Prolonged Treatment of Hyperthyroidism With Sodium Tyropanoate, an Oral Cholecystographic Agent: A Re‐evaluation of Its Clinical Utility

Noguchi, Kazuya; Suzuki, Hoji; Nakahata, Motonobu; Kurosawa, Shinji; Nakagawa, Shoichi

doi:10.1111/j.1365-2265.1986.tb01694.x

Cited by 9 publications

(2 citation statements)

References 20 publications

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“…These drugs have been used effectively in both adult and neonatal Graves' disease (10,11,31,(52)(53)(54), as part of a preoperative regimen for thyroidectomy (55)(56)(57), in destruction-induced thyroiditis (12,32), and in massive levothyroxine overdose (49,50). Escape from inhibition occurs after 2 to 12 weeks when these agents are used as sole therapy (5,6,9,58).…”

Section: Clinical Usementioning

confidence: 98%

The Use of Oral Radiographic Contrast Agents in the Management of Hyperthyroidism

Fontanilla

Schneider²,

Sarne³

2001

Thyroid

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Oral iodinated radiographic contrast agents such as ipodate and iopanoic acid form an important part of the armamentarium used to treat hyperthyroidism. They rapidly and dramatically reduce serum triiodothyronine (T3) levels by inhibiting conversion of thyroxine (T4) to T3 in the periphery and by blocking secretion from the thyroid. Potential risks from the large iodine load resulting from their use limit their widespread applicability. In addition, they are ineffective when used alone on a long-term basis. However, these agents may be especially useful in treating thyrotoxic patients preoperatively, in neonatal Graves' disease, in massive levothyroxine ingestion, and when other conventional antithyroid drugs are unsuccessful or contraindicated.

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Section: Clinical Usementioning

confidence: 98%

The Use of Oral Radiographic Contrast Agents in the Management of Hyperthyroidism

Fontanilla

Schneider²,

Sarne³

2001

Thyroid

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“…In addition there may be a particular problem with more severely affected patients in that iopanoic acid can fail to control thyroid hormones and symptoms (Wang et al 1987). A similar drug, so¬ dium tyropanoate, has also failed to control Graves' disease in the long-term despite an initial satisfactory fall in thyroid hormones (Noguchi et al 1986). We can only support the short-term use of sodium iopodate and similar drugs in the man¬ agement of hyperthyroidism.…”

Section: Discussionmentioning

confidence: 98%

Resistant hyperthyroidism induced by sodium iopodate used as treatment for Graves' disease

Caldwell

Errington

Toft

1989

Acta Endocrinologica

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Sodium iopodate has recently been advocated for long-term control of hyperthyroidism in Graves' disease. Its advantages over conventional therapy are a rapid fall in thyroid hormones and control of symptoms with a simple dosage regime. We report a case in which severe resistant hyperthyroidism developed during treatment of Graves' disease with sodium iopodate. Sodium iopodate may not be suitable for long-term use in all patients with Graves' disease. Sodium iopodate was introduced as a contrast agent for oral cholecystography, but more recently its use has been advocated in the acute and longterm management of thyrotoxicosis (Wu et al. 1987b;Sharp et al. 1981;Shen et al. 1985). We re¬ port a case in which severe resistant hyperthyroid¬ ism developed during treatment of Graves' disCase Report A 36-year-old man was admitted for control of hyperthy¬ roidism. He gave a 3 month history of weight loss, tremor, sweating and frequent defecation. On examination he was severely hyperthyroid, had exophthalmos and a moderate smooth goitre with a bruit. The serum total thyroxine (TT4) and total triiodothyroninie (TT3) meas¬ ured by radioimmunoassay (Seth et al. 1976) were 296 nmol/1 (normal range 65-145) and 8.7 nmol/1 (normal range 1.1-2.8), respectively. Serum thyrotropin using a sensitive assay (Seth et al. 1984) was undetectable (normal range 0.3-5.0 mU/1). Treatment was commenced with 500 mg sodium iopodate (Bilopten*, Schering) once a day and long acting propranolol (Inderai LA®, ICI), 320 mg a day. Within 72 h the TT4 and TT, had fallen to 197 and 2.0 nmol/1, respectively, and his condition improved. A week later he was discharged when the TT4 and TT3 were 168 and 1.9 nmol/1 and his weight had increased by 2 kg.On review 3 weeks after starting treatment with sodium iopodate, TT4 and TT3 were 131 and 3.0 nmol/1 and he had discontinued the propranolol. He defaulted from clinic for 6 weeks, but continued to take the sodium iopo¬ date, receiving further supplies from his general practi¬ tioner. On review he was again severely hyperthyroid and the TT4 and TT3 were 269 and 10 nmol/1. The sodium io¬ podate was stopped and propylthiouracil, 150 mg three times daily, commenced. After 3 weeks there had been no fall in thyroid hormone levels and he was readmitted and the propylthiouracil continued. Over the next 6 weeks in hospital his weight continued to drop and the TT4 and TT3 remained 215 and 8.3 nmol/1. Carbimazole, 15 mg four times daily, was then substituted for the pro¬ pylthiouracil and after 2 weeks the TT4 and TT3 fell to 146 and 5.6 nmol/1, but he remained clinically hyperthy¬ roid and lithium carbonate, 400 mg twice daily, was added to his treatment Two weeks later the TT4 and TT3 were 107 and 3.4 nmol/1. After a further 2 weeks (3 months after starting propylthiouracil) a near total thy¬ roidectomy was performed. Postoperatively he has re¬ quired thyroxine and 1 alpha hydroxycholecalciferol. DiscussionSodium iopodate and similar drugs are iodine con¬ taining agents used for oral cholecystography. When introduced the...

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Ipodate Therapy in Patients With Severe Destruction-Induced Thyrotoxicosis

Arem

Dabrh²

1996

Arch Intern Med

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We describe 4 patients with severe destruction-induced thyrotoxicosis who had a rapid clinical response to oral sodium ipodate (500 mg daily). The underlying thyroid disorders in the patients were postpartum thyroiditis, subacute thyroiditis, silent thyroiditis, and radiation-induced thyroiditis. Ipodate therapy was given for 6 to 10 weeks until restoration of thyroid function to normal. In all patients, an almost complete resolution of symptoms occurred by the third day of ipodate treatment. In the patient with radiation thyroiditis, a daily clinical score of thyrotoxicosis declined within 2 to 3 days. The score remained low as long as the patient was receiving ipodate, but 2 attempts to discontinue ipodate therapy while thyroxine levels were elevated resulted in a rise of the thyrotoxicosis clinical score. This suggests that ipodate therapy, by rapidly reducing triiodothyronine levels through inhibition of the 5' monodeiodination and blockage of the peripheral effects of thyroid hormone, controls severe thyrotoxicosis mediated by destruction and should be considered in this setting in conjunction with beta-adrenergic blockade.

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Prolonged Treatment of Hyperthyroidism With Sodium Tyropanoate, an Oral Cholecystographic Agent: A Re‐evaluation of Its Clinical Utility

Cited by 9 publications

References 20 publications

The Use of Oral Radiographic Contrast Agents in the Management of Hyperthyroidism

The Use of Oral Radiographic Contrast Agents in the Management of Hyperthyroidism

Resistant hyperthyroidism induced by sodium iopodate used as treatment for Graves' disease

Ipodate Therapy in Patients With Severe Destruction-Induced Thyrotoxicosis

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