RAI treatment failure. Abbreviations: ATD = antithyroid drug; BMI = body mass index; EMR = electronic medical record; I-123 = iodine 123; I-131 = iodine 131; MMI = methimazole; PTU = propylthiouracil; RAI = radioactive iodine; TRAb = TSH receptor antibody; TSH = thyroid-stimulating hormone

scholarly journals Assessment of Factors Affecting the Treatment Efficacy of Radioactive Iodine (I-131) Therapy in Patients with Hyperthyroidism

2021 ◽  
Author(s):  
Ferhat Arık ◽  
Ferhat Gökay ◽  
Bade Erturk Arık
Keyword(s):  
Treatment Efficacy ◽  
Radioactive Iodine ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Multinodular Goitre ◽  
Toxic Adenoma ◽  
Adequate Treatment ◽  
Efficient Treatment ◽  
Factors Affecting ◽  
Iodine Treatment

Objective: Hyperthyroidism is an increase in hormone production in the thyroid gland and the exposure of tissues to the hormones of the thyroid glands in the circulation. The most common causes encountered are Graves’ Disease, Toxic Multinodular Goiter and Toxic Adenoma. The purpose of radioactive iodine treatment is to make patients become euthyroid or hypothyroid. Despite adequate treatment, hyperthyroidism persists or reccurs in some patients. The aim of our study is to investigate the factors affecting the efficacy of radioactive iodine treatment in hyperthyroidism. Methods: In this retrospective study, relevant clinical and laboratory data were recorded in database of Kayseri Training and Research Hospital, Endocrinology and Metabolism Diseases Outpatient Unit between 2013-2016. Results: A total of 79 cases including 17 (21%) male, and 62 (79%) female patients were enrolled in the study. There were 33 (42%) Graves’ disease 9 (11%) Toxic Multinodular Goitre and 37 (47%) Toxic Adenoma patients when grouped according to diagnoses. Mean age was 56.5 ± 16,80. Development of hypothyroidism or euthyroidism were accepted as efficient treatment, hyperthyroidism or recurrence were considered as treatment failure. In 71 (89%) patients, treatment efficiently resulted in hypothyroidism or euthyroidism, whereas in 8 (11%) patients, the treatment failed due to recurrence or persistent disease. Treatment was 100 % effective in Toxic Multinodular Goitre and Toxic Adenoma groups, while it was effective in 75.7 of patients with Graves’ Disease. Patients who did not use antithyroid drugs recovered faster than patients who did. Conclusion: Radioactive iodine therapy is an efficient treatment in patients with hyperthyroidism. It was determined that 1 mm increase in nodule size decreased the treatment efficacy by 1.07 times (p<0,05). However, there are many factors that affect the efficacy of this treatment. To elucidate these factors and improve clinical practice, prospective long-term studies providing more reliable data with larger samples needed.

scholarly journals The Efficacy and Short- and Long-Term Side Effects of Radioactive Iodine Treatment in Pediatric Graves’ Disease: A Systematic Review

2021 ◽  
pp. 1-11
Author(s):  
Sarah L. Lutterman ◽  
Nitash Zwaveling-Soonawala ◽  
Hein J. Verberne ◽  
Frederik A. Verburg ◽  
A.S. Paul van Trotsenburg ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Radioactive Iodine ◽  
Definitive Treatment ◽  
Antithyroid Drugs ◽  
Dosing Regimen ◽  
The Past ◽  
Short And Long Term ◽  
Iodine Treatment

<b><i>Background:</i></b> Graves’s disease (GD) is the most common cause of hyperthyroidism. Maximal 30% of pediatric GD patients achieve remission with antithyroid drugs. The majority of patients therefore require definitive treatment. Both thyroidectomy and radioactive iodine (RAI) are often used as definitive treatment for GD. However, data on efficacy and short- and long-term side effects of RAI treatment for pediatric GD are relatively scarce. <b><i>Methods:</i></b> A systematic review of the literature (PubMed and Embase) was performed to identify studies reporting the efficacy or short- and long-term side effects of RAI treatment in pediatric GD. <b><i>Results:</i></b> Twenty-three studies evaluating 1,283 children and adolescents treated with RAI for GD were included. The treatment goal of RAI treatment changed over time, from trying to achieve euthyroidism in the past to aiming at complete thyroid destruction and subsequent hypothyroidism in the last 3 decades. The reported efficacy of a first RAI treatment when aiming at hypothyroidism ranged from 42.8 to 97.5%, depending on the activity administered. The efficacy seems to increase with higher RAI activities. When aiming at hypothyroidism, both short- and long-term side effects of treatment are very rare. Long-term side effects were mainly seen in patients in whom treatment aimed at achieving euthyroidism. <b><i>Conclusion:</i></b> RAI is a safe definitive treatment option for pediatric GD when aiming at complete thyroid destruction. When aiming at hypothyroidism, the efficacy of treatment seems to increase with a higher RAI activity. Prospective studies are needed to determine the optimal RAI dosing regimen in pediatric GD.

scholarly journals Treatment of Grave’s Disease in Adults

2021 ◽  
Author(s):  
Mauricio Alvarez Andrade ◽  
Lorena Pabón Duarte
Keyword(s):  
Autoimmune Disease ◽  
Lower Risk ◽  
Radioactive Iodine ◽  
Antithyroid Drug ◽  
Poor Response ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Radioactive Iodine Therapy ◽  
Common Cause ◽  
Multiple Factors

Graves disease is an autoimmune disease, with a genetic susceptibility, activated by environmental factors like stress, iodine excess, infections, pregnancy and smoking. It is caused by thyroid stimulating immunoglobulin (TSI) or thyroid stimulating antibody (TSAb) and is the most common cause of hyperthyroidism with an incidence of 21 per 100,000 per year. Treatment of Graves disease includes antithyroid drugs such as methimazole and propylthiouracil, radioactive iodine therapy and thyroidectomy. Methimazole, an antithyroid drug that belongs to the thioamides class, is usually the first line of treatment due to lower risk of hepatotoxicity compared to propylthiouracil. Radioactive iodine therapy is reserved for those patients who do not respond to antithyroid drugs or have contraindication or adverse effects generated by antithyroid drugs, and thyroid surgery is an option in people with thyroid nodular disease with suspected malignancy or large goiters such as predictors of poor response to antithyroid drugs and radioactive iodine therapy. Multiple factors influence the management of patients with Graves disease including patient and physician preferences, access to medical services and patients features such as age, complications and comorbidities.

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