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.

scholarly journals Factors Affecting and Outcome of Radioactive Iodine Therapy in Hyperthyroidism: A study at Institute of Nuclear Medicine & Allied Sciences (INMAS), Sylhet

2018 ◽  
Vol 19 (1) ◽  
pp. 19-23
Author(s):  
Kamrun Nahar ◽  
Papia Akhter
Keyword(s):  
Radioactive Iodine ◽  
Antithyroid Drug ◽  
Nodular Goiter ◽  
Fixed Dose ◽  
Graves Disease ◽  
Radioactive Iodine Therapy ◽  
Cure Rate ◽  
Toxic Adenoma ◽  
Significant Difference ◽  
One Year

Objective: Radioactive iodine therapy (RIT) is the most commonly used modality to treat hyperthyroidism and is indeed in most cases, the treatment of choice. The aim of this study was to assess the clinical outcome one year after radioactive Iodine-131 (RAI -131) therapy and to identify the factors associated with response of the therapy.Patients and Methods: A total 107 hyperthyroid patients were included in this study. All patients were pre-treated with anti-thyroid drugs (ATD). A fixed dose of 8 mCi of radioiodine was given to the patients with Graves’ disease, 12 mCi to patients with single toxic adenoma and 15 mCi to patients with toxic multi-nodular goiter . The patients were done serum FT4 initially and followed up with serum T3, T4, and TSH at three months , six months and one year of RAI therapy . The clinically and biochemically euthyroid and hypothyroid patients were considered as cure of the disease.Results : The cure rate was about 94.7% seen in female patients and 93.8% in male ( P=0.92), 93.6% in younger age group (below 40 years) and 95.0% of the older patients ( P=1.51), 95.5% of the patients who were taking ATD for more than one year and 92.7% of the patients who were taking ATD for less than one year before therapy( P=1.95), 95.4 % of the patients who had initial FT4 level less than 35 pmol/L and 92.7 % of the patients who had high initial FT4 ( P=1.54). Cure rate of Graves’ disease was 45/53 (92.5%), multi-nodular goiter 41/43 (95.3% ) and for single toxic adenoma was 11/11 (100% ) (P= 0.65). The incidence of radioiodine induced hypothyroidism was 6.5 % at three months, 13.1 % at six months and 15.0 % at one year. Overall incidence of cure rate of RAI therapy after one year was 101 (94.4 %).Conclusion: No statistically significant difference was found in the cure rate when sex, age, duration of pretreatment with antithyroid drug, initial FT4 level and cause of hyperthyroidism were considered.   From this study it can be concluded that cure rate of RAI therapy is quite good and the pretreatment factors have little influence on the final outcome.Bangladesh J. Nuclear Med. 19(1): 19-23, January 2016

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.

Abstract #1116 Radioactive Iodine Therapy for Graves Disease: What Predicts Failure?

2018 ◽  
Vol 24 ◽  
pp. 281-282
Author(s):  
Kalyani Regeti ◽  
Rajinikanth Yatavelli ◽  
Harsha Karanchi ◽  
Binod Pokhrel
Keyword(s):  
Radioactive Iodine ◽  
Graves Disease ◽  
Radioactive Iodine Therapy

Hyperparathyroidism subsequent to radioactive iodine therapy for Graves' disease

Head & Neck ◽  
2021 ◽  
Author(s):  
Richard H. Law ◽  
Daniel L. Quan ◽  
Andrew J. Stefan ◽  
Edward L. Peterson ◽  
Michael C. Singer
Keyword(s):  
Radioactive Iodine ◽  
Graves Disease ◽  
Radioactive Iodine Therapy

Effects of high and low doses of methimazole in patients with Graves' thyrotoxicosis

1987 ◽  
Vol 116 (1_Suppl) ◽  
pp. S312-S317 ◽  
Author(s):  
G. Benker ◽  
D. Reinwein ◽  
H. Creutzig ◽  
H. Hirche ◽  
W. D. Alexander ◽  
...  
Keyword(s):  
Antithyroid Drug ◽  
Drug Dosage ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Duration Of Treatment ◽  
Disease Heterogeneity ◽  
Remission Rates ◽  
Set Up ◽  
The Many ◽  
The Impact

Abstract. In spite of the long-established use of antithyroid drugs, there are many unsettled questions connected with this treatment of Graves' disease. There is a lack of controlled prospective trials studying the results of antithyroid drug therapy while considering the many variables such as disease heterogeneity, regional differences, drug dosage and duration of treatment. Therefore, a multicenter study has been set up in order to compare the effects of two fixed doses of methimazole (10 vs 40 mg) with thyroid hormone supplementation on the clinical, biochemical and immunological course of Graves' disease and on remission rates. Experience accumulated so far suggests that treatment is safe using either 10 or 40 mg of methimazole. While there is a tendency for an advantage of the higher dose within the first weeks (higher effectiveness in controlling hyperthyroidism), this difference is not significant. The impact of dosage on remission rates remains to be shown.

scholarly journals Anaplastic Thyroid Carcinoma Following Radioactive Iodine Therapy for Graves' Disease

2013 ◽  
Vol 28 (1) ◽  
pp. 61 ◽  
Author(s):  
Sun Hwa Kim ◽  
Hee Young Kim ◽  
Kwang Yoon Jung ◽  
Dong Seop Choi ◽  
Sin Gon Kim
Keyword(s):  
Thyroid Carcinoma ◽  
Radioactive Iodine ◽  
Anaplastic Thyroid Carcinoma ◽  
Graves Disease ◽  
Radioactive Iodine Therapy
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