Thyroid disorders, dementia and Down syndrome
Vee P. Prasher in 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).
C
Caroline Ashley, Aileen Dunleavy, John Cunningham in The Renal Drug Handbook, 2018
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.
Introduction to the clinical stations
Sukhpreet Singh Dubb in 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.
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.
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).
Thyrotropin receptor antibodies and a genetic hint in antithyroid drug-induced adverse drug reactions
Published in Expert Opinion on Drug Safety, 2018
Lin-Chau Chang, Chien-Ching Chang, Pei-Lung Chen, Shun-Huo Wang, Yi-Hsuan Chen, Yung-Hsin Tsai, Shyang-Rong Shih, Wei-Yih Chiu, Cathy Shen-Jang Fann, Wei-Shiung Yang, Tien-Chun Chang
Although concomitant use of antihistamines can sometimes alleviate the cutaneous reactions, thereby enabling the continued use of ATDs [1,13], in many cases the use of these drugs must be discontinued and another category of ATD or treatment with radioactive iodine be administered instead [6,11]. A retrospective case–control study indicated that allergic reactions to ATDs are associated with autoimmunity [13]. Chivu et al. found that among 72 patients with the autoimmune Basedow–Graves’ disease who were treated with thiamazole, six developed allergic reactions [13]. In contrast, none of the 56 patients with the non-autoimmune toxic multinodular goiter who were treated with thiamazole experienced allergic reactions [13]. Furthermore, the genetic predisposition of patients could have an impact on both the predictable (type A) and unpredictable (type B) types of ADRs [14,15].
Related Knowledge Centers
- Hyperthyroidism
- Graves' Disease
- Toxic Multinodular Goitre
- Thyroid Storm
- Pancytopenia
- Liver Failure
- Vasculitis
- Pregnancy
- Breastfeeding
- Propylthiouracil