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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
I would advise thiamazole except in the first trimester of pregnancy. Although propylthiouracil works by the same mechanism, it has a higher risk of hepatotoxicity, but in the first trimester thiamazole is associated with congenital defects.
Thyroid disorders, dementia and Down syndrome
Published in Vee P. Prasher, Down Syndrome and Alzheimer’s Disease, 2018
This is treated by one of three modalities, namely antithyroid medications, subtotal or total thyroidectomy, or radioactive iodine ablation.135,137,184 In many cases these treatments can render the patient euthyroid, but they all have potential adverse effects. Drug treatment may not eliminate recurrences. Pregnant women with hyperthyroidism should be treated with drugs or surgery and not with radioactive iodine, as the latter may have adverse effects on the neonate, such as prematurity, intrauterine growth retardation and fetal or neonatal thyrotoxicosis. Antithyroid medications include the thionamide drugs thiamazole and propylthiouracil. Rare side-effects include rash, itching, fever, liver inflammation or white-blood-cell deficiency. When these drugs are discontinued the problem usually recurs. Radioactive iodine treatment for hyperthyroidism can be administered by mouth without the need for hospitalisation. The majority of patients are cured, but they may end up hypothyroid. Surgical removal of all or part of the thyroid gland as warranted is a permanent cure. This is highly suitable for removing nodules, but not for treating Graves’ disease, which affects the whole thyroid. With removal of much or all of the gland comes the need for permanent hypothyroid medication. Surgery also carries the risk of injury to the recurrent laryngeal nerve (the nerve to the voice box).
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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
Carbimazole is rapidly metabolised to thiamazole, which is concentrated in the thyroid gland. Over 90% of orally administered carbimazole is excreted in the urine as thiamazole or its metabolites. The remainder appears in faeces. There is 10% enterohepatic circulation. Thiamazole is metabolised, probably by the liver, and excreted in the urine. Less than 12% of a dose of thiamazole may be excreted as unchanged drug.
Two consecutive pregnancies in a patient with premature ovarian insufficiency in the course of classic galactosemia and a review of the literature
Published in Gynecological Endocrinology, 2022
Jagoda Kruszewska, Hanna Laudy-Wiaderny, Sandra Krzywdzinska, Monika Grymowicz, Roman Smolarczyk, Blazej Meczekalski
Six months later, the patient conceived without any medical intervention. The course of pregnancy was uneventful. Spontaneous labor occurred in the 40th week of gestation and a healthy boy, weighing 3500 g was born. Seven weeks later, the patient developed postpartum thyroiditis (TSH 0.003 UIU/m, fT4 1.61 pmol/L, fT3 4.17 pmol/L, FSH 94 mIU/mL, estradiol <10 pg/mL) and was treated with thiamazole at a dose of 3 × 15 mg until results normalization. Eight months after delivery, she conceived again, and again with a positive outcome, giving birth to a healthy girl weighing 3185 g. Throughout the second pregnancy, she was administered 25 μg thyroxine daily due to subclinical hypothyroidism. After both pregnancies she did not breastfeed the offspring. Afterwards, fertility issues were discussed and oral contraception was implemented (2 mg dienogest + 0.03 mg ethinylestradiol).
A cross-sectional survey of hospitalization and blood tests implementation status in patients who received tolvaptan under 75 years of age using a Japanese claims database
Published in Expert Opinion on Drug Safety, 2021
Shungo Imai, Kenji Momo, Hitoshi Kashiwagi, Yuki Sato, Takayuki Miyai, Mitsuru Sugawara, Yoh Takekuma
As the prescription start date is not always the administration start date, it is difficult to assess the status of the implementation of blood tests. Thus, we defined a case as ‘without serum sodium and liver function tests’ if blood tests were not performed even once from the day of prescription to the end of each evaluation period. We presumed that these cases did not comply with the package insert recommendations. Although the number of patients was not large, we included patient data from more than 300 institutions in total; thus, our results may be generalized. Among FA-CHF and FA-LC groups, proportions of patients without blood tests ranged from 11.0 to 17.6%. Of these, liver function tests in the FA-CHF group tend to be ignored. Nasuhara et al. investigated the implementation of blood tests in patients who were prescribed thiamazole at a single hospital in Japan [21] and found that the proportion of outpatients who never received blood tests was 3.9% during the 6-month evaluation period. For thiamazole, a ‘blue letter’ (a healthcare professional letter of rapid safety information from a regulatory agency) was issued in February 2004 to perform periodic monitoring of white blood cells. Although a simple comparison is difficult, a ‘blue letter’ may be related to differences in the proportions of patients without blood tests.
The Role of Vitamin D Receptor Gene Polymorphisms in Thyroid-Associated Orbitopathy
Published in Ocular Immunology and Inflammation, 2020
Adam Maciejewski, Michał J. Kowalczyk, Teresa Gasińska, Anna Szeliga, Michał Prendecki, Jolanta Dorszewska, Ryszard Żaba, Katarzyna Łącka
On enrolment, all patients were euthyroid due to previous treatment with the antithyroid drug – thiamazole (for 6–24 months) – followed in selected cases by radioiodine therapy or thyroidectomy (see Table 1). To assess orbitopathy, patients underwent ophthalmic examination and CT or MRI of the orbit. The severity of the orbitopathy was classified according to NOSPECS (all participants presented with class II or greater – moderate to severe disease).13 To assess the activity of the orbitopathy at the time of diagnosis, we utilized clinical activity score (CAS).14 All patients studied were found with active disease at diagnosis (CAS values of 3 or greater). They were treated with intravenous glucocorticoids and, in selected cases, radiotherapy of the orbits.