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1.
Cambios rev. méd ; 22 (2), 2023;22(2): 927, 16 octubre 2023. ilus, tabs
Article in Spanish | LILACS | ID: biblio-1516527

ABSTRACT

El hipertiroidismo es un trastorno caracterizado por el exceso de hormonas tiroideas. El déficit de yodo es un factor clave en dicha patología y en lugares con suficiencia del mismo se asocian a au-toinmunidad tiroidea. La prevalencia de hipertiroidismo mani-fiesto varía del 0,2% al 1,3% en áreas con suficiencia de yodo, sin embargo, esto puede variar en cada país por diferencias en umbrales de diagnóstico, sensibilidad de ensayo y población se-leccionada. Un reporte de The Third National Health and Nutri-tion Examination Survey (NHANES III) mostró que el hiperti-roidismo manifiesto se presenta en 0,7% de la población general e hipertiroidismo subclínico en el 1,7%1,2.En incidencia, la patología se asocia con la suplementación de yodo, con la mayor frecuencia en áreas de deficiencias, por au-mento de nódulos tiroideos en la población anciana, teniendo a regiones de áreas montañosas como América del Sur, África Central y suroeste de Asia dentro de este grupo. Un meta aná-lisis de estudios europeos mostró una incidencia general de 50 casos por 100000 personas/años1. En Ecuador, según los datos del Instituto Nacional de Estadísticas y Censos (INEC) del 2017, se reportaron 157 casos de hipertiroidismo, de los cuales la En-fermedad de Graves (EG) fue la causa más común, seguida por el bocio multinodular tóxico (BMNT) y finalmente el adenoma tóxico (AT) con una incidencia de 61 %, 24 % y 14 % respecti-vamente3.Los pacientes con esta patología tienen aumento de riesgo com-plicaciones cardiovasculares y mortalidad por todas las causas, siendo falla cardíaca uno de sus principales desenlaces, así el diagnóstico precoz evita estos eventos, principalmente en pobla-ción de edad avanzada.El presente protocolo se ha realizado para un correcto trata-miento de esta patología en el Hospital de Especialidades Carlos Andrade Marín (HECAM).


Hyperthyroidism is a disorder characterized by an excess of thyroid hormones. Iodine deficiency is a key factor in this pa-thology and in places with iodine deficiency it is associated with thyroid autoimmunity. The prevalence of overt hyperthyroidism varies from 0,2% to 1,3% in iodine-sufficient areas; however, this may vary from country to country due to differences in diag-nostic thresholds, assay sensitivity, and selected population. A report from The Third National Health and Nutrition Examina-tion Survey (NHANES III) showed that overt hyperthyroidism occurs in 0,7% of the general population and subclinical hyper-thyroidism in 1,7%1,2.In incidence, the pathology is associated with iodine supplemen-tation, with the highest frequency in areas of deficiencies, due to increased thyroid nodules in the elderly population, having regions of mountainous areas such as South America, Central Africa and Southwest Asia within this group. A meta-analysis of European studies showed an overall incidence of 50 cases per 100000 person/years1. In Ecuador, according to data from the National Institute of Statistics and Census (INEC) in 2017, 157 cases of hyperthyroidism were reported, of which, Graves' di-sease (GD) was the most common cause, followed by toxic mul-tinodular goiter (BMNT) and finally toxic adenoma (TA) with an incidence of 61 %, 24 % and 14 % respectively3.Patients with this pathology have an increased risk of cardiovas-cular complications and all-cause mortality, with heart failure being one of the main outcomes, so early diagnosis avoids these events, mainly in the elderly population.The present protocol has been carried out for the correct treat-ment of this pathology at the Carlos Andrade Marín Specialties Hospital (HECAM).


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Antithyroid Agents , Thyroid Hormones , Graves Disease , Endocrinology , Graves Ophthalmopathy , Hyperthyroidism , Thyroid Diseases , Thyroid Gland , Iodine Deficiency , Thyroid Crisis , Adenoma , Ecuador , Goiter, Nodular
4.
Arch. argent. pediatr ; 119(1): S1-S7, feb. 2021. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1147352

ABSTRACT

El hipertiroidismo es el cuadro clínico resultante del exceso de hormonas tiroideas debido a hiperfunción glandular. Es una enfermedad rara en niños y adolescentes, pero con una alta morbilidad. La causa más frecuente es la enfermedad de Graves. El objetivo de esta publicación es realizar una revisión y actualización del hipertiroidismo infantojuvenil para guiar su detección y derivación temprana al endocrinólogo pediatra. Debe ser considerado cuando el niño o adolescente presente síntomas asociados a esta patología y bocio de grado variable. Se confirma con el perfil bioquímico característico.El tratamiento consiste, inicialmente, en bloquear los efectos del exceso de hormonas tiroideas con betabloqueantes y, además, disminuir su producción con drogas antitiroideas como primera elección. Ante efectos secundarios a su administración, recidivas o ausencia de remisión de la enfermedad, se optará por el tratamiento definitivo: yodo radioactivo o cirugía con el objetivo de lograr el hipotiroidismo o eutiroidismo


Hyperthyroidism is a serious and rare disorder in childhood characterized by the overproduction of thyroid hormones by the thyroid gland. Graves disease is the most common cause. The objective of this paper is to review and update hyperthyroidism in children and adolescents aiming to guide its early detection and referral to the pediatric endocrinologist. The disease should be suspected if typical symptoms and goiter are present and has to be confirmed with the characteristic biochemical profile. Initially, treatment to block the effect of the thyroid excess is needed. Antithyroid drugs are the recommended first-line treatment to diminish hormone production. Alternative treatments, such us radioactive iodine or thyroidectomy, are considered in cases of adverse effects to drugs, relapse or non-remission of the disease, in order to achieve hypothyroidism or euthyroidism.


Subject(s)
Humans , Male , Female , Child , Adolescent , Hyperthyroidism/diagnosis , Hyperthyroidism/drug therapy , Antithyroid Agents/therapeutic use , Graves Disease , Hyperthyroidism/etiology , Hyperthyroidism/therapy , Iodine/therapeutic use
5.
Rev. Soc. Bras. Clín. Méd ; 18(2): 95-99, abril/jun 2020.
Article in Portuguese | LILACS | ID: biblio-1361449

ABSTRACT

A paralisia periódica hipocalêmica tireotóxica é uma complicação inusitada do hipertireoidismo, porém é considerada urgência endocrinológica e ainda frequentemente subdiagnosticada. Sua apresentação clínica consiste na tríade de défice de potássio, tireotoxicose e fraqueza muscular ­ sendo esse último sintoma comum em diversas patologias. Realizamos uma revisão bibliográfica e destacamos, por meio do relato de caso, a importância do diagnóstico precoce dessa doença, possibilitando uma evolução favorável ao paciente, independente de sua etnia, sexo ou região geográfica. Atentamos ainda ao tratamento da doença, que, apesar de sua simplicidade, acarreta muitos equívocos.


The thyrotoxic hypokalemic periodic paralysis is a rare complication of hyperthyroidism, but is considered an endocrinological urgency, and yet frequently underdiagnosed. Its clinical presentation consists of potassium deficit, thyrotoxicosis, and muscular weakness, with the latter symptom being very common in several pathologies. We performed a bibliographic review and highlight, through a case report, the importance of the early diagnosis of this disease to allow favorable progression to the patient, regardless of ethnicity, sex, or geographical region. We also reinforce the importance of the disease treatment which, despite its simplicity, leads to many mistakes.


Subject(s)
Humans , Male , Adult , Young Adult , Thyrotoxicosis/diagnosis , Hypokalemic Periodic Paralysis/diagnosis , Potassium Chloride/therapeutic use , Tachycardia/diagnosis , Tachycardia/drug therapy , Antithyroid Agents/therapeutic use , Thyroxine/therapeutic use , Thyrotoxicosis/drug therapy , Thyrotoxicosis/blood , Hypokalemic Periodic Paralysis/drug therapy , Hypothyroidism/chemically induced , Hypothyroidism/drug therapy , Iodine/adverse effects , Iodine/therapeutic use , Anti-Arrhythmia Agents/therapeutic use
6.
Braz. j. otorhinolaryngol. (Impr.) ; 85(5): 636-641, Sept.-Oct. 2019. tab
Article in English | LILACS | ID: biblio-1039280

ABSTRACT

Abstract Introduction: The side effects of antithyroid drugs are well known. Antineutrophil cytoplasmic antibody-associated vasculitis is a severe adverse reaction. Most studies evaluating antineutrophil cytoplasmic antibodies related to antithyroid drugs have been carried out with patients treated with propylthiouracil, but less information is available for methimazole. Furthermore, most studies that investigated antineutrophil cytoplasmic antibodies related to antithyroid drugs were conducted on Asian populations. Objective: To evaluate the frequency of antineutrophil cytoplasmic antibodies and antineutrophil cytoplasmic antibodies-positive vasculitis in an adult population of Brazilian patients treated with methimazole. Methods: This was a prospective study. We evaluated patients ≥18 years with Graves' disease who have been using methimazole for at least 6 months (Group A, n = 36); with Grave's disease who had been previously treated with methimazole but no longer used this medication for at least 6 months (Group B, n = 33), and with nodular disease who have been using methimazole for at least 6 months (Group C, n = 13). Results: ANCA were detected in 17 patients (20.7%). Four patients (4.9%) had a strong antineutrophil cytoplasmic antibodies-positive test. The frequency of antineutrophil cytoplasmic antibodies was similar in the groups. When Groups A and B were pooled and compared to Group C to evaluate the influence of Grave's disease, and when Groups A and C were pooled and compared to Group B to evaluate the influence of methimazole discontinuation, no difference was found in the frequency of antineutrophil cytoplasmic antibodies. No difference was observed in sex, age, etiology of hyperthyroidism, anti-TSH receptor antibodies, dose or time of methimazole use between patients with versus without antineutrophil cytoplasmic antibodies. The titers of these antibodies were not correlated with the dose or time of methimazole use. None of the antineutrophil cytoplasmic antibodies-positive patient had clinical event that could potentially result from vasculitis. Conclusion: This clinical study of a Brazilian population shows a considerable frequency of antineutrophil cytoplasmic antibodies in patients treated with methimazole but the clinical repercussion of these findings remains undefined.


Resumo Introdução: Os efeitos adversos de drogas antitireoidianas são conhecidos. Vasculite associada a anticorpos anticitoplasma de neutrófilos é uma reação adversa grave. A maioria dos estudos que avaliam anticorpos anticitoplasma de neutrófilos relacionado a drogas antitireoidianas envolveu pacientes tratados com propiltiouracil, entretanto menos informação se encontra disponível para o metimazol. Além disso, a maioria dos estudos que investigaram anticorpos anticitoplasma de neutrófilos relacionado a drogas antitireoidianas foi conduzida em populações asiáticas. Objetivo: Avaliar a frequência de anticorpos anticitoplasma de neutrófilos e vasculite anticorpos anticitoplasma de neutrófilos-positivo em uma população adulta de pacientes brasileiros tratados com metimazol. Método: Este foi um estudo prospectivo. Avaliamos pacientes ≥ 18 anos com doença de Graves com o uso de metimazol há pelo menos seis meses (Grupo A, n = 36); com doença de Graves previamente tratados com metimazol, mas que não usaram esse medicamento por pelo menos seis meses (Grupo B, n = 33) e com doença nodular em uso de metimazol há pelo menos seis meses (Grupo C, n = 13). Resultado: Anticorpos anticitoplasma de neutrófilos foram detectados em 17 pacientes (20,7%). Quatro pacientes (4,9%) tinham anticorpos anticitoplasma de neutrófilos fortemente positivos. A frequência de anticorpos anticitoplasma de neutrófilos foi semelhante nos grupos. Quando os Grupos A e B foram somados e comparados ao Grupo C para avaliar a influência da doença de Graves, e quando os Grupos A e C foram somados e comparados ao Grupo B para avaliar a influência da interrupção do metimazol, não foi encontrada diferença na frequência de anticorpos anticitoplasma de neutrófilos. Não houve diferença em relação a sexo, idade, etiologia do hipertireoidismo, anticorpos antirreceptor de TSH, dose ou tempo de uso de metimazol entre pacientes com e sem anticorpos anticitoplasma de neutrófilos. Os títulos desses anticorpos não se correlacionaram com dose ou tempo de uso de metimazol. Nenhum paciente anticorpos anticitoplasma de neutrófilos-positivo apresentou evento clínico resultante de vasculite. Conclusão: Este estudo clínico de uma população brasileira apresenta frequência considerável de anticorpos anticitoplasma de neutrófilos em pacientes tratados com metimazol, mas a repercussão clínica desse achado permanece indefinida.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Antithyroid Agents/adverse effects , Graves Disease/drug therapy , Antibodies, Antineutrophil Cytoplasmic/immunology , Brazil , Graves Disease/immunology , Prospective Studies , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/chemically induced , Methimazole/adverse effects
7.
Rev. Assoc. Med. Bras. (1992) ; 65(6): 755-760, June 2019. tab
Article in English | LILACS | ID: biblio-1013003

ABSTRACT

SUMMARY INTRODUCTION: Graves' disease (GD) is an autoimmune disorder characterized by hyperthyroidism. Antithyroid drugs (ATDs) are available as therapy. Agranulocytosis is a rare but potentially fatal complication of this therapy. In this study, we report agranulocytosis induced by propylthiouracil (PTU) in a patient with GD and the difficulties of clinical management. CASE: RNBA, male, 30 years old, with GD, treated with propylthiouracil (PTU). He progressed with pharyngotonsillitis. Then, PTU was suspended and antibiotic, filgrastim, propranolol, and prednisone were initiated. Due to the decompensation of hyperthyroidism, lithium carbonate, dexamethasone, and Lugol's solution were introduced. Total thyroidectomy (TT) was performed with satisfactory postoperative progression. DISCUSSION: We describe here the case of a young male patient with GD. For the treatment of hyperthyroidism, thioamides are effective options. Agranulocytosis induced by ATDs is a rare complication defined as the occurrence of a granulocyte count <500/mm3 after the use of ATDs. PTU was suspended, and filgrastim and antibiotics were prescribed. Radioiodine (RAI) or surgery are therapeutic alternatives. Due to problems with ATD use, a total thyroidectomy was proposed. The preoperative preparation was performed with beta-blocker, glucocorticoid, lithium carbonate, and Lugol solution. Cholestyramine is also an option for controlling hyperthyroidism. TT was performed without postoperative complications. CONCLUSION: Thionamide-induced agranulocytosis is a rare complication. With a contraindication to ATDs, RAI and surgery are definitive therapeutic options in GD. Beta-blockers, glucocorticoids, lithium carbonate, iodine, and cholestyramine may be an adjunctive therapy for hyperthyroidism.


RESUMO INTRODUÇÃO: A doença de Graves (DG) é uma doença autoimune caracterizada por hipertireoidismo. As drogas antitireoidianas (DAT) são opções terapêuticas disponíveis. A agranulocitose é uma complicação rara, potencialmente fatal desta terapia. Neste estudo, relatamos um caso de agranulocitose induzida por propiltiouracil (PTU) em paciente com DG e as dificuldades do manejo clínico. RELATO DE CASO: RNBA, sexo masculino, 30 anos, com DG, tratado com PTU. Evoluiu com faringoamigdalite, sendo o PTU suspenso e antibióticos, filgrastim, propranolol e prednisona, iniciados. Devido à descompensação do hipertireoidismo, iniciou carbonato de lítio (CL), dexametasona e a solução de Lugol. A tireoidectomia total (TT) foi realizada com boa evolução pós-operatória. DISCUSSÃO: Descrevemos caso de paciente jovem, sexo masculino, com DG. Para o tratamento do hipertireoidismo, as tionamidas são opções efetivas. A agranulocitose induzida por DATs é uma complicação rara, definida como a ocorrência de contagem de granulócitos <500/mm3 após uso de dats. PTU foi suspenso e foram prescritos filgrastim e antibiótico. O radioiodo (RAI) ou a cirurgia são alternativas terapêuticas. Devido a problemas com o uso de DAT, a TT foi proposta. A preparação pré-operatória foi realizada com betabloqueador, glicocorticoide, CL e solução de Lugol. A colestiramina também é uma opção para controlar o hipertireoidismo. A TT foi realizada sem complicações pós-operatórias. CONCLUSÃO: A agranulocitose induzida por drogas antitireoidianas é uma complicação rara. Com a contraindicação às DATs, RAI e cirurgia são opções terapêuticas definitivas para DG. Os betabloqueadores, glicocorticoides, CL, iodo e a colestiramina podem ser uma terapia adjuvante para o hipertireoidismo.


Subject(s)
Humans , Male , Adult , Propylthiouracil/adverse effects , Antithyroid Agents/adverse effects , Graves Disease/drug therapy , Agranulocytosis/chemically induced , Thyroid Function Tests , Thyroidectomy , Rare Diseases
8.
Annals of Pediatric Endocrinology & Metabolism ; : 133-136, 2019.
Article in English | WPRIM | ID: wpr-762599

ABSTRACT

Thyrotoxic periodic paralysis (TPP) is a notable and potentially lethal complication of thyrotoxicosis, and Graves' disease is the most common cause of TPP. TPP is commonly reported in Asian males between 20–40 years of age, but it is rare in children and adolescents. We report 2 Korean adolescents (a 16-year-old male and a 14-year-old female) with episodes of TPP who were previously diagnosed with Graves' disease. These 2 patients presented with lower leg weakness in the morning after waking up. They were diagnosed with TPP-associated with thyrotoxicosis due to Graves' disease. After they were initially treated with potassium chloride and antithyroid drugs, muscle paralysis improved and an euthyroid state without muscle paralytic events was maintained during follow-up. Therefore, clinicians should consider TPP when patients have sudden paralysis and thyrotoxic symptoms such as goiter, tachycardia, and hypertension.


Subject(s)
Adolescent , Child , Humans , Male , Antithyroid Agents , Asian People , Follow-Up Studies , Goiter , Graves Disease , Hypertension , Hypokalemia , Hypokalemic Periodic Paralysis , Leg , Paralysis , Potassium Chloride , Tachycardia , Thyrotoxicosis
9.
Braz. J. Pharm. Sci. (Online) ; 55: e18005, 2019. tab, graf
Article in English | LILACS | ID: biblio-1039053

ABSTRACT

Moringa leaves and spinach used as vegetables containing cyanogens and polyphenols having suspected antithyroidal activity; however, detailed studies in this aspect found unavailable. Goitrogenic/antithyroid potentiality of those plant foods of Indian origin was evaluated. To explore the goitrogenic/antithyroid effect of those plant foods cyanogenic glucosides, glucosinolates, thiocyanate and polyphenol content were measured. These plant foods were fed with diet regularly to adult male albino rats for 30 and 60 days respectively, followed by evaluation of morphological and functional status of thyroid,as thyroid gland weight, the activity status of thyroid hormone synthesizing enzymes viz. TPO, Na+-K+-ATPase, deiodinase I, thyroid hormone profiles, thyroid histoarchitecture as well as urinary iodine and thiocyanate. In moringa leaves and spinach fed diet, there was a significant increase in urinary excretion of thiocyanate and iodine, enlargement of thyroid gland along with hypertrophy of thyroid follicles and altered in the activities of thyroid hormone synthesizing enzymes with concomitant changes of thyroid hormone profiles. Effects were more severe in moringa leaves treated group than that of spinach. Biochemical analysis moringa leaves and spinach reveal that those are rich sources of goitrogens and their prolonged consumption gradually developed a relative state of biochemical and morphological hypothyroidism.


Subject(s)
Animals , Male , Rats , Antithyroid Agents/analysis , Moringa oleifera/adverse effects , Spinacia oleracea/adverse effects , Hypothyroidism , India/ethnology
10.
International Journal of Thyroidology ; : 79-84, 2019.
Article in Korean | WPRIM | ID: wpr-785845

ABSTRACT

Among the three treatment modalities of Graves' disease which include antithyroid drug (ATD), radioactive iodine and surgery, the ATD is most commonly preferred in Korea due to ease of use and definite curative effects on the thyrotoxic symptoms. However, several uncertainties about ATD remain: for example, the mechanism of actions on immune modulation, differences in the effects of drugs among individuals and associated factors in the view of remission. In recent years, long-term ATD treatment has been confirmed as an effective and safe therapy modality in adults, and several treatment guidelines have been released which accept long-term ATD therapy as an acceptable alternative to ablative therapy in Graves' patients. In this review, we summarize the recent progress in understanding the clinical role of ATD and emerging new antithyroid drugs focusing on immunomodulation.


Subject(s)
Adult , Humans , Antithyroid Agents , Graves Disease , Immunomodulation , Iodine , Korea
11.
Journal of the ASEAN Federation of Endocrine Societies ; : 99-102, 2019.
Article in English | WPRIM | ID: wpr-960988

ABSTRACT

@#<p style="text-align: justify;">A 34-year-old Filipino with Graves' disease on methimazole came in due to fever, sore throat and jaundice. Patient was initially diagnosed with methimazole induced agranulocytosis and drug induced liver injury. She was treated with intravenous broad spectrum antibiotic and granulocyte colony stimulating factor. On day 4 of admission, patient had pancytopenia and was managed as methimazole induced aplastic anemia and was started on steroid therapy and 1 unit of packed red blood cell was transfused. The jaundice also increased hence she was given ursodeoxycholic acid. On day 9 of admission, with the consideration of "lineage steal phenomenon," biopsy was done and eltrompobag was started. Patient was discharged stable at 12th day of hospital admission. This case presents the 3 rarest, life threatening complication of methimazole: agranulocytosis, aplastic anemia and hepatitis. </p>


Subject(s)
Humans , Female , Anemia , Agranulocytosis , Methimazole , Antithyroid Agents
12.
Endocrinology and Metabolism ; : 29-38, 2019.
Article in English | WPRIM | ID: wpr-739222

ABSTRACT

Whether or not Graves' hyperthyroidism can be really cured, depends on the definition of “cure.” If eradication of thyroid hormone excess suffices for the label “cure,” then all patients can be cured because total thyroidectomy or high doses of 1¹³¹I will abolish hyperthyroidism albeit at the expense of creating another disease (hypothyroidism) requiring lifelong medication with levothyroxine. I would not call this a “cure,” which I would like to define as a state with stable thyroid stimulating hormone (TSH), free thyroxine, and triiodothyronine serum concentrations in the normal range in the absence of any thyroid medication. Surgery and radioiodine are unlikely to result in so-defined cures, as their preferable aim as stated in guidelines is to cause permanent hypothyroidism. Discontinuation of antithyroid drugs is followed by 50% recurrences within 4 years; before starting therapy the risk of recurrences can be estimated with the Graves' Recurrent Events After Therapy (GREAT) score. At 20-year follow-up about 62% had developed recurrent hyperthyroidism, 8% had subclinical hypothyroidism, and 3% overt hypothyroidism related to TSH receptor blocking antibodies and thyroid peroxidase antibodies. Only 27% was in remission, and might be considered cured. If the definition of “cure” would also include the disappearance of thyroid antibodies in serum, the proportion of cured patients would become even lower.


Subject(s)
Humans , Antibodies , Antibodies, Blocking , Antithyroid Agents , Follow-Up Studies , Graves Disease , Hyperthyroidism , Hypothyroidism , Iodide Peroxidase , Receptors, Thyrotropin , Recurrence , Reference Values , Thyroid Gland , Thyroidectomy , Thyrotropin , Thyroxine , Triiodothyronine
13.
Acta méd. colomb ; 43(3): 150-155, jul.-set. 2018. tab, graf
Article in English, Spanish | LILACS, COLNAL | ID: biblio-983697

ABSTRACT

Resumen Introducción: en Colombia no se conoce la prevalência de los trastornos asociados a tirotoxicosis ni se dispone de estudios fármacoepidemiológicos acerca de la prescripción de los medicamentos antitiroideos. Objetivo: determinar los patrones de prescripción de los antitiroideos y variables asociadas a su uso en una población de pacientes en Colombia. Métodos: estudio de corte transversal, realizado entre enero 1 y marzo 30 de 2015 sobre los hábitos de prescripción de medicamentos antitiroideos en una población afiliada al sistema de salud colombiano. Se midieron variables sociodemográficas, farmacológicas y de comedicación. Se diseñó una base de datos sobre el consumo de medicamentos y se utilizaron pruebas t de student, X 2 y modelos de regresión logística. Resultados: un total de 327 pacientes en tratamiento con medicamentos antitiroideos fueron incluidos. La edad media fue de 53.7±18.1 años y 78.3% de pacientes correspondió a mujeres. El metimazol se prescribió en 95.4% de los pacientes, el propiltiouracilo en 4.6%. En 76.8% de pacientes se presentó comedicación; en particular con antihipertensivos (38.2%) y adicionalmente con propranolol (34.3%). Conclusiones: la tendencia de prescripción de medicamentos antitiroideos en Colombia es similar a lo reportado en diferentes estudios a nivel mundial. El principal medicamento antitiroideo es metimazol, con una tasa de uso mayor a la reportada en Norteamérica y en estudios europeos. Las dosis del metimazol y de propiltiouracilo reportadas en este estudio se ajustan a las recomendaciones de la Asociación Americana de Endocrinología Clínica.


Abstract Introduction: the prevalence of disorders associated with thyrotoxicosis is not known in Colombia, nor pharmacoepidemiological studies are available on the prescription of antithyroid drugs. Objective: to determine the prescription patterns of antithyroid drugs and variables associated with their use in a population of Colombian patients. Methods: cross-sectional study, conducted between January 1 and March 30, 2015 on the prescription habits of antithyroid drugs in a population affiliated with the Colombian Health System. Sociodemographic, pharmacological and comedication variables were measured. A database on drug consumption was designed and student t-tests, X 2 and logistic regression models were used. Results: a total of 327 patients in treatment with antithyroid drugs were included. The mean age was 53.7 ± 18.1 years and 78.3% of patients corresponded to women. Methimazole was prescribed in 95.4% of patients, propylthiouracil in 4.6%. In 76.8% of patients, comedication was present in particular with antihypertensive agents (38.2%) and additionally with propranolol (34.3%). Conclusions: the prescription tendency of antithyroid drugs in Colombia is similar to that reported in different studies worldwide. The main antithyroid drug is methimazole, with a rate of use higher than that reported in North America and in European studies. The doses of methimazole and propylthiouracil reported in this study are in accordance with the recommendations of the American Association of Clinical Endocrinology.


Subject(s)
Hyperthyroidism , Propylthiouracil , Antithyroid Agents , Thyrotoxicosis , Pharmacoepidemiology , Methimazole
14.
Arq. neuropsiquiatr ; 76(1): 32-40, Jan. 2018. graf
Article in English | LILACS | ID: biblio-888340

ABSTRACT

ABSTRACT In this study, the effect of thymoquinone (TQ) on propylthiouracil (PTU)-induced memory impairment was investigated in juvenile rats. The rats were grouped into control, Hypo, Hypo-TQ5 and Hypo-TQ10. Propylthiouracil increased latency time in the Morris water maze test and decreased delay in entering the dark compartment in the passive avoidance test. Both 5 mg/kg and 10 mg/kg doses of TQ decreased latency time in the Morris water maze test and increased delay in entering the dark compartment in a passive avoidance test. The PTU also increased malondialdehyde and nitric oxide metabolites in the brain while reduced the thiol content and superoxide dismutase and catalase activities and serum T4 level. Both doses of TQ decreased malondialdehyde and nitric oxide metabolites in the brain while enhanced the thiol content and superoxide dismutase and catalase activities and serum T4 level. The results of the present study showed that TQ protected against PTU-induced memory impairments in rats.


RESUMO Neste estudo, foi investigado o efeito da timoquinona (TQ) contra deficiências de memória induzidas por propiltiouracilo (PTU) em ratos juvenis. Os ratos foram agrupados em grupos: controle, Hypo, Hypo-TQ5, e Hypo-TQ10. O PTU aumentou o tempo de latência no teste do labirinto aquático de Morris (MWM) e diminuiu o atraso para entrar no compartimento escuro no teste de evasão passiva (PA). Ambas as doses de TQ diminuíram o tempo de latência no teste de MWM e aumentaram o atraso para entrar no compartimento escuro no teste de PA. O PTU também aumentou os metabolitos de malondialdeído (MDA) e óxido nítrico (NO) no cérebro, enquanto reduziu o teor de tiol e as atividades de superóxido dismutasa (SOD) e catalasa (CAT) e o nível sérico de T4. Ambas as doses de TQ diminuíram os metabolitos de MDA e de NO no cérebro, aumentaram o conteúdo de tiol e as atividades de SOD e CAT e o nível de T4 no soro. Os resultados do presente estudo mostraram que a TQ protegeu contra deficiências de memória induzidas por PTU em ratos.


Subject(s)
Animals , Male , Benzoquinones/pharmacology , Oxidative Stress/drug effects , Hypothyroidism/complications , Learning Disabilities/drug therapy , Memory Disorders/drug therapy , Antioxidants/pharmacology , Propylthiouracil , Avoidance Learning/drug effects , Superoxide Dismutase/analysis , Antithyroid Agents , Brain Injuries/metabolism , Catalase/analysis , Rats, Wistar , Maze Learning/drug effects , Disease Models, Animal , Hippocampus/drug effects , Hypothyroidism/chemically induced , Learning Disabilities/chemically induced , Malondialdehyde/analysis , Memory Disorders/chemically induced , Nitric Oxide/analysis
15.
Journal of the Korean Medical Association ; : 248-252, 2018.
Article in Korean | WPRIM | ID: wpr-766499

ABSTRACT

Graves disease is the most common disease that causes hyperthyroidism. It is an autoimmune disease characterized by the overproduction of thyroid hormones due to continuous stimulation of the thyroid gland by thyroid-stimulating hormone receptor antibody. Therapeutic modalities for Graves disease include antithyroid drugs (ATDs), radioactive iodine, and thyroidectomy. ATDs are the most preferred therapeutic option by physicians in most countries except North America. However, current treatment strategies are unfortunately aimed at inhibiting thyroid hormone production or ablating the thyroid to induce permanent hypothyroidism, not at inhibiting thyroid-stimulating hormone receptor antibody. ATD therapy has a high relapse rate (more than 50%), and morbidity and mortality increase in cases of relapse. Therefore, the proper and prompt management of relapsed patients is very important.


Subject(s)
Humans , Antithyroid Agents , Autoimmune Diseases , Graves Disease , Hyperthyroidism , Hypothyroidism , Iodine , Iodine Radioisotopes , Mortality , North America , Recurrence , Thyroid Gland , Thyroid Hormones , Thyroidectomy , Thyrotropin
16.
Journal of the Korean Medical Association ; : 253-258, 2018.
Article in Korean | WPRIM | ID: wpr-766498

ABSTRACT

Thyroid dysfunction during pregnancy can result in serious complications for both the mother and infant. However, these complications can be prevented by the optimal treatment of overt maternal thyroid dysfunction. The serum thyroid-stimulating hormone (TSH) concentration is the most reliable measure of thyroid function during pregnancy. Due to the physiologic changes in TSH levels during pregnancy, the correct interpretation of thyroid function requires knowledge of the gestational week and the appropriate population-based reference interval. In addition to a TSH test, the measurement of thyroid peroxidase antibody helps determine whether to treat subclinical hypothyroidism during pregnancy. Since the use of antithyroid drugs during pregnancy is associated with birth defects, it is recommended to discontinue the medication and to perform repeated thyroid function testing during the first trimester. If therapy is needed during the first trimester, propylthiouracil is preferred over methimazole.


Subject(s)
Female , Humans , Infant , Pregnancy , Antithyroid Agents , Congenital Abnormalities , Hyperthyroidism , Hypothyroidism , Iodide Peroxidase , Methimazole , Mothers , Pregnancy Trimester, First , Propylthiouracil , Thyroid Function Tests , Thyroid Gland , Thyrotropin
17.
Journal of the ASEAN Federation of Endocrine Societies ; : 190-193, 2018.
Article in English | WPRIM | ID: wpr-961517

ABSTRACT

@#A 51-year-old Caucasian male developed Graves’ thyrotoxicosis following long-standing treatment for hypothyroidism. After a short period of treatment with carbimazole, he developed agranulocytosis and required total thyroidectomy. In this relevant case report, we review several pathogenetic mechanisms that explain the transformation of autoimmune hypothyroidism into Graves’ disease and the possible approaches to the management of agranulocytosis secondary to antithyroid medications. Further studies are required to determine the best way to manage severe thyrotoxicosis when agranulocytosis develops due to antithyroid medications.


Subject(s)
Hypothyroidism , Antithyroid Agents , Carbimazole , Agranulocytosis
18.
International Journal of Thyroidology ; : 176-181, 2018.
Article in English | WPRIM | ID: wpr-738939

ABSTRACT

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis has been reported in Graves' disease patients treated with antithyroid drugs (ATDs), especially propylthiouracil. ATD-induced ANCA-associated vasculitis usually involved the kidneys followed by the respiratory organs and skin. The treatment of ANCA-associated vasculitis induced by ATDs is to stop ATD therapy immediately, which often leads to an overall good prognosis. We report a case of ANCA-associated vasculitis in the peripheral nerves of the lower extremities in a 66-year-old woman who was treated with methimazole (MMI) for Graves' disease. To our knowledge, this is the third case of peripheral nervous system (PNS) involvement of ATD-induced vasculitis and the first case of PNS vasculitis associated with MMI.


Subject(s)
Aged , Female , Humans , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis , Antibodies, Antineutrophil Cytoplasmic , Antithyroid Agents , Graves Disease , Kidney , Lower Extremity , Methimazole , Peripheral Nerves , Peripheral Nervous System , Prognosis , Propylthiouracil , Skin , Vasculitis
19.
Rev. med. Rosario ; 83(2): 75-78, mayo-ago. 2017.
Article in Spanish | LILACS | ID: biblio-973301

ABSTRACT

Los fármacos antitiroideos constituyen uno de los pilares del tratamiento del hipertiroidismo. En nuestro país solo se encuentra disponible el metimazol. Estas drogas han sido asociadas a múltiples reacciones adversas, la mayoría leves. Efectos adversos infrecuentes pero potencialmente letales como la agranulocitosis, hepatitis y el síndrome de artritis por antitiroideos, obligan a suspender el tratamiento. Comunicamos dos casos de complicaciones infrecuentes del tratamiento con metimazol.


Antithyroid drugs are one of the cornerstones in the management of hyperthyroidism. In our country, only methimazole is available. These drugs have been related to a variety of adverse reactions, most of them minor. Infrequent but potentially lethal side effects such as agranulocytosis, hepatitis and the antithyroid arthritis syndrome, demand drug cessation. We report two cases of infrequent complications of methimazole.


Subject(s)
Humans , Female , Adult , Antithyroid Agents , Antithyroid Agents/administration & dosage , Antithyroid Agents/adverse effects , Methimazole/administration & dosage , Methimazole/adverse effects , Agranulocytosis , Hyperthyroidism , Pharmaceutical Preparations
20.
Journal of the ASEAN Federation of Endocrine Societies ; : 100-107, 2017.
Article in English | WPRIM | ID: wpr-997849

ABSTRACT

Objective@#The study aims to develop and validate the Filipino version of Thyroid-disease specific quality of life Patient Reported Outcome (ThyPROph) questionnaire, and to conduct a pilot study comparing the quality of life of patients with Graves’ disease at University of Santo Tomas Hospital (USTH) after receiving radioactive iodine ablation (RAI) or anti-thyroid drug (ATD) using the validated ThyPROph. @*Methodology@#This study has 2 phases. Phase 1 is the development and validation of the ThyPROph with prior translation and pretesting to Graves’ disease patients. Phase 2 is the pilot study involving 58 euthyroid patients with Graves’ disease recruited to answer the validated ThyPROph. All of the participants completed the ThyPROph. A cross sectional comparative design was used to compare health-related quality of life (HRQoL) under two modes of treatment for Graves’ disease: RAI and ATD. Likewise, correlation of the domains with the demographics was determined using Pearson correlation coefficient and Spearman rank signed test. @*Results@#For the phase 1 study, internal consistency exists across all domains of ThyPROph with Cronbach’s alpha of 0.839. Overall, discriminant validity falls within range of 0.028-0.606 and convergent validity showed moderate correlations. Phase 2 study showed that there is a significant difference in the domains “goiter symptoms” (p=0.0209), “emotional susceptibility” (p=0.0067) and “impaired daily life” (p=0.0463). The HRQoL is significantly better in the RAI group based on these three domains. Statistically significant correlations exist between goiter grade and goiter symptoms domain (p=0.0001), gender and impaired daily life domain (p=0.016), cosmetic complaints domain with age (p=0.002), marital status (p=0.046), and disease duration (p=0.005). @*Limitations@#Results are not powered to achieve the primary objective because complications of Graves’ disease were excluded. The reliability of the domains is reduced. A prospective randomized study is more ideal. @*Conclusion@#Quality of life of patients with Graves’ disease as assessed by ThyPROph is significantly better with RAI compared to ATD. RAI therapy can be considered as the better treatment option in our setting especially for patients who have noticeable goiters with symptoms attributable to their goiters, and those with emotional instability.


Subject(s)
Graves Disease , Quality of Life , Antithyroid Agents
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