Treatment Flashcards
What are the treatment options for thyrotoxicosis?
- Beta-adrenergic blockers (helps reduce HR and tremor)
- Antithyroid drugs - carbimazole (methimazole) + propylthiouracil
- Radioactive iodine
- Surgery - sub-total, near-total thyroidectomy
Describe antithyroid drugs
- Carbimazole OD
- Propylthiouracil TD
- Usually 6-24 months then: 50-60% remission at 1yr, 40% at 10yrs
- Block-replace therapy - higher dose then as becoming hypo add thyroxine (not in pregnancy)
What are the side effects of antithyroid drugs?
- Rash, itching
- Arthralgia
- Nausea/vomiting
- Mild leucopenia
- Agranulocytosis (leukopenia, low WBC)
How may eye disease worsen after radioiodine treatment?
- Smokers
- May relate to T-cell after RAI
- Reduced by prednisolone
Why is near-total thyroidectomy good?
- Remnant tissue <2g
- Patient needs T4 post-op
- Relapse rate <2%
- May be recommended for large goitre or severe hyperthyroidism
What are side effects for carbimazole?
Report signs of infection, especially sore throat and doctor should stop treatment if WCC is low.
How does radioactive iodine work?
Taken orally and is then rapidly taken up by thyroid gland, there the release of radiation destroys the tissue over 6-18 weeks.
What are the early complications of radioactive iodine?
- Neck discomfort
- Possible precipitation of Graves’ opthalmopathy
- Progressive incidence of hypothyroidism
What is the treatment for hypothyroidism?
- Thyroxine (T4) 50-150ug, mostly 100-125ug per day (levothyroxine)
- Once daily dose - long half life
- Monitor dose with TFTs
- Issues of compliance, interference with absorption (iron)
How do you know if the dose of levothyroxine is sufficient?
- Resolution of symptoms
- TSH level within normal range
What is the treatment for thyroid cancer?
- Surgery (total thyroidectomy or lobectomy)
- Post-operative radioactive iodine treatment (selected cases)
- Thyroid hormone suppression (to suppress TSH so that tumour growth is not stimulated)
What is the treatment for post partum thyroiditis?
Rarely requires treatment - self-limiting condition, beta blockers for symptoms, annual TFTs
What is a common condition to look out for from hypothyroidism?
Hypercholesterolaemia so TFTs should be checked
What is the treatment of secondary hypothyroidism?
Cortisol deficiency treated before thyroid hormone replacement otherwise hyperadrenal crisis. Monitoring requires adjustment of T4 to be in upper half of range.
