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Paper 2
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Start treatment with thyroxine 25 micrograms/day.Check thyroid peroxidase antibodies.Start carbimazole treatment.Start treatment with thyroxine 50 micrograms/day.Repeat thyroid function tests in 3 months’ time.
The patient with acute endocrine problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Hyperthyroidism results from an excess of thyroid hormones (T3 and T4), with an exaggerated form being a thyroid crisis. A thyroid crisis (or storm) can be triggered by infection, surgery, trauma or any other acute episode (e.g., myocardial infarction, stroke and eclampsia), but fortunately, is very rare. An over-secretion of thyroid hormones will lead to a hypermetabolic state, resulting in hyperpyrexia, tachycardia, hypertension, agitation and tremors. The management is aimed essentially at reducing the effects of these hormones until the patient is stable. Drug therapy will include the use of: Beta-blockers such as metoprolol, to reduce sympathetic activity.Sedatives, such as chlorpromazine or haloperidol.Corticosteroids such as hydrocortisone, to inhibit the conversion of T3 to T4.Carbimazole, a specific anti-thyroid drug, inhibits enzymes that play a role in T3 and T4 production.Iodine is a specific antithyroid therapy used to inhibit thyroxine release and treat some forms of hyperthyroidism.
Benign Thyroid Disease
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Christopher M. Jones, Kristien Boelaert
All patients with hyperthyroidism require specialist referral and patients should be commenced on antithyroid drug treatment while they await further clinical review.65 Carbimazole is available as 5 mg and 20 mg tablets and is usually given in a starting dose of 20–30 mg per day in a single dose. Treatment should usually begin at 30 mg in cases of severe disease (fT3 and fT4 levels more than twice the upper limit of the normal reference range). Propylthiouracil is given in divided doses, with a dose of 200 mg approximately equivalent to 20 mg carbimazole. Patients begin to feel an improvement at 10–14 days and fT4 and fT3 values return to normal levels over 4–6 weeks.
Reactivation of Graves’ Disease and Thyroid Eye Disease following COVID-19 Vaccination – A Case Report
Published in Ocular Immunology and Inflammation, 2023
Chien-Wei Hung, Chih-Heng Hung
A 51-year-old Asian male had a history of well-controlled GD under regular follow-up, treated with carbimazole (10 mg per day) for 10 years, and TED with post bilateral (OU) orbital decompression 7 years ago. Recent thyroid function tests showed stable results. However, two weeks after the administration of the second dose of the BNT162B2 messenger ribonucleic acid (mRNA) (Pfizer-BioNTech) COVID-19 vaccine, he presented symptoms of anxiety, persistent tiredness and weakness. Five weeks after the injection, thyroid function tests showed elevated levels of thyroxine (free T4) (2.30 ng/dL; normal range, 0.93–1.70 ng/dL) and low levels of thyroid-stimulating hormone (TSH) (< 0.01 uIU/mL; normal range, 0.27–4.20 uIU/mL). During the follow-up period, the antithyroid drug was as previously prescribed with carbimazole (10 mg per day). Five months after the second dose of the Pfizer-BioNTech COVID-19 vaccine, he received the booster shot of the mRNA-1273 (Moderna) COVID-19 vaccine. Follow-up thyroid function tests showed worsened free T4 (7.77 ng/dL) and TSH (< 0.01 uIU/mL), and carbimazole (30 mg per day) was prescribed for another 3 months. The patient subsequently experienced hypothyroidism, and the antithyroid drug was halted for one month. After that, thyroid function tests showed elevated free T4 (6.31 ng/dL) and low levels of TSH (< 0.01 uIU/mL). Since then, the patient received carbimazole (10 mg per day), and recent thyroid function tests showed stable results for 2 months. Reactivation of GD lasted for a total duration of 11 months.
Evaluating thyroid function in pregnant women
Published in Critical Reviews in Clinical Laboratory Sciences, 2022
K. Aaron Geno, Robert D. Nerenz
Subclinical Graves’ Disease is not likely worth the risk of treatment when balanced against the harms associated with drugs typically used in treatment. Propylthiouracil is associated with maternal injury and increased risk of birth defects such as preauricular sinuses and hydronephrosis [77,78,82]. Methimazole and carbimazole are associated with agranulocytosis and increased risks of other birth defects (e.g. choanal atresia, aplasia cutis, and omphalocele) [77,78,83,84]. If previously treated with radioactive iodine, patients should be monitored for a year after treatment for increases in TSH receptor antibodies, which are usually greater in concentration after radioactive iodine than other treatments, as they can cross the placenta and stimulate the fetal thyroid [85].
A retrospective study of pediatric thyroid eye disease: the Asian experience
Published in Orbit, 2022
Bryan Sim, Chiaw Ling Chng, Chia Audrey, Lay Leng Seah
Patient A (Figure 1) was a 13 year old Chinese girl, with Graves’ hyperthyroidism (diagnosed in January 2018) on carbimazole treatment, who had inactive mild TED. She had no surgical thyroidectomy or radioactive iodine treatment performed. Ophthalmic examination showed bilateral superior epiblepharon worse on the left with occasional lash corneal touch. Exophthalmometry revealed minimal proptosis with 18 mm in the right eye and 17 mm in the left eye. She also had preexisting myopia with a refractive error of −5DS in the right eye and −2.50DS in the left eye. Extraocular movements were full except for mild abduction deficits bilaterally with a mild elevation deficit in her right eye but she did not experience diplopia (Figure 2). Systemic clinical examination also revealed a diffuse soft non-tender enlarged goiter (Figure 3).