RESUMO
To investigate the effects of iopanoic acid (IA) and carbimazole on increased activity of the hypothalamic-pituitary-adrenal (HPA) axis in hyperthyroidism, we studied 14 women with hyperthyroidism caused by Graves' disease (n + 11) or toxic multinodular goitre (n + 3) before and after carbimazole or IA treatment. Seven normal women comprised the control group. Changes in thyroid-stimulating hormone, total and free thyroid hormones, arginine vasopressin (AVP), urinary free cortisol, adrenocorticotrophin (ACTH) and cortisol in response to human corticotrophin-releasing hormone (hCRH; 100 microg, i.v.) were estimated under basal conditions and after treatment with IA (3 g/day; n + 7) for 7 days or carbimazole (30 mg/day; n + 7) for 1 month. A higher ACTH response, with normal cortisol secretion, was observed in hyperthyroid patients in response to hCRH compared with the control group. After 7 days treatment, IA induced a significant reduction in total tri-iodothyronine (T(3)) and free T(3) to normal levels and a stronger ACTH response to hCRH, whereas plasma and urinary cortisol levels remained unchanged. Patients treated with carbimazole showed normalization of thyroid hormone levels, a reduction in basal and stimulated ACTH secretion and higher urinary free cortisol levels compared with pretreatment levels. Neither IA nor carbimazole treatment had any effect on AVP levels in hyperthyroid patients. In conclusion, hyperthyroid patients showed HPA axis hyperactivity of central origin with reduced cortisol responses, which were reversed by carbimazole treatment. The differential effects of IA and carbimazole on HPA function indicate that thyroid hormones have a role in modulation of the HPA axis.
Assuntos
Antitireóideos/farmacologia , Antitireóideos/uso terapêutico , Hipertireoidismo/tratamento farmacológico , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Sistema Hipófise-Suprarrenal/efeitos dos fármacos , Adolescente , Hormônio Adrenocorticotrópico/sangue , Adulto , Antitireóideos/efeitos adversos , Carbimazol/efeitos adversos , Carbimazol/farmacologia , Carbimazol/uso terapêutico , Hormônio Liberador da Corticotropina/farmacologia , Feminino , Humanos , Hidrocortisona/sangue , Hipertireoidismo/sangue , Hipertireoidismo/fisiopatologia , Sistema Hipotálamo-Hipofisário/fisiopatologia , Ácido Iopanoico/farmacologia , Ácido Iopanoico/uso terapêutico , Pessoa de Meia-Idade , Testes de Função Adreno-Hipofisária , Sistema Hipófise-Suprarrenal/fisiopatologia , Tireotropina/sangue , Adulto JovemRESUMO
This paper reports the case of a 21-year-old Afro-Caribbean pregnant woman with hyperthyroidism and hypokalaemic quadriparesis and reviews the literature on the topic. Thyrotoxic periodic paralysis is a very rare condition in the Caribbean. This case reminds West Indian physicians to consider this rare condition in any patient that presents with paralysis.
Assuntos
Hipopotassemia/etiologia , Paralisia/etiologia , Complicações na Gravidez/diagnóstico , Tireotoxicose/complicações , Adulto , Antitireóideos/uso terapêutico , População Negra , Carbimazol/uso terapêutico , Feminino , Humanos , Hipopotassemia/tratamento farmacológico , Potássio/uso terapêutico , Gravidez , Complicações na Gravidez/tratamento farmacológico , Tireotoxicose/diagnóstico , Tireotoxicose/tratamento farmacológicoRESUMO
This paper reports the case of a 21-year-old Afro-Caribbean pregnant woman with hyperthyroidism and hypokalaemic quadriparesis and reviews the literature on the topic. Thyrotoxic periodic paralysis is a very rare condition in the Caribbean. This case reminds West Indian physicians to consider this rare condition in any patient that presents with paralysis
Assuntos
Humanos , Feminino , Gravidez , Adulto , Tireotoxicose , Complicações na Gravidez/diagnóstico , Hipopotassemia/etiologia , Paralisia/etiologia , Antitireóideos , Tireotoxicose , População Negra , Carbimazol/uso terapêutico , Complicações na Gravidez/tratamento farmacológico , Hipopotassemia/tratamento farmacológico , Potássio/uso terapêuticoRESUMO
OBJECTIVES: In children with Graves' disease, the prevalence of osteopenia is unknown, and the possible restoration of bone mass by antithyroid treatment has not been evaluated. The aim of this study was to prospectively evaluate the bone mineral density (BMD) and bone metabolism at diagnosis and after 1 and 2 years of medical treatment. Twenty-six children (19 girls and 7 boys) aged 11 +/- 3.4 years (range 3.4 to 15.3 years) were studied. STUDY DESIGN: BMD of the lumbar spine and proximal femur were measured by dual-energy x-ray absorptiometry. Values were compared with those of healthy children of similar age, sex, and pubertal stage. RESULTS: At diagnosis the mean BMD (standard deviation score [SDS]) was significantly reduced in both sites (P <.001) with a preferential loss of cortical bone (femoral BMD = -1.7 +/- 1.0 SDS) rather than trabecular bone (lumbar spine BMD = -0.8 +/- 1.1 SDS) (P =.003). Severe osteopenia (below -2 SDS) was found in 11 (42%) of 26 patients. Osteocalcin was significantly higher than in the control group (P <.0001), but other bone metabolism markers were normal. During treatment (n = 19) a significant gain in femoral (F = 14.7; P =.001) and lumbar spine (F = 5; P =.02) BMD (SDS) was observed, and none of the patients showed osteopenia. The annual percent change in the BMD values at the femoral (+23% +/- 11% and +6% +/- 4%, respectively, during the first and second years) and lumbar spine (+19% +/- 9% and +6% +/- 5%, respectively, during the first and second years) sites was greater during the first year than during the second year of treatment (P <.02 for femoral, P <.04 for lumbar spine). No significant age difference in BMD SD score or in BMD percent change values was observed. Osteocalcin returned rapidly to normal values, and all other bone metabolism markers remained in the normal range. CONCLUSIONS: In conclusion, severe osteopenia was observed at diagnosis in children with Graves' disease but was rapidly corrected after 1 and 2 years of treatment. Initial reduced bone mass with high bone turnover caused by hyperthyroidism was corrected after 1 year of euthyroid conditions.
Assuntos
Densidade Óssea , Doenças Ósseas Metabólicas/etiologia , Calcificação Fisiológica , Doença de Graves/fisiopatologia , Hipertireoidismo/fisiopatologia , Adolescente , Antitireóideos/uso terapêutico , Carbimazol/uso terapêutico , Criança , Pré-Escolar , Feminino , Doença de Graves/tratamento farmacológico , Doença de Graves/metabolismo , Humanos , Masculino , Estudos ProspectivosRESUMO
Neste artigo säo analisadas as três grandes modalidades terapêuticas do hipertireoidismo - o tratamento clínico, o radioiodo e a cirurgia -, discutindo-se detalhadamente cada uma delas, enfocando seus mecanismos de açäo, vantagens e desvantagens, principais indicaçöes e contra indicaçöes. A abordagem terapêutica também será analisada em grupos especiais como neonatos, crianças e adolescentes, gestantes e idosos
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Adulto , Idoso , Alprenolol/uso terapêutico , Carbimazol/uso terapêutico , Carteolol/uso terapêutico , Doença de Graves/cirurgia , Doença de Graves/tratamento farmacológico , Doença de Graves/radioterapia , Hipertireoidismo/tratamento farmacológico , Hipertireoidismo/radioterapia , Hipertireoidismo/cirurgia , Propranolol/uso terapêutico , Ácido Iopanoico/uso terapêutico , Bócio/cirurgia , Iodeto de Potássio/uso terapêutico , Iodo/uso terapêutico , Ipodato/uso terapêutico , Metimazol/uso terapêutico , Metoprolol/uso terapêutico , Nadolol/uso terapêutico , Propiltiouracila/uso terapêutico , TireoidectomiaAssuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Doença de Graves/tratamento farmacológico , Carbimazol/efeitos adversos , Carbimazol/farmacologia , Carbimazol/uso terapêutico , Doença de Graves/cirurgia , Metimazol/efeitos adversos , Metimazol/farmacologia , Metimazol/uso terapêutico , Prognóstico , Propiltiouracila/efeitos adversos , Propiltiouracila/farmacologia , Propiltiouracila/uso terapêutico , RecidivaRESUMO
Of 17 pregnancies complicated by thyrotoxicosis, detection and treatment commenced in 11 before conception, and in 6 during pregnancy. Treatment consisted of carbimazole alone in 13, and carbimazole and propanolol in 4 pregnancies. There was one abortion in the group treated with carbimazole. In the four pregnancies managed with carbimazole and propanolol, there were two perinatal deaths. There was adequate response with minimal doses of anti-thyroid drugs, supported by clinical assessment and assays of thyroid hormones (AU)
Assuntos
Feminino , Humanos , Recém-Nascido , Hipertireoidismo/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Antitireóideos/uso terapêutico , Carbimazol/uso terapêutico , Quimioterapia Combinada , Gravidez , Propranolol/uso terapêutico , Trinidad e TobagoRESUMO
Since 1946 104 children and adolescents with toxic diffuse goiter have been treated. Sixty-seven were treated with a thioamide for more than 12 months. Remission occurred in 61%. Twenty-five patients had a 12-hour perchlorate discharge test to determine the least frequent dose schedule required for disease control: 68% could be controlled on a single daily dose and an additional 25% on an every 12-hour schedule. A one-hour radioiodine uptake on combined therapy and change in thyroid gland size during treatment were found to be highly correlated with the presence of a spontaneous remission. Thirty-six patients have been treated by subtotal thyroidectomy. To date 65% have developed permanent hypothyroidism. In the author's opinion, thoamides are the treatment of choice for the majority of children and adolescents.
Assuntos
Antitireóideos/uso terapêutico , Doença de Graves/tratamento farmacológico , Adolescente , Antitireóideos/efeitos adversos , Carbimazol/uso terapêutico , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Seguimentos , Doença de Graves/sangue , Doença de Graves/diagnóstico , Humanos , Masculino , Metimazol/uso terapêutico , Percloratos/uso terapêutico , Propiltiouracila/uso terapêutico , Testes de Função Tireóidea , Glândula Tireoide/efeitos dos fármacos , Tireoidectomia , Tiroxina/sangue , Tiroxina/uso terapêuticoRESUMO
The effects of cortisone on thyroid radio-iodine metabolism has been demonstrated in a patient. Two other patients, one euthroid and the other hyperthyroid who were receiving long term treatment with cortisone for rheumatoid arthritis, showed evidence of an enhanced response to cortisone after commencing anti-thyroid therapy with carbimazole