Adrenergic beta‐receptor blockade in hyperthyroidism.

Ramsay, Ian

doi:10.1111/j.1365-2125.1975.tb00545.x

Cited by 19 publications

(7 citation statements)

References 32 publications

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“…Our results, however, show that the addition of bisoprolol to L-T, suppressive therapy improves the quality of life in those patients with clinical features of enhanced adrenergic activity. (J Clin Endocrinol Metub '78: 10281033,1994) S EVERAL symptoms and signs of hyperthyroidism, such as palpitations, tremor, tachycardia, nervousness, heat intolerance, and sweating, mimic the manifestations of Padrenergic activity (1,2). Thus, ,&adrenergic blocking drugs are frequently used to relieve these symptoms in the management of hyperthyroidism (3-7).…”

mentioning

confidence: 98%

Control of adrenergic overactivity by beta-blockade improves the quality of life in patients receiving long term suppressive therapy with levothyroxine.

Biondi

Fazio

Carella

et al. 1994

The Journal of Clinical Endocrinology & Metabolism

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Several symptoms and signs of hyperthyroidism are frequently shared by patients receiving L-T4 suppressive therapy. The aim of this study was to evaluate whether a beta-adrenergic blocking drug could reduce the severity of these symptoms and signs in these patients, as previously reported in patients with hyperthyroidism. Eleven patients (mean age, 42 +/- 11 yr; 10 females and one male) affected with differentiated thyroid carcinoma or nontoxic goiter were selected from a more numerous group of patients receiving suppressive therapy based on the presence of palpitations, increased heart rate, left ventricular systolic function, and other symptoms mimicking exaggerated beta-adrenergic activity. In these patients the cardioselective beta-blocking drug bisoprolol was added to the L-T4 suppressive therapy at a dose of 2.5-5 mg/day. Blood samples were collected for the determination of thyroid hormones and TSH concentration during L-T4 therapy and after 3 and 6 months of associated L-T4 plus bisoprolol therapy. Cardiac function was assessed by clinical evaluation, standard and Holter electrocardiogram, as well as one- and two-dimensional echocardiography. Furthermore, we applied the symptom-rating scale previously used by Klein et al. in hyperthyroid patients to assess the quality of life in our group of patients. Our findings show that the addition of bisoprolol to L-T4 suppressive therapy produces a normalization of heart rate, which was significantly increased during TSH suppressive therapy, and the disappearance of atrial arrhythmias with considerable reduction of palpitations. Furthermore, bisoprolol produced an effective improvement in measures of the hyperthyroid symptom scale, with significant reduction of the mean score. The echocardiographic data showed an increased left ventricular mass index with significantly enhanced systolic function at the basal evaluation. After 6 months of combined L-T4 plus bisoprolol therapy, left ventricular mass index normalized, and the indices of left ventricular systolic function were reduced, with a tendency to normalize. Further studies conducted on a larger series of patients are required to verify the long term implications of cardiac parameter variations on cardiovascular morbidity and mortality. Our results, however, show that the addition of bisoprolol to L-T4 suppressive therapy improves the quality of life in those patients with clinical features of enhanced adrenergic activity.

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mentioning

confidence: 98%

Control of adrenergic overactivity by beta-blockade improves the quality of life in patients receiving long term suppressive therapy with levothyroxine.

Biondi

Fazio

Carella

et al. 1994

The Journal of Clinical Endocrinology & Metabolism

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“…Beta-adrenoceptor blocking agents are frequently used in the treatment of hyperthyroidism (Shanks et al 1969;Grossman et al 1971;Turner 1974;Ramsey 1975) and their administration might lead to a further impairment in the carbohydrate meta¬ bolism. The most frequently used ß-blocking agent in hyperthyroidism is propranolol, a non-selective ß-blocker (Shanks et al 1969;Turner 1974;Mazzaferrietal.…”

mentioning

confidence: 99%

Insulin release and carbohydrate tolerance in hyperthyroid patients during non-selective or selective β-l-adrenoceptor blockade

Nilsson¹,

Kågedal²,

Tegler³

1980

Acta Endocrinologica

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The insulin release and the glucose disappearance rate (K-value) during an iv glucose tolerance test were evaluated in 20 hyperthyroid patients before and during treatment with either a non-selective (propranolol, n = 10) or a selective (metoprolol, n = 1 0 ) \g=b\-l-adrenoceptorblocking agent. Mean daily doses were 240 mg of propranolol and 280 mg of metoprolol, administered four times daily for 10 to 14 days. The insulin increase after glucose injection remained unchanged during treatment with each drug. Fasting blood glucose concentrations and the K-values were not altered during treatment. Sixteen patients were re-investigated 10 to 36 weeks later when euthyroid due to treatment by surgery, thyrostatic drugs or radioiodine. In the euthyroid state mean serum insulin concentrations after the glucose load were not significantly different from the values found when the patients were hyperthyroid. However, mean fasting blood glucose concentrations decreased from 5.5 mmol/l to 5.0 (P < 0.01) and the mean K-value increased from 1.5 to 2.0 (P < 0.05) when the patients were euthyroid. It is concluded that short-term treatment of hyperthyroid patients with non-selective or selective \g=b\-l-adrenoceptor blocking agents does not impair the glucose stimulated insulin secretion or the carbohydrate tolerance.

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“…Although β-blockers predominantly affect heart rates, it is reported that β-blockers also improve nervousness, sweating, tremors and muscle weakness (1)(2)(3). In this study, specific symptoms such as 'easy fatigability' and 'shortness of breath' improved more significantly with β-blocker treatment, and 'physical functioning' assessed using SF-36 improved in the group treated with β-blockers only.…”

Section: Discussionmentioning

confidence: 51%

“…Many of the clinical features of thyrotoxicosis, such as palpitations, tremors, nervousness, sweating and heat intolerance, mimic the manifestations of excess β-adrenergic activity (1,2). β-adrenergic blocking agents (β-blockers) have been used to treat thyrotoxicosis for the past 40 years, as these agents rapidly ameliorate many of the signs and symptoms observed in patients with thyrotoxicosis (3).…”

Section: Introductionmentioning

confidence: 99%

Short-Term Effects of β-adrenergic Antagonists and Methimazole in New-Onset Thyrotoxicosis Caused by Graves' Disease

et al. 2012

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Objective β-adrenergic antagonists (β-blockers) are often used to attenuate the hyperadrenergic symptoms of Graves' disease (GD), including palpitation. Although β-blockers reduce the heart rate, cardiac output and oxygen consumption, no firm evidence exists regarding the effects of combined therapy with β-blockers and anti-thyroid drugs. The objective is to elucidate the effects of β-blockers on anti-thyroid drug therapy in GD. Methods Patients newly diagnosed with mild GD were randomly assigned to receive methimazole with or without β-blockers in a prospective multi-center survey. The heart rate and thyroid function were measured and the quality of life was assessed using original and SF-36 questionnaires at 0 and 4 weeks. Results A total of 28 patients were enrolled in the study. Fourteen patients (one man, 13 women) were randomly assigned to the group treated with β-blockers and 14 patients (one man, 13 women) were randomly assigned to the group not treated with β-blockers. Although no significant differences in the improvement of thyroid function were observed between the two groups, the heart rates improved more significantly in the group treated with β-blockers. Specific symptoms, such as easy fatigability and shortness of breath, also improved more significantly with the β-blocker treatment. In addition, 'physical functioning' assessed with the SF-36 questionnaires significantly improved only in the group treated with β-blockers. Conclusion Although β-blockers may not reinforce the effects of anti-thyroid drugs on thyroid function, at least during the course of one month, they are effective in reducing heart rates and ameliorating specific symptoms in patients with mild GD.

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Adrenergic beta‐receptor blockade in hyperthyroidism.

Cited by 19 publications

References 32 publications

Control of adrenergic overactivity by beta-blockade improves the quality of life in patients receiving long term suppressive therapy with levothyroxine.

Control of adrenergic overactivity by beta-blockade improves the quality of life in patients receiving long term suppressive therapy with levothyroxine.

Insulin release and carbohydrate tolerance in hyperthyroid patients during non-selective or selective β-l-adrenoceptor blockade

Short-Term Effects of β-adrenergic Antagonists and Methimazole in New-Onset Thyrotoxicosis Caused by Graves' Disease

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