Consenso brasileiro para o diagnóstico e tratamento do hipertireoidismo: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

Abstract

SIntroduction: Hyperthyroidism is characterized by increased synthesis and release of thyroid hormones by the thyroid gland. Thyrotoxicosis refers to the clinical syndrome resulting from excessive circulating thyroid hormones, secondary to hyperthyroidism or due to other causes. This article describes evidence-based guidelines for the clinical management of thyrotoxicosis. Objective: This consensus, developed by Brazilian experts and sponsored by the Department of Thyroid Brazilian Society of Endocrinology and Metabolism, aims to address the management, diagnosis and treatment of patients with thyrotoxicosis, according to the most recent evidence from the literature and appropriate for the clinical reality of Brazil. Materials and methods: After structuring clinical questions, search for evidence was made available in the literature, initially in the database Medline, PubMed and Embase databases and subsequently in SciELO -Lilacs. The strength of evidence was evaluated by Oxford classification system was established from the study design used, considering the best available evidence for each question. Results: We have defined 13 questions about the initial clinical approach for the diagnosis and treatment that resulted in 53 recommendations, including the etiology, treatment with antithyroid drugs, radioactive iodine and surgery. We also addressed hyperthyroidism in children, teenagers or pregnant patients, and management of hyperthyroidism in patients with Graves' ophthalmopathy and various other causes of thyrotoxicosis. Conclusions: The clinical diagnosis of hyperthyroidism usually offers no difficulty and should be made with measurements of serum TSH and thyroid hormones. The treatment can be performed with antithyroid drugs, surgery or administration of radioactive iodine according to the etiology of thyrotoxicosis, local availability of methods and preferences of the attending physician and patient. Arq Bras Endocrinol

Guidelines for the treatment of childhood-onset Graves’ disease in Japan, 2016

“…In some studies, the remission rate did not improve after 18 mo of antithyroid drug therapy (43, 104). According to other studies, either 131 I therapy or surgical treatment should be considered if remission cannot be achieved after 2 yr of antithyroid drug therapy and if a child requires at least 2–4 yr to achieve remission (73, 105, 106). …”

“…Specifically, the suggested doses are 1.25 mg/d for infants, 2.5–5.0 mg/d for children aged 1–5 yr, 5–10 mg/d for children aged 5–10 yr, and 10–20 mg/d (i.e., the adult dose) for children and adolescents aged 10–18 yr. For severe cases, the dose can be increased to as high as twice the above-listed amounts. According to the guidelines used in Brazil (73), the suggested dose of MMI is 0.2–0.5 mg/kg/d, and MMI should be used within a range of 0.1–1.0 mg/kg/d. The upper limits are 30 mg/d for MMI.…”

“…For patients with a smaller goiter, 131 I therapy is useful at a 131 I dose between 10 and 15 mCi. 131 I dose exceeding 150 μCi/g of thyroid tissue induced hypothyroidism in 95% of patients (73, 161, 162). …”

Hyperthyroidism

“…This recommendation is shared by the Brazilian Thyroid Consensus that consider TRAb testing useful only in selected cases and prefer radioactive iodine uptake for initial assessment of thyrotoxicosis. 49 In our clinical practice, we follow the approach of our European and Asian colleagues, using ultrasound and TRAb measurements.…”

Painless thyroiditis associated to thyroid carcinoma: role of initial ultrasonography evaluation

“…Thyroid ultrasound (US) is not routinely indicated for the assessment of hyperthyroidism and it is usually limited to cases when a nodule is discovered by palpation (6). Characteristic ultrasound features of SAT, especially granulomatous form, are enlargement of thyroid gland, focal hypoechoic zones with indefinite borders or diffuse hypoechoecogenicity, and lack or low flow on color Doppler in these areas (7).…”