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Thyroid : Official Journal of the... Oct 2016Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting...
BACKGROUND
Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition.
METHODS
The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group.
RESULTS
Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the preparation of patients for thyroid surgery. The sections on less common causes of thyrotoxicosis have been expanded.
CONCLUSIONS
One hundred twenty-four evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
Topics: Combined Modality Therapy; Evidence-Based Medicine; Humans; Hyperthyroidism; Precision Medicine; Severity of Illness Index; Societies, Medical; Thyrotoxicosis; United States
PubMed: 27521067
DOI: 10.1089/thy.2016.0229 -
Journal of the American Academy of... 1992Hyperthyroidism is an endocrine disorder encountered in adult primary care clinics. This article reviews normal thyroid physiology as well as the pathophysiology,... (Review)
Review
Hyperthyroidism is an endocrine disorder encountered in adult primary care clinics. This article reviews normal thyroid physiology as well as the pathophysiology, diagnosis, clinical signs and symptoms, and diagnostic tests and treatment for the most common clinical hyperthyroid entities. Current research is also discussed as it relates to clinical practice.
Topics: Humans; Hyperthyroidism; Thyroid Function Tests
PubMed: 1605993
DOI: 10.1111/j.1745-7599.1992.tb01105.x -
Indian Heart Journal 2017Atrial fibrillation is the most common arrhythmia worldwide with increasing frequency noted with age. Hyperthyroidism is a well-known cause of atrial fibrillation with a... (Review)
Review
Atrial fibrillation is the most common arrhythmia worldwide with increasing frequency noted with age. Hyperthyroidism is a well-known cause of atrial fibrillation with a 16%-60% prevalence of atrial fibrillation in patients with known hyperthyroidism Ross et al. (2016). While hyperthyroidism as a causative factor of atrial fibrillation is well established, this literature review aims to answer several questions on this topic including: 1. The relationship of atrial fibrillation to hyperthyroidism 2. Atrial fibrillation as a predictor of hyperthyroidism 3. The pathophysiology of thyrotoxic atrial fibrillation 4. Subclinical hyperthyroidism and the relationship with atrial fibrillation 5. Cardioversion and Catheter ablation of hyperthyroid patients with atrial fibrillation 6. Thrombotic risk of hyperthyroid patients with atrial fibrillation 7. Management of Thyrotoxic Atrial fibrillation 8. Pharmacological rhythm control in patients with hyperthyroidism and atrial fibrillation 9. Treatment of Hyperthyroidism to prevent atrial fibrillation 10. Clinical Implications of Hyperthyroidism and Atrial Fibrillation.
Topics: Atrial Fibrillation; Global Health; Heart Rate; Humans; Hyperthyroidism; Prevalence; Prognosis; Risk Factors
PubMed: 28822529
DOI: 10.1016/j.ihj.2017.07.004 -
The Veterinary Clinics of North... Sep 2020In cats, hyperthyroidism can be treated in 4 ways: medical management with methimazole or carbimazole, nutritional management (low-iodine diet), surgical thyroidectomy,... (Review)
Review
In cats, hyperthyroidism can be treated in 4 ways: medical management with methimazole or carbimazole, nutritional management (low-iodine diet), surgical thyroidectomy, and radioactive iodine (I). Each form of treatment has advantages and disadvantages that should be considered when formulating a treatment plan for the individual hyperthyroid cat. Medical and nutritional managements are considered "reversible" or palliative treatments, whereas surgical thyroidectomy and I are "permanent" or curative treatments. The author discusses how each treatment modality could be the optimal choice for a specific cat-owner combination and reviews the advantages and disadvantages of each treatment option.
Topics: Animals; Antithyroid Agents; Carbimazole; Cat Diseases; Cats; Humans; Hyperthyroidism; Ownership; Quality of Life; Thyroidectomy
PubMed: 32665137
DOI: 10.1016/j.cvsm.2020.06.004 -
Clinical Obstetrics and Gynecology Mar 1997The prevalence of hyperthyroidism in pregnancy is about 0.2%. The most common cause is Graves' disease. Maternal, fetal, and neonatal morbidity and mortality may be... (Review)
Review
The prevalence of hyperthyroidism in pregnancy is about 0.2%. The most common cause is Graves' disease. Maternal, fetal, and neonatal morbidity and mortality may be reduced to a minimum with careful attention to the clinical symptoms and interpretation of thyroid tests. Ideally, hyperthyroid women should be rendered euthyroid before considering conception. The incidence of maternal and neonatal morbidity is significantly higher in those patients whose hyperthyroidism is not medically controlled. Even the incidence of thyroid storm is high in women who are under poor medical supervision in the presence of a medical or obstetric complication. Maternal morbidity includes a higher incidence of toxemia, premature delivery, placenta abruptio, congestive heart failure, and thyroid crisis. In some series, anemia and infections were also reported. Neonatal morbidity includes SGA neonates, intrauterine growth retardation, LBW infants, and prematurity. Fetal goiter and transient neonatal hypothyroidism is occasionally reported in infants of mothers who have been overtreated with ATD. Propylthiouracil and MMI are equally effective in controlling the disease. In most patients, symptoms improved and thyroid tests returned to normal in 3-8 weeks after initiation of therapy. Resistance to ATD is extremely rare, most cases are caused by patient poor compliance. Surgery for the treatment of hyperthyroidism is reserved for the unusual patient who is allergic to both ATD; to those who have large goiters; to those who require large doses of ATD; or to those patients who poorly comply. Fetal and neonatal hyperthyroidism can be predicted in the majority of cases by the previous maternal medical and obstetric history and by the proper interpretation of thyroid tests. Finally, hyperthyroidism may recur in the postpartum period.
Topics: Antithyroid Agents; Diagnosis, Differential; Female; Humans; Hyperthyroidism; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prevalence
PubMed: 9103949
DOI: 10.1097/00003081-199703000-00007 -
Endocrinology and Metabolism Clinics of... Mar 1998Hyperthyroidism is second to diabetes mellitus as the most common endocrinopathy in pregnancy. Inappropriate secretion of hCG is the most common cause of hyperthyroidism... (Review)
Review
Hyperthyroidism is second to diabetes mellitus as the most common endocrinopathy in pregnancy. Inappropriate secretion of hCG is the most common cause of hyperthyroidism in the first part of gestation. In addition to hydatidiform mole and hyperemesis gravidarum, nonpathologic-conditions including multiple gestation, mild nausea and vomiting, and even normal pregnancies may present with transient undetectable or suppressed serum TSH values. The syndrome of transient hyperthyroidism of hyperemesis gravidarum is defined as severe nausea and vomiting, dehydration, ketonuria, and weight loss of more than 5% by 6 to 9 weeks of pregnancy. Thyroid tests are in the hyperthyroid range, and the abnormalities are related to the severity of symptoms. Tests normalize with resolution of the vomiting, and ATD therapy is not indicated. The natural history of Graves' disease in pregnancy is characterized by aggravation in the first trimester, amelioration in the second half, and recurrence in the year following delivery. ATD treatment is the therapy of choice in pregnancy. Either PTU or MMI may be used; the goal is to keep the FT4I in the upper limits of normal with the minimum dose of ATD. In approximately 30% of patients, ATDs may be discontinued in the last few weeks of gestation. Maternal, fetal, and neonatal complications are frequent when hyperthyroidism is not under control. Postpartum hyperthyroidism may be caused by an episode of silent thyroiditis or Graves' disease.
Topics: Antithyroid Agents; Female; Humans; Hyperthyroidism; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 9534033
DOI: 10.1016/s0889-8529(05)70303-0 -
Endocrine Jul 2019While the effects of hypothyroidism on renal function have been studied extensively, there is less information concerning the effect of hyperthyroidism. We aimed to...
PURPOSE
While the effects of hypothyroidism on renal function have been studied extensively, there is less information concerning the effect of hyperthyroidism. We aimed to elucidate the effect of overt and subclinical hyperthyroidism, on estimated glomerular filtration rate (eGFR) with large number of patients treated for hyperthyroidism and after euthyroidism was achieved.
METHOD
A total of 433 consecutive overt and subclinical hyperthyroid patients were included in the study. We assessed serum fT3, fT4, TSH, BUN, creatinine, and eGFR measurements during both hyperthyroid and euthyroid states of the same patients. The eGFR was calculated using the simplified modification of diet in renal disease (MDRD) Formula.
RESULTS
Among these patients, 367 had overt, and 66 had subclinical hyperthyroidism. fT3, fT4, and eGFR measurements decreased, meanwhile BUN, creatinine and TSH levels increased significantly after euthyroidism was achieved (p < 0.0001 for all). The correlation analyses revealed that eGFR in hyperthyroid state (eGFRh) and fT3 in hyperthyroid state (fT3h) (r = 0,210, p < 0,0001), and fT4 in hyperthyroid state (fT4h) (r = 0,176, p < 0,0001) were significantly correlated. ∆GFR did not differ between overt hyperthyroid group and subclinical hyperthyroid group.
CONCLUSIONS
We observed a significant decline in eGFR measurements after the patients became euthyroid. Some of these patients had lower values than 60 mL/min/1.73 m, which mean that hyperthyroidism may be masking mild renal failure.
Topics: Adult; Aged; Asymptomatic Diseases; Creatinine; Female; Glomerular Filtration Rate; Humans; Hyperthyroidism; Kidney; Male; Middle Aged; Retrospective Studies; Thyroid Function Tests; Thyrotropin; Thyroxine; Triiodothyronine; Young Adult
PubMed: 30904999
DOI: 10.1007/s12020-019-01903-2 -
Journal of the College of Physicians... Nov 2022Hyperthyroidism is associated with a number of heart diseases, and it may aggravate previous cardiac problems or cause new ones, such as hyperthyroid cardiopathy. Cases...
Hyperthyroidism is associated with a number of heart diseases, and it may aggravate previous cardiac problems or cause new ones, such as hyperthyroid cardiopathy. Cases of hyperthyroidism presenting with coronary vasospasm are rarely reported. Herein, we present a case of a 54-year male patient with recurrent left chest pain for 2 months. Coronary angiography showed no obvious coronary artery stenosis, and coronary vasospasm was suspected. After admission, the patient's thyroid function and TSH-receptor antibody (TRAb) were abnormal. However, there was no obvious palpitation, hyperhidrosis, or weight loss, and the diagnosis of Graves' disease was rendered, which seemed to be the cause of coronary vasospasm. The patient did not experience chest pain after treatment with methimazole. Patients with coronary vasospasm should be investigated for the possibility of hyperthyroidism. Key Words: Hyperthyroidism, Chest pain, Coronary angiography, Coronary vasospasm.
Topics: Humans; Male; Coronary Vasospasm; Hyperthyroidism; Methimazole; Graves Disease; Antithyroid Agents; Chest Pain
PubMed: 36377023
DOI: 10.29271/jcpsp.2022.11.1492 -
ORL; Journal For Oto-rhino-laryngology... 2008Surgical treatment of hyperthyroidism requires an understanding of the pathophysiology of thyrotoxicosis and of differentiating hyperthyroidism from non-hyperthyroid... (Review)
Review
Surgical treatment of hyperthyroidism requires an understanding of the pathophysiology of thyrotoxicosis and of differentiating hyperthyroidism from non-hyperthyroid causes of thyrotoxicosis. The surgeon must determine or confirm the etiology of the patient's hyperthyroidism for surgical planning and ensure that surgery is indicated. Furthermore, preoperative preparation with appropriate medication is essential for minimizing intraoperative and postoperative complications. This chapter outlines the differential diagnosis of thyrotoxicosis, preoperative evaluation and preparation for surgery.
Topics: Humans; Hyperthyroidism; Patient Selection; Risk Assessment; Thyroidectomy
PubMed: 18971594
DOI: 10.1159/000149834 -
Thyroid : Official Journal of the... Jun 2003This study examined changes in bone mineral and fracture risk after treatment for hyperthyroidism in a meta-analysis. The PubMed and EMBASE were searched using the MESH... (Meta-Analysis)
Meta-Analysis Review
This study examined changes in bone mineral and fracture risk after treatment for hyperthyroidism in a meta-analysis. The PubMed and EMBASE were searched using the MESH terms "hyperthyroidism," "bone mineral density" (BMD), and "fracture," resulting in retrieval of 289 references. Twenty references describing BMD and five describing fracture risk were included in the meta-analysis. BMD was significantly decreased in patients with untreated hyperthyroidism. Upon treatment BMD increased significantly and reversed to normal levels with a temporary increase above normal levels 1-4 years after diagnosis. The risk of hip fractures increased significantly with age at diagnosis of hyperthyroidism. The hip fracture risk after diagnosis predicted from studies on BMD was close to that observed in clinical studies comparing fracture risk in hyperthyroid patients with normal controls. Thus BMD is significantly decreased and fracture risk increased in untreated hyperthyroidism. Upon normalization of the hyperthyroid state BMD return to normal even though no specific antiosteoporotic measures are taken other than normalizing the hyperthyroid state.
Topics: Age Factors; Bone Density; Cohort Studies; Cross-Sectional Studies; Fractures, Bone; Hip Fractures; Humans; Hyperthyroidism; Risk; Spine; Therapeutics; Time Factors
PubMed: 12930603
DOI: 10.1089/105072503322238854