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ISSN 0188-9796 (Print)

2011, Number 1

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Rev Endocrinol Nutr 2011; 19 (1)

Treatment of the principal forms of thyrotoxicosis. Thiocarbamides and surgery (first of two parts)

Bolaños-Gil de Montes F, Rangel-Sánchez G, Navarro-Hermosillo L

Language: Spanish
References: 53
Page: 21-30
PDF size: 100.38 Kb.


ABSTRACT

Nowadays, there is no specific etiologic treatment for thyrotoxicosis, including autoimmune hyperthyroidism. In this context, our main therapeutic resources act by decreasing thyroid hormone biosynthesis (thionamides) or by ablation of thyroid tissue (surgery and radioactive iodine). Radioactive iodine is the preferred treatment method for autoimmune hyperthyroidism in the United States and Mexico, whereas thionamides are preferred in Europe and Japan. Long term thionamide treatment for autoimmune hyperthyroidism results in a 30 to 50% remission rate, with the best results obtained in female patients with a small goiter, without Graves’ orbitopathy and with low levels of antibodies against the thyrotropin receptor. Thionamides are also used in the treatment of pediatric and pregnant women with hyperthyroidism, to prepare hyperthyroid patients for surgical treatment, in the case of a thyrotoxic crisis and between two radioactive iodine doses. Even though propylthiouracil hepatic toxicity is not frequent, due to the seriousness of the clinical picture, the American Thyroid Association (ATA) advises its use during the first trimester of pregnancy, in the treatment of thyrotoxic crises and in case of methimazole toxicity, except agranulocytosis. Surgical treatment of hyperthyroid patients is indicated in patients with large goiters with obstructive symptoms, for cosmetic reasons or in case of coexistent thyroid cancer. Due to the fact that we do not have an ideal and etiologic treatment for patients with thyrotoxicosis, we suggest treatment has to be individualized and perhaps, decided in common agreement with the patient.


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