Threatement Options

Treatment Options: Trostmart Methimazole TAPAZOLE (PT) Radioactive lodine (RAJ) Adventages Noninvasive Low initial cost Disadvantages Low curs rate (40050%) Adverse drug reactions Low risk of permanent hypothyroidism Drig comokance Possible remissions due to immune effects Care of hyperthyroidism Surgery Lowest cost before adjustment for ODL Rapid, affective treatment, especially for patients with large gorters Permanent hypothwutam almond inevitabile Might worsen ophthalmopathe Pregnancy must be defered for f 17 rannthes: no breast-feeding Small potential riskat exacerbation of hyperthyroidism Most imasive Last costly in long term after quality-of-life adjustment Permanent hypothyroidism Pain, scar Cinical Consideration Methimazole is the drug of choice copt in first trimester of pregnancy and in thyroid Initid Deanem in severe cases ar preoperative preparation Only treatment that leaves thyroid intact Best weather tous nabuland multinodular goiter Potential hotze in pragnanicy of maper side effect from antichyrod drugs Potential complications (recurrent larmgea nerve damage, hypoparathyroidism) Useful when coexisting suspicious nocule present Option for patients who refuse ndioindine Thioamides preferred Duer PTU except during pregnang or hhyroid stomm Treatment Methimazole TAPAZOLE Tabs: 5mg 10mg Propylthiouracil (PTU) Desing Initial: 15-60mg depending on disease severity Maintenance: 5 to 15 mg daily po in 2- 3 divided dours, higher doses are sometimes necessary, stop or taper after 12 to 18 months Max: 120mg/day Thyroid storm up to 40 mg 810 may be required Initial: Initially 50 to 150 mg po TID Maintenance: 50 mg po 880 or TID Tabs: 50mg. 100mz Max: 1200mg/day Thyroid storm: up to 1200 mg daily in dinded doses Radioactive lodine (13) I) Common adverse effects Fisk of skin rash, allergic maction, agranulocytosis (rare), hepatotooicity (rare) Fisk of skin rash, allergic reaction, agranulocytosis, severe hesatotoxicity that may be fatal (rare [1/10000) Warn patient to stop if rach, fever, sore throat or jaundice develop Onset of action, monitoring, sluration of therapy Onset: 3-4 weeks, euthyroid in 6-8 weeks (inhibits new thyroid hormone synthesis but takes time for depletion of stond thyroid hormone) Monitering: Raseline TSH, FT4, WBC count with diff, LIT. Measure 13H & FTA monthly until euthyroid, then 41-6 months Duration: 12 to 18 months of Treatment achieves 60% remission Source: Thyre CTC. Моштедна •destroys thyroid tissue via DNA damage to cells • Preferred for: -Pts wl cardiac disease - Pts wl toxic multinodular goiter - Pts who fail to respond to thioamides or experience SES - Pts ul recurrent hyper. after surgery. small risk of exacerbation of thyrotoxicosis shortly after treatment due to TH release pretreat & thioamide Until euthyroid in those ischemia, heart failure or arrhythmia-stop I week before I -CI in pts & active opthalamopathy, pregnanal lactation • 1° Risk = Hypothy rodiom (o wk - 6 mo Follouring 1st I) audio for 3 wh Surgem total / partial removal of thyroid gland Treatment of choice Por: Large thyroid gland (log) or malignancy Esophageal obstruction difficulty swallowing - Severe ophthalmopathy - lack of remissior w/ thioarnides - CI to thioamides of RAI •Pt should be in euthyroid state prior to surgery Begin a methimazok, -2-4 wks prior begin w iodides - Propanolol 7-10 days post-of complications RARE - Hypo parathyrodism Laingeal nerve damage Hyperthyrodism Adjunctive Therapy: i-lodides (Lugol's solution) • symptomatic reliee, pre-op. thyroid storm do not use prior to Rai or Chronically during pregnancy. • •inhibitory effect of iodide Organification process is inhibited due to the wolff-Chalk off effect (temp. + short suppression of TH synthesis) via 6mg/day. Lo Inhibits organifcation proces in thyroid gland, TH formation in follicular cells & TH release Advantages rapid onset (2-7 days) simple, cheap, relatively hon-toxic, no glandular destruction Disadvantages • escape phenomenon ülin 10 days - thyrotoxicosis relapse • interferance & RAL Jod-Basedow Phenomenon -lodide-induced hyperthyrodism - Negatur Feedback not working properly -Sources - dler •media of medical Imaging. • amiodarone -does hor occur in normal thyroid function -Hyper may develop 1-12 wk after