Comparison of long‐term antithyroid drugs versus radioactive iodine or surgery for Graves' disease: A review of the literature

2020 ◽  
Author(s):  
Omar M. El Kawkgi ◽  
Douglas S. Ross ◽  
Marius N. Stan
Keyword(s):  
Radioactive Iodine ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Review Of The Literature

Surgical treatment of diffuse toxic goiter in children. A review of the literature

2013 ◽  
Vol 4 (4) ◽  
pp. 69-76
Author(s):  
Alexander Vadimovich Gostimsky ◽  
Sergey Sergeevich Peredereev
Keyword(s):  
Surgical Treatment ◽  
Radioactive Iodine ◽  
Term Treatment ◽  
Graves Disease ◽  
Radioactive Iodine Therapy ◽  
Review Of The Literature ◽  
Large Size ◽  
Long Term Treatment ◽  
Toxic Goiter

Diffuse toxic goiter (DTG) is an autoimmune disease, to which there is a genetic predisposition. In children DTG is less common than in adults. Manifestation of graves‘ disease in childhood has a number of peculiarities. During the DTG in children is usually manifested thyrotoxicosis, requiring long-term treatment to achieve euthyroid, tendency to relapse and more frequently than adults, accompanied by ophthalmopathy and the large size of goiter. Diagnosis of graves‘ disease is based on the clinical picture of thyrotoxicosis, the existence of which is confirmed by the level of thyroid hormones and TSH in the blood. There are three types of treatment of patients DTG: medical, radioactive iodine therapy and surgery. There is no а single glance at the choice of the volume of operations in children.

scholarly journals Clinical experience with radioactive iodine in the treatment of childhood and adolescent Graves' disease

2013 ◽  
Vol 2 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Adriano N Cury ◽  
Verônica T Meira ◽  
Osmar Monte ◽  
Marília Marone ◽  
Nilza M Scalissi ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Medical Records ◽  
Radioactive Iodine ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Age Group ◽  
Large Goiter ◽  
Definitive Therapy

Background/aims Treatments for Graves' disease (GD) in children and adolescents include oral antithyroid drugs (ATDs), near total thyroidectomy, and radioactive iodine (RAI). ATDs remain the preferred choice in this age group, but because persistent remission occurs in 30% of cases, RAI is becoming a common option for definitive therapy. Methods We performed a review of 65 medical records of GD patients under age 19 years who were followed between 1985 and 2005. Results The prevalence of GD was higher in females (3:1) and during puberty (for both genders). If no remission was detected during ATD treatment, RAI was indicated when the following criteria were present: non-compliance, relapse, or side effects that were related to ATDs, large goiter, and long-term use of ATDs. The majority of patients developed hypothyroidism within 6 months after RAI. A progressive higher dose regimen was implemented in the last 10 years of the study period. A second RAI dose was necessary in eight cases. During the follow-up period, three pregnancies occurred. One patient with a thyroid nodule and benign cytology was detected. Conclusions RAI therapy is effective and safe in the treatment of GD in children and adolescents.

scholarly journals Evaluating the Efficacy of Primary Treatment for Graves’ Disease Complicated by Thyrotoxic Periodic Paralysis

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Rita Yuk-Kwan Chang ◽  
Brian Hung-Hin Lang ◽  
Ai Chen Chan ◽  
Kai Pun Wong
Keyword(s):  
Radioactive Iodine ◽  
Primary Treatment ◽  
Periodic Paralysis ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Thyrotoxic Periodic Paralysis ◽  
Term Efficacy ◽  
Life Threatening ◽  
Life Threatening Complication

Objective. Thyrotoxic periodic paralysis (TPP) is a potentially life-threatening complication of Graves’ disease (GD). The present study compared the long-term efficacy of antithyroid drugs (ATD), radioactive iodine (RAI), and surgery in GD/TPP.Methods. Sixteen patients with GD/TPP were followed over a 14-year period. ATD was generally prescribed upfront for 12–18 months before RAI or surgery was considered. Outcomes such as thyrotoxic or TPP relapses were compared between the three modalities.Results. Eight (50.0%) patients had ATD alone, 4 (25.0%) had RAI, and 4 (25.0%) had surgery as primary treatment. Despite being able to withdraw ATD in all 8 patients for 37.5 (22–247) months, all subsequently developed thyrotoxic relapses and 4 (50.0%) had ≥1 TPP relapses. Of the four patients who had RAI, two (50%) developed thyrotoxic relapse after 12 and 29 months, respectively, and two (50.0%) became hypothyroid. The median required RAI dose to render hypothyroidism was 550 (350–700) MBq. Of the 4 patients who underwent surgery, none developed relapses but all became hypothyroid.Conclusion. To minimize future relapses, more definitive primary treatment such as RAI or surgery is preferred over ATD alone. If RAI is chosen over surgery, a higher dose (>550 MBq) is recommended.

Factitious thyrotoxicosis: how to find it

Diagnosis ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. 141-145
Author(s):  
Pakaworn Vorasart ◽  
Chutintorn Sriphrapradang
Keyword(s):  
Radioactive Iodine ◽  
Graves Disease ◽  
Case Presentation ◽  
Thyroglobulin Antibodies ◽  
Definitive Therapy ◽  
Thyroid Uptake ◽  
Thyroid Hormone Levels ◽  
Difficult Challenge

AbstractBackgroundAlthough the most common cause of thyrotoxicosis is Graves’ disease, the determination of the cause of thyrotoxicosis is important for establishing appropriate management. Diagnosis of surreptitious ingestion of thyroid hormones or factitious thyrotoxicosis often presents a difficult challenge especially in a patient with previously diagnosed Graves’ disease. The objective of this report was to demonstrate various approaches to support the diagnosis of factitious thyrotoxicosis.Case presentationWe describe a patient with underlying Graves’ disease who underwent definitive therapy and needed long-term levothyroxine (LT4) replacement therapy. Later she developed thyrotoxicosis. Although factitious thyrotoxicosis was suspected because of very low thyroid uptake and low thyroglobulin (Tg) levels with the absence of thyroglobulin antibodies (TgAbs), she still refused any medication or substance use. After the administration of bile acid sequestrant, the thyroid hormone levels rapidly returned to normal within 1 month.ConclusionsThe diagnosis of factitious thyrotoxicosis is based upon the absence of goiter, suppressed serum Tg level, decreased radioactive iodine (RAI) uptake, and excellent response after cholestyramine treatment.

Outcomes analysis of radioactive iodine and total thyroidectomy for pediatric Graves’ disease

2016 ◽  
Vol 29 (3) ◽  
Author(s):  
Reuven Zev Cohen ◽  
Eric I. Felner ◽  
Kurt F. Heiss ◽  
J. Bradley Wyly ◽  
Andrew B. Muir
Keyword(s):  
Children And Adolescents ◽  
Total Thyroidectomy ◽  
Relapse Rate ◽  
Radioactive Iodine ◽  
High Volume ◽  
Graves Disease ◽  
Complication Rates ◽  
Case Volume ◽  
Definitive Therapy

AbstractThe majority of pediatric patients with Graves’ disease will ultimately require definitive therapy in the form of radioactive iodine (RAI) ablation or thyroidectomy. There are few studies that directly compare the efficacy and complication rates between RAI and thyroidectomy. We compared the relapse rate as well as the acute and long-term complications of RAI and total thyroidectomy among children and adolescents with Graves’ disease treated at our center.Medical records from 81 children and adolescents with a diagnosis of Graves’ disease who received definitive therapy over a 12-year period were reviewed.Fifty one patients received RAI and 30 patients underwent thyroidectomy. The relapse rate was not significantly different between RAI and thyroidectomy (12.1% vs. 0.0%, p=0.28). There were no acute or long-term complications in the RAI group, but there were eight cases of hypoparathyroidism (two transient and six permanent) in the thyroidectomy group. None of the patients developed a recurrent laryngeal nerve injury.RAI is a safe and effective option for treatment of children and adolescents with Graves’ disease. In light of the rate of permanent hypoparathyroidism seen at our center with thyroidectomy and previously published long-term safety of RAI, we recommend RAI as the first line treatment for children and adolescents with Graves’ disease. For those centers performing thyroidectomies, we recommend that each center select 1–2 high-volume pediatric surgeons to perform all thyroid procedures, allowing individuals to increases case volume and potentially decrease long-term complications of thyroidectomy.

Radioactive Iodine, Surgery or Antithyroid Drugs in Treatment of Graves' Disease

1958 ◽  
Vol 23 (1) ◽  
pp. 78-86 ◽  
Author(s):  
F. Raymond Keating ◽  
Howard A. Patterson ◽  
Willard P. Vanderlaan
Keyword(s):  
Radioactive Iodine ◽  
Antithyroid Drugs ◽  
Graves Disease

Diagnosis and Treatment of Graves Disease

2003 ◽  
Vol 37 (7-8) ◽  
pp. 1100-1109 ◽  
Author(s):  
Darcie D Streetman ◽  
Ujjaini Khanderia
Keyword(s):  
Thyroid Gland ◽  
Radioactive Iodine ◽  
Radioiodine Therapy ◽  
Patient Adherence ◽  
Treatment Options ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Extensive Experience ◽  
Long Term Treatment ◽  
Β Blockers

OBJECTIVE: To review the etiology, diagnosis, and clinical presentation of Graves disease and provide an overview of the standard and adjunctive treatments. Specifically, antithyroid drugs, β-blockers, inorganic iodide, lithium, and radioactive iodine are discussed, focusing on current controversies. DATA SOURCES: Primary articles were identified through a MEDLINE search (1966–July 2000). Key word searches included β-blockers, Graves disease, inorganic iodide, lithium, methimazole, and propylthiouracil. Additional articles from these sources and endocrinology textbooks were also identified. We agreed to include articles that would highlight the most relevant points, as well as current areas of controversy. DATA SYNTHESIS: Graves disease is the most common cause of hyperthyroidism. The 3 main treatment options for patients with Graves hyperthyroidism include antithyroid drugs, radioactive iodine, and surgery. Although the antithyroid drugs propylthiouracil (PTU) and methimazole (MMI) have similar efficacy, there are situations when 1 agent is preferred. MMI has a longer half-life than PTU, allowing once-daily dosing that can improve patient adherence to treatment. PTU has historically been the drug of choice for treating pregnant and breast-feeding women because of its limited transfer into the placenta and breast milk. Adjuvant therapies for Graves disease include β-blockers, inorganic iodide, and lithium. β-Blockers are used to decrease the symptoms of hyperthyroidism. Inorganic iodide is primarily used to prepare patients for thyroid surgery because of its ability to decrease the vascularity of the thyroid gland. Lithium, which acts in a manner similar to iodine, is not routinely used due to its transient effect and the risk of potentially serious adverse effects. In the US, radioiodine therapy has become the preferred treatment for adults with Graves disease. It is easy to administer, safe, effective, and more affordable than long-term treatment with antithyroid drugs. Hypothyroidism is an inevitable consequence of radioiodine therapy. Radioiodine is contraindicated in pregnant women because it can damage the fetal thyroid gland, resulting in fetal hypothyroidism. Bilateral subtotal thyroidectomy, which was once the only treatment available, is now performed only in special circumstances. In addition to the normal risks associated with surgery, laryngeal nerve damage, hypoparathyroidism, and hypothyroidism can occur following that procedure. CONCLUSIONS: Despite extensive experience with medical management, controversy prevails regarding choosing among the various drugs for treatment of Graves disease. None of the treatment options, including antithyroid drugs, radioiodine, and surgery, is ideal. Each has risks and benefits, and selection should be tailored to the individual patient.

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