[Effect of long-term continuous methimazole treatment of thyrotoxicosis: comparison with radioiodine]

The major complication of radioiodine therapy for thyrotoxicosis is hypothyroidism, the long-term management of which is often problematic. In this study, the long-term effects of continuous methimazole [MMI] therapy are investigated. One hundred and thirty-two patients, aged between 36-66 years, with Graves recurrence, were semi randomly randomized in 2 groups for continuous antithyroid and radioiodine treatment. The number of thyroid dysfunctions in each patient were recorded and serum TSH, FT4, Anti TPO, TRAb, FBS, HOMA IR, and lipid profiles were measured. Bone mineral density and echocardiography were performed. There was no significant differences in age, duration of symptoms and thyroid function between the 2 groups. No serious complications occurred in the MMI group and no difference in any of parameters was seen between groups 1 and 2. Goiter rate and anti TPO concentration were higher in group 1 than in group 2. Serum triglycerides and cholesterol were increased in group 2 as compared to group 1. Bone mineral density was more reduced in group 2, especially in the spine. Echocardiography showed diastolic dysfunction in group 2 as compared to group 1. Some parameters in neuro-pschyciatric evaluation were significantly better in the MMI group, as compared to the radioiodine one. Considering it is a safe treatment and has fewer complications, methimazole is another option for patients with recurrent Graves', who do not wish to use radioiodine

Outcome of thyrotoxicosis treatment with 3 different modalities

To assess the efficacy of 3 different treatment modalities for thyrotoxicosis and a comparison of their cost effectiveness. The case records of 100 patients treated for thyrotoxicosis at King Khalid National Guard Hospital in Jeddah were reviewed, during the period January 1992 through to January 2000. Their various treatments and responses were recorded as well as their thyriometabolic status, one year following the last treatment. The treatment consisted of an average of 9 months of antithyroid medication, thyroidectomy or treatment with radioactive iodide. Cure was defined as a patient being euthyroid or hypothyroid for a minimum period of at least one year. Cost-effectiveness was calculated as the total cost of treating the patient in a specific treatment modality, divided by those who were considered to be cured. For the remainder, the cost could not be definitively determined. The mean age was 41 +/- 15.7 years, with female to male ratio of 6:1. Grave's disease was the underlying cause in 76% of cases, toxic multinodular goiter in 13% and toxic nodule in 1%. Ninety-one patients, who were treated with anti-thyroid medication for an average of 9 months, had a success rate of 11%. The success rate with surgery was 54.5%, while of 68 patients treated with radioactive iodide 65 [96%] were cured. Radioactive iodide was the most cost effective modality of treatment costing 1700 Saudi Riyals, followed by surgery at 40,000 Saudi Riyals. Medical treatment was the most expensive at 135,000 Saudi Riyals per cure. A treatment of thyrotoxicosis with radioactive iodine is much more efficacious than medical or surgical modalities. Furthermore, it is by far the most cost effective and has no harmful effects

Proposición de consenso para el uso de yodo 131 en el tratamiento de la tirotoxicosis y el cáncer del tiroides / Consensus proposal on the use of iodine-131 in hyperthyroidism and thyroid cancer

A consensus meeting held by the Chilean Endocrinological Society reached to 22 consensus proposals on the use of iodine-131 in hyperthyroidism and thyroid cancer, that are reported in this paper. Some of these propositions are: 1) Hyperthyroidism: A previous 131I uptake test must be performed. A calculated or an ablative dose should be administered. Hypothyroidism must be considered an objective rather than a complication. In patients with cardiovascular risk, normal thyroid function must be attained with propythioturacil. In cases of treatment failure, the dose should not be repeated before six months. It must be used with used with caution in children and teenagers. 2) Thyroid cancer: A iodine free diet is recommended prior to the therapeutic dose. A 100 mCi complementary ablative dose should be given after surgery, with a posterior exploration. This examination must not be done routinely, and if required, a 5 mCi dose should be used. For the treatment of metastases, a dose of 150 to 200 mCi is recommended. There is no radiation risk in hyperthyroidism or thyroid cancer. The only absolute contraindication is pregnancy. Recommendations for radiological protection are formulated. Hospitalization is suggested to protect other people from radiation exposure

Thyrotoxicosis--treatment by I131 therapy and early prediction of hypothyroidism following this therapy.

This study was undertaken in 68 thyrotoxic patients to assess the predictive value of various post treatment biochemical and immunological tests for early hypothyroidism after I131 therapy and to determine whether pretreatment with carbimazole protects against post I131 therapy hypothyroidism. Early changes observed in serum T3, T4, TSH, thyroid microsomal and thyroglobulin antibody levels were found to be of no predictive value. A sharp increase in TRAb levels around 3 months following I131 therapy indicated that hypothyroidism was likely to occur as this rise reflected a greater degree of thyroid damage. Lower levels of thyroglobulin in patients who became hypothyroid by 12 months after treatment would support this view. Carbimazole pretreatment for eight weeks did not appear to protect against hypothyroidism, in our study.

Radioiodine therapy in thyrotoxicosis.

One hundred and two patients (81 females, 21 males) suffering from thyrotoxicosis as diagnosed clinically and confirmed by laboratory investigations including the estimation of thyroid hormones in blood were treated with radioiodine (I-131) at the University of Minnesota Hospital between 1976 and 1986. Nine (9%) patients needed two and 3 (3%) patients needed three therapeutic doses of I-131. The age range of the patients was 17-82 years (mean 43, SD 17). The doses of I-131 administered ranged from 3.9 to 100 mCi (mean 13.7). Twenty of these patients received a relatively high dose from 20 to 100 mCi. The others were given smaller calculated doses based on radioiodine uptake and thyroid size is determined by palpation and nuclear scans. Of the 73 patients for whom follow-up information was available, 66 (90%) eventually became hypothyroid as judged by clinical criteria. These data also suggest that the incidence of hypothyroidism is quite independent of the dose (microCi/g thyroid) administered.

Infarto do miocárdio com coronárias normais, associado a tireotoxicose: relato de caso / Myocardial infarction with normal coronary, associated with thyrotoxicosis: a case report

Os autores apresentam o caso de um paciente de 45 anos, portador de tireotoxicose que piorou após terapêutica com iodo radioativo e morreu 5 dias após a internaçäo. A necrópsia demonstrou bócio difuso tóxico e intenso infarto subendocárdico com coronárias normais. O elevado consumo de oxigênio associado a encurtamento da duraçäo da diástole poderia explicar a ocorrência de infarto do miocárdio associado a tireotoxicose