1 / 23

Graves’ hyperthyroidism and anti-thyroid drugs

Graves’ hyperthyroidism and anti-thyroid drugs. By 蔡文欽. Case. The patient is a 77 years female with history of hypertension with regular treatment for many years.

edan
Télécharger la présentation

Graves’ hyperthyroidism and anti-thyroid drugs

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Graves’ hyperthyroidism and anti-thyroid drugs By 蔡文欽

  2. Case • The patient is a 77 years female with history of hypertension with regular treatment for many years. • She suffered from poor appetite, body weight loss, diarrhea, sweating, insomnia, palpitation, weakness, anxiety and hand tremor difficult swallow function for two months. • She went to our OPD and was admitted for further evaluation and management .

  3. PE • Conscious:clear • Skin: warm and moist • HEENT: no protrudent eye; fine air • Neck: no palpable mass • Heart: tachycardia; RHB. • Limbs: proximal weakness; edema(+); tremor(+)

  4. Treatment • PTU(50mg/tab) 2# BID • Propranolol 2# TID

  5. Graves' disease • Patient with biochemically confirmed thyrotoxicosis, diffuse goiter on palpation, ophthalmopathy, positive TPO antibodies, and often a personal or family history of autoimmune disorders.

  6. Introduction • Thionamides, a sulfhydryl group and a thiourea moiety within a heterocyclic structure • Propylthiouracil (PTU, 6-propyl-2-thiouracil). • Methimazole (1-methyl-2-mercaptoimidazole); in US, Asia and Europe. • Carbimazle (analogue of methimazole); in UK. • Inhibit TPO-mediated iodination

  7. Introduction • Propylthiouracil block the conversion of T4T3 within the thyroid and in peripheral tissues • Immunosuppressive effects • TRAb, intracellular adhesion molecule, IL-2 and IL-6 receptors.

  8. clinical pharmacology • Rapid GI absorbtion. • No dosed adjustment in children, elderly, liver disease or renal failure. • PTU • T1/2: 90mins • 80-90% bound to albumin • Methimazole • T1/2: 6hrs • Free form

  9. clinical use of drugs • Primary treatment for hyperthyroidism or as preparative therapy before radiotherapy or surgery. • Weighed against the risks and benefits of the more definitive therapy, such as radioiodine and surgery. • Ophthalmopathy, pregnancy and most children and adolescents. • Randomized trial comparing antithyroid drugs, radioiodine, and surgery patient satisfaction was more than 90 percent for all three, Lowest medical costs in ATD.

  10. choice of drugs • oncedaily in methimazole; better adherence and rapid improvement in T3 and T4 than PTU. • PTU (300 mg daily)  $408 /year • Methimazole (15 mg daily, $360; or 30 mg daily, $720). • Side-effect profiles of the two drugs methimazole. • PTU is preferred during pregnancy.

  11. practical considerations • methimazole vs PTU1:10; underestimate • 10mg85%; 40mg92% after six weeks • Follow-up every 4-6 weeks2-3 months after 3-6 months; then 4-6 months

  12. Remission • Less remission if more severe degrees of hyperthyroidism, large goiters, high TRAb or a high T3/T4 after course of drug treatment. • High relapse if depression, paranoia and problem of daily life. • Poor clinical or biochemical predictor in 300 patients study. • TRAb(+) after treatmentrelapse; normal relapse(30-50%). • Duration and dose vs relapse. • 12 to 18 months is recommended.

  13. Discontinuation of drug treatment • Stopped or tapered after 12 to 18 ms except children and adolescents. • Relapse after 3-6 ms; 50-60%. • Pregnancypostpartum relapse or thyroiditis. • ↑Failure rate of radioiodine in PTU.

  14. Minor side effect • Dose-related in methimazole. • Cross-reactivity50%. • Arthragiaantithyroid arthritis syndrome.

  15. Major side effect • Agranulocytosis(90 days; 0.35% vs 0.37%) • Autoimmune process; ANCA. 1000-1500. • Fever and sore throat; stop drugs and G-CSF. • Pseudomonas aeruginosa. • Hepatotoxicity(0.1-0.2%) • Hepatocellular injury in PTU and cholestatsis in methimazole • Vasculitis (PTU>methimazole) • Lupus; self-limited • Steroid or cyclophosphamide; H/D.

  16. Use of antithyroid drugs during pregnancy and lactation • Congenital anomalies, esp aplasia cutis while methimazole (1/2000 births). • Methimazole embryopathy; 2/241 vs. 1/2500 to 1/10,000 (esophageal atresia and choanal atresia). No increase in other studies. • Class D (risk of fetal hypothyroidism). • No risk in breast milk

More Related