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Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Methimazole (a thioamide) and carbimazole (a thioamide metabolized to methimazole) are not recommended drugs for first-line use during pregnancy. These medications may be considered if other medications (i.e., PTU) do not provide control the condition. The antithyroid action of methimazole and carbimazole block synthesis but not the release of thyroid hormone.
Hyperthyroidism
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Breastfeeding and use of ATDsBoth PTU and methimazole are minimally secreted into breast milkRecommended maximum dose of PTU is 250–300 mg/dayRecommended maximum dose of methimazole is 20 mg/dayAt these doses, a risk to the thyroid of a breastfed infant is considered negligible27
Thyroidectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Grave's disease causes hyperthyroidism when autoantibodies stimulate the TSH receptor on thyroid follicular cells resulting in increased vascularity, follicular hyperplasia, and increased synthesis and secretion of thyroid hormone. Grave's disease is the most common cause of hyperthyroidism in children, but it occurs rarely, in about 1 in 100 000 children. Medical treatment with methimazole and beta blockers provides initial treatment. If ineffective, radioactive iodine ablation or, preferably in children, a total thyroidectomy is required.
Mechanical circulatory support for thyrotoxicosis-induced cardiomyopathy
Published in Baylor University Medical Center Proceedings, 2023
Nikita Dhir, Travis Haneke, Timothy Mixon
A 55-year-old man with known hyperthyroidism, depression, and asthma presented to the emergency department with shortness of breath and weakness. He had been noncompliant with his methimazole due to lack of insurance and failure to follow-up. Initially he was afebrile, with a heart rate of 140 beats/min and blood pressure of 141/115 mm Hg. Laboratory results were significant for a brain natriuretic peptide of 1164 pg/mL (reference <100 pg/mL); troponin, 0.04 ng/mL (0.00–0.09 ng/mL); free T3, 6.4 nmol/L (1.6–3.9 nmol/L); and free thyroxine, 1.65 ng/dL (0.76–1.46 ng/dL). Electrocardiogram showed atrial flutter with 2:1 conduction. Imaging showed small bilateral pleural effusions but no evidence of pulmonary embolism. The patient received 60 mg of methimazole, three doses of 5 mg intravenous metoprolol, and 50 mg of oral metoprolol. He developed acutely worsening hypoxic respiratory failure requiring 15 L of oxygen by nonrebreather.
Free thyroxine measurement in clinical practice: how to optimize indications, analytical procedures, and interpretation criteria while waiting for global standardization
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Federica D’Aurizio, Jürgen Kratzsch, Damien Gruson, Petra Petranović Ovčariček, Luca Giovanella
Despite best efforts, there are many examples in the literature where assay interferences and subsequent misinterpretation of thyroid hormone levels have led to misdiagnosis, incorrect treatment, and potential harm to patients [62]. One example concerns a pregnant woman who was diagnosed with hyperthyroidism based on her clinical symptoms (palpitations, dyspnea, and tachycardia) and a discordant thyroid hormone profile (elevated FT3, elevated FT4, and TSH within the RI), which persisted throughout her pregnancy [279]. Her daughter also had a similar thyroid hormone profile for over a month after birth without displaying clinical signs of congenital hyperthyroidism. It was hypothesized that the abnormal thyroid hormone profiles observed were due to THAb interference, and further analytical investigations supported this by demonstrating the presence of anti-T3 and anti-T4 in the serum of the woman and her daughter. In this case, the woman was incorrectly treated with methimazole throughout her pregnancy, which highlights the importance of accurate understanding and interpretation of assay values.
Pre- and Post-treatment Serum BAFF Levels and BAFF Gene Polymorphisms in Patients with Graves’ Disease
Published in Endocrine Research, 2023
Tarak Dhaouadi, Imen Rojbi, Sameh Ghammouki, Ibtissem Ben Nacef, Meriem Adel, Sabrine Mekni, Karima Khiari, Taïeb Ben Abdallah, Imen Sfar, Yousr Gorgi
Our data revealed a significant higher level of BAFF in patients comparatively to controls. This finding is in line with previous reports.15–19 Therefore, using a ROC curve, we estimated the respective sensitivity and specificity to be 83.9% and 90.8% for a threshold value of 654.9 pg/ml baseline serum BAFF. The slight decrease in BAFF level during GD treatment in our patients was not significant which corroborates the results of previous studies. In fact, Fabris et al.15 noted that BAFF levels tended to be lower in patients undergoing methimazole (1.1 ± 0.4 ng/ml) than in untreated cases (1.3 ± 0.4 ng/ml), but the difference was not statistically significant. Of note, 75.8% of our patients were treated with methimazole, a molecule which inhibits thyroid hormone synthesis and reduces TRAB production by thyroid autoreactive B cells.20 These methimazole-induced reductions might be due to a decline in BAFF levels which could result from a thyroid inflammation decrease and/or a direct effect on BAFF secreting cells.