Comparison of propranolol and metoprolol in the management of hyperthyroidism.

Murchison, L E; How, Jacques; Bewsher, PD

doi:10.1111/j.1365-2125.1979.tb01048.x

Cited by 58 publications

(38 citation statements)

References 29 publications

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“…The possibility of an important effect of catecholamines on extrathyroidal conversion of T4 to T3 was suggested by clinical studies where -receptor antagonists decreased the plasma concentration of T3 in thyrotoxic or hypothyroid patients maintained on a fixed dose of T4 (Murchison et al 1979, Sulkin et al 1984. Subsequently, in vitro studies in liver and kidney demonstrated that D1 inhibitory effects of propranolol were related to its lipid solubility and not to its -adrenergic blocking activity (Heyma et al 1978, Sulkin et al 1984.…”

Section: Discussionmentioning

confidence: 99%

Effect of suckling and adrenergic stimulation on peripheral deiodination in lactating rats: differential expression of type 1 deiodinase mRNA forms

Aceves

Rojas-Huidobro²

2001

Journal of Endocrinology

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Previous works led us to propose that peripheral iodothyronine deiodination is mainly regulated by the reciprocal interaction between the thyroid and the sympathetic nervous system (SNS). In this study, we analyzed the role suckling exerts, through SNS activation, upon deiodination of thyronines in liver, heart, brown adipose tissue and mammary gland during lactation. Our results showed that resuckling causes a concurrent stimulatory response on deiodinase type 1 (D1) in heart and mammary gland, but not in liver and brown adipose tissue. The stimulatory response was mimicked by norepinephrine and by the -adrenergic agonist isoproterenol, through the overexpression of the large form of D1 mRNA. These results suggested that, during lactation, peripheral thyronine deiodination is co-ordinated by the SNS, and suckling is a major modulatory influence.

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Section: Discussionmentioning

confidence: 99%

Effect of suckling and adrenergic stimulation on peripheral deiodination in lactating rats: differential expression of type 1 deiodinase mRNA forms

Aceves

Rojas-Huidobro²

2001

Journal of Endocrinology

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“…It has been amply confirmed that propranolol causes a significant reduction in serum T3 and a concomitant increase in serum rT3 (Verhoeven et al 1977; Kallner et al 1978;Saunders et al 1978), although its effect on thyroxine is less consistent (Kallner et al 1978;Murchison et al 1979). It was reported that propranolol has no direct effect on thyroid functions, as measured by radioiodine uptake and serum protein-bound-iodine (Wartofsky et al 1975).…”

Section: Discussionmentioning

confidence: 99%

“…Several authors (Heyma et al 1980;Nilsson et al 1980) suggest that propranolol-induced changes in T3 and rT3 concentrations might be due to MSA (Heyma et al 1980) or direct inhibition of the enzyme responsible for the T4 monodeiodionation to T3 (Nilsson et al 1980). It is also possible that the changes might result from f32-adrenoreceptor blockade, since some authors have noticed a decrease in T3 during propranolol treatment, but no changes during the administration of selective f31-adrenoreceptor blockers such as atenolol (Nilsson et al 1979), practolol (Murchison et al 1976), and metoprolol (Murchison et al 1979; Nilsson et al TABLE 3. Pharmacological properties and effect on serum thyroid hormones of carteolol, indenolol and metoprolol 1980).…”

Section: Discussionmentioning

confidence: 99%

Effect of carteolol, indenolol and metoprolol on the thyroid hormone of hyperthyroid patients.

Yamamoto

Sato

Yoshida

et al. 1985

Tohoku J. Exp. Med.

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----Thirty-four hyperthyroid patients were divided into four groups : placebo, carteolol (20 mg/day), indenolol (60 mg/day) and metoprolol (120 mg/day) groups. The heart rate was determined before and two weeks after the treatment with each drug. Serum levels of T4, T3 and rT3 were measured before, and one and two weeks after the treatment. Both indenolol and metoprolol significantly reduced the heart rate (p <0.01 and p <0.05, respectively), whereas carteolol was ineffective. Carteolol significantly decreased T4 from 23.4± 4.4 ,u g/ 100 ml to 20.1 + 3.2,u g/ 100 ml (p < 0.01) in one week and to 20.0±3.7,ug/100 ml (p <0.01) in two weeks. T3 and rT3 were also decreased significantly (p <0.05 and p <0.01, respectively) two weeks after the treatment with carteolol. After two weeks of indenolol treatment, T4 was decreased significantly from 26.2±8.5 u g/ 100 ml to 23.9±8.2 p g/100 ml (p < 0.05) and T3 from 789+391ng/100 ml to 592+340 ng/100 ml (p <0.02). Metoprolol had no effect on serum thyroid hormone levels. The decrease in the serum level of thyroid hormones by carteolol and indenolol but not by metoprolol in patients with hyperthyroidism would be due to the blockade of f2-adrenoreceptors concerning with thyroid hormone secretion.carteolol; indenolol ; metoprolol ; thyroid hormone ; hyperthyroidism Propranolol causes a fall in serum triiodothyronine (T3) concentration in hyperthyroid patients (Verhoeven et al. 1977 ;Kallner et al. 1978 ;Saunders et al. 1978), probably by its action on peripheral conversion of thyroxine (T4) to T3 and reverse T3 (rT3) (Heyma et al. 1980;Nilsson et al. 1980), although f3-adrenoreceptor blockers other than propranolol were reported to have no effect on serum thyroid hormones (Murchison et al. 1976;Wahlberg et al. 1976;Nilsson et al. 1979: Jones et al. 1981.

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“…Peden in 1982 41 reported the use of daily nadolol and being adequately assessed prior to the commencement of surgery. This is important as there is large individual variability in response to propranolol 40,41,51 . Therefore, targets of heart rates <90 beats per minute and absence of symptomatic thyrotoxicosis should be used as end points prior to proceeding to surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Difficulties surrounding the use of propranolol led to a number of studies of other beta-blockers, in particular, more cardioselective agents such as metoprolol 4 . In a doubleblind crossover trial by Murchison in 1979, 51 each patient received 4 weeks of treatment with propranolol and 4 weeks with metoprolol. All showed improvement in clinical symptoms and signs.…”

Section: Resultsmentioning

confidence: 99%

Beta-blockers and the thyrotoxic patient for thyroid and non-thyroid surgery: A clinical review

Tay¹,

Khoo²,

Tancharoen³

et al. 2013

OA Anaesthetics

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IntroductionThyrotoxic patients presenting for surgery should ideally be biochemically and clinically euthyroid. This is conventionally achieved through the use of anti-thyroid drugs, beta-blocker therapy and iodine. However, there are some circumstances where antithyroid drugs may not be a viable option. The implications of this scenario are not widely reported in the literature. This clinical review looks at the evidence on the safety of beta-blocker therapy without the use of antithyroid drugs in the preparation of the thyrotoxic patient for surgery. We also highlight key points in the pathophysiology of thyrotoxicosis and the management goals of these patients. ConclusionIn circumstances where the use of anti-thyroid drugs is not possible in the preoperative management of patients for thyroid or non-thyroid surgery, the use of beta-blockers has been shown to be safe and effective. Safety can be increased by using iodine with or without corticosteroids up to the day of surgery in the rapid preoperative preparation of a severely thyrotoxic patient.

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Comparison of propranolol and metoprolol in the management of hyperthyroidism.

Cited by 58 publications

References 29 publications

Effect of suckling and adrenergic stimulation on peripheral deiodination in lactating rats: differential expression of type 1 deiodinase mRNA forms

Effect of suckling and adrenergic stimulation on peripheral deiodination in lactating rats: differential expression of type 1 deiodinase mRNA forms

Effect of carteolol, indenolol and metoprolol on the thyroid hormone of hyperthyroid patients.

Beta-blockers and the thyrotoxic patient for thyroid and non-thyroid surgery: A clinical review

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