Therapy of Hyperthyroidism

Abstract

Hyperthyroidism is a common disorder and affects approximately 2 % of women and 0.2 % of men. The review focuses on the therapy of overt hyperthyroidism with special emphasis on treatment strategies in Germany and Europe. Current treatment schedules for the different causes of hyperthyroidism are described and new therapeutic aspects are discussed. Special sections deal with the treatment of hyperthyroidism in pregnancy, neonates and children, and the treatment of thyrotoxic storm.

Radioiodine Therapy of Graves' Hyperthyroidism in Patients Without Pre-existing Ophthalmopathy: Can Glucocorticoids Prevent the Development of New Ophthalmopathy?

“…Graves' disease remains a common disorder (Miehle and Paschke, 2003) and its differentiation from diffuse toxic goiter may be difficult in the absence of thyroid receptor stimulating antibodies (Wallaschofski et al, 2004). In such cases other diagnostic tools such as Doppler sonography or quantitative thyroid scintigraphy may help to identify the underlying thyroid disease Fig.…”

“…Several studies and reviews (Bartalena et al, 1995;Bartalena et al, 1998 b;Bartalena et al, 2002;Burch and Wartofsky, 1993;Heufelder, 2000;Miehle and Paschke, 2003;Prummel and Wiersinga, 1993;Tallstedt et al, 1994;Tellez et al, 1992;Wiersinga, 1999;Winsa et al, 1993) have suggested that in addition to the therapy modality, other confounding factors known to be associated with a higher risk of worsening or new development of GO may influence the posttherapeutical course of GO itself. These are smoking, relapse of hyperthyroidism, elevated TSH levels and high serum TSH-receptor antibody levels.…”

Treatment of Graves’ Disease During Pregnancy

“…It is estimated that hyperthyroidism is present in approximately 0.1-0.2% of pregnancies (Miehle, 2003;Mestman, 2004;Galofre, 2009). Of those pregnancies, neonatal Graves' disease occurs in 1-5% of those babies (Fitzpatrick, 2010;Marx, 2008).…”

“…Radioactive iodine is contraindicated during pregnancy; inappropriate radioiodine administration given after 10-12 weeks destroys the fetal thyroid and results in neonatal hypothyroidism and cretinism (Gorman, 1999;Abalovich, 2007). Surgery is reserved for patients who require large doses of antithyroid drugs, or those who demonstrate poor medication adherence and continue to remain hyperthyroid (Cooper, 2005;Miehle &Paschke, 2003;Mestman, 2004;Mestman, 1998;Glinoer, 2003;Karabinas & Tolis, 1998;Masiukiewicz &Burrow, 1999;Atkins, Cohen & Phillips, 2000). If surgery is necessary, surgery is preferred during the second trimester to decrease the risk of spontaneous abortion (Galofre, 2009).…”

Amiodarone-Induced Thyrotoxicosis Due to Destructive Thyroiditis

“…Amiodarone will cause hypothyroidism in about 6% and thyrotoxicosis in about 3 ± 15% of patients (Cardenas et al, 2003;Martino et al, 1994;Miehle and Paschke, 2003;Newman et al, 1998;Trip and Wiersinga, 1991). It is assumed that AIT is more frequent in iodine-deficient than in iodine-sufficient areas.…”