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Endocrinology
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
Because of its clinical severity, high dependency or intensive therapy unit input is strongly recommended. The mainstay form of treatment relies on the use of beta blockers – namely, propranolol, antithyroid drugs, Lugol’s iodine or potassium iodide, steroids (which help to decrease the conversion of T4 to T3), aggressive cooling and fluid resuscitation typically with dextrose. The antithyroid drug of choice is propylthiouracil.
Endocrinology and metabolism
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Medical Propranolol may be symptomatically useful initially.Antithyroid drugs (carbimazole, propylthiouracil): side effects of rash, joint pains, agranulocytosis. Propylthiouracil preferred in pregnancy.Radioiodine: used first line for some patients with Graves’ or toxic MNG, those who have relapsed after initial drug treatment or allergies to drug treatment.
Drugs in pregnancy and lactation
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Hyperthyroidism during pregnancy is usually attributable to Grave’s disease, an autoimmune disease caused by the presence of thyroid-stimulating immunoglobulin (TSI). TSI crosses the placenta and may cause intrauterine hyperthyroidism. The treatment of hyperthyroidism during pregnancy is based on maternal administration of antithyroid drugs that easily cross the placenta. Propylthiouracil is the drug of choice, but carbimazole and thiamiazole are also prescribed during pregnancy. Careful titration of the dose should be continued throughout pregnancy [34].
A practical approach to the management of thyroid dysfunction during pregnancy
Published in Gynecological Endocrinology, 2022
Costanzo Moretti, Natalia Lazzarin, Elena Vaquero, Alessandro Dal Lago, Luisa Campagnolo, Herbert Valensise
Thyrotoxicosis in pregnancy is usually treated by reducing TH synthesis using antithyroid drugs (ATD). The main ATD are thionamides, such as propylthiouracil (PTU), carbimazole (CBZ), and the active metabolite of the latter, methimazole (MMI). Thionamides inhibit the coupling of iodothyronines, reducing the biosynthesis of TH [53]. All inhibit the function of thyroperoxidase, reducing oxidation and the organification of iodide. Moreover, MMI determines the inhibition of the production of TRABs, by inhibiting the activity of lymphocytes that mediate the intrathyroidal inflammatory process. Propylthiouracil is considered the first-choice treatment for pregnant patients. Although the embryo toxic effects of methimazole have not been confirmed, it is not recommended as a first-choice option in pregnancy [54]. The suggested initial doses are of 200 mg of PTU daily.
Acute appendicitis complicated by concomitant thyroid storm
Published in Baylor University Medical Center Proceedings, 2021
Michael M. Mohseni, Charles Graham
Intraoperatively, the patient had perforated appendicitis with phlegmon by the liver edge. After abscess irrigation and appendectomy, a drain was placed with the tip in the right paracolic region. Intravenous dexamethasone, piperacillin-tazobactam, and esmolol were continued. On postoperative day 1, the patient was cleared for oral medications, and oral propylthiouracil 250 mg every 4 hours was initiated. Given her severe intolerance to propranolol, she was maintained on an esmolol drip. On postoperative day 3, she transitioned to methimazole 10 mg and oral atenolol 25 mg, both twice a day. Repeat T4 and T3 levels were 2.0 ng/dL and 43 ng/dL, respectively. She was discharged that same evening after removal of her drain and prescribed 10 days of amoxicillin/clavulanate 875 to 125 mg. At 2-week follow-up, her incisional staples were removed without event.
Prolonged coma resulting from massive levothyroxine overdose and the utility of N-terminal prohormone brain natriuretic peptide (NT-proBNP)
Published in Clinical Toxicology, 2019
Ophelia Wong, Anselm Wong, Shaun Greene, Andis Graudins
Treatment of thyrotoxicosis and toxicity after levothyroxine overdose is similar. Thyroid storm is treated using principles highlighted by Idrose [7]:Supportive care – management of dehydration, fever, cardiac monitoring and glucose.Inhibition of new thyroid hormone synthesis, e.g., propylthiouracil or methimazole.Inhibition of thyroid hormone release, e.g., iodine with Lugol solution.Beta adrenergic receptor blockade, e.g., propranolol.Preventing peripheral conversion of T4 to T3, e.g., steroids, propranolol and propylthiouracil.Treat the underlying cause.