Toxic Adenoma medical therapy: Difference between revisions
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{{CMG}} ; {{AE}} {{ADG}} | {{CMG}} ; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
The mainstay of treatment for most patients with toxic adenoma includes radioiodine, anti thyroid drugs. | |||
==Medical Treatment== | ==Medical Treatment== | ||
The mainstay of treatment for most patients with toxic adenoma includes radioiodine, anti thyroid drugs. | The mainstay of treatment for most patients with toxic adenoma includes radioiodine, anti thyroid drugs. | ||
Revision as of 21:59, 10 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
The mainstay of treatment for most patients with toxic adenoma includes radioiodine, anti thyroid drugs.
Medical Treatment
The mainstay of treatment for most patients with toxic adenoma includes radioiodine, anti thyroid drugs.
RADIOACTIVE IODINE
In United States radioactive iodine is the preferred choice of treatment for patients with toxic adenoma.
Indications
Radioactive iodine is generally preferred over surgery when there is
- No suspicion of coexisting thyroid malignancy
- No large goiter threatening local compressive symptoms
- No other reason for neck surgery (e.g., primary hyperparathyroidism)
- No imperative for immediate cure, and whenever the patient’s general health makes him or her a poor candidate for surgery. <Ref>
Contraindications
- Pregnant women
- Children and adolescents(associated with risk of thyroid cancer)<ref>
Complications
Potential adverse effects of 131 I therapy for toxic nodular goiter include
- Radiation thyroiditis
- Postablative hypothyroidism.
Radiation thyroiditis =
- Radiation thyroiditis presents with anterior neck pain in the week after therapy and exacerbation of thyrotoxicosis because of the release of preformed thyroid hormone from the gland, which typically occurs 2 to 8 weeks after treatment.
- Pretreatment with an antithyroid drug has been shown to decrease the severity of thyrotoxicosis caused by radiation thyroiditis in Graves’ disease, 132 133 134 135 but this has not been established for toxic nodular goiter.
- Thyroiditis-related gland swelling with potential worsening of compressive symptoms is a concern that has not actually been realized in studies of radioiodine therapy for nodular goiter. 136 137
- Long term, thyroid volume typically decreases by about 40% after 131 I treatment. 138 139
Postablative hypothyroidism
- The incidence of postablative hypothyroidism after radioiodine therapy has been reported to be 25% to 50%, which is lower than that encountered after treatment of patients with Graves’ disease.
- This is presumably because suppressed extranodular thyroid tissue does not take up radioiodine.
- Radioisotopic distribution within functioning tissue can also be heterogeneous.
- Postablative hypothyroidism is more common when higher doses of radioactive iodine are administered.
ANTITHYROID DRUGS
- Unlike hyperthyroid Graves’ disease, thyroid autonomy in toxic nodular goiter rarely remits unless it has been provoked by an iodine load.
- Thionamide therapy alone may not control hyperthyroidism completely because of the substantial store of previously synthesized thyroid hormone that can be present in the large gland of a patient with toxic nodular goiter.
- Nonetheless, there remain certain indications for short-term antithyroid drug therapy.
- First, thionamides can be useful for the initial control of hyperthyroidism that is severe or complicates cardiac or other conditions in a fragile patient.
- Second, PTU is the immediate treatment of choice for pregnant patients with hyperthyroidism, although toxic nodular goiter is rare in this population.
- Third, a time-limited course of antithyroid drugs can sometimes be useful to evaluate the clinical status of patients with subclinical hyperthyroidism who have nonspecific symptoms, such as nervousness or insomnia, that may or may not improve with definitive treatment of mild hyperthyroidism.
- If a patient experiences an improvement in symptoms or sense of well-being when thyroid function has been restored to normal on thionamide therapy, then radioiodine therapy or surgery is indicated.