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https://www.readbyqxmd.com/read/28716776/increased-risk-for-thionamide-induced-agranulocytosis-in-elderly-patients-a-case-presentation-and-literature-review
#1
Sumera Bukhari, Muhammad Khan, Naresh Kumar, Vinuta Mohan
Thionamides, such as methimazole and propylthiouracil, are used for the management of hyperthyroidism. Agranulocytosis is a rare adverse effect of thionamides and elderly patients are especially vulnerable. Here we discuss a case of an 80-year-old woman who developed agranulocytosis and pneumonia approximately 4 weeks after starting low dose methimazole therapy. Despite aggressive treatment with broad-spectrum antibiotics and granulocyte colony stimulating factor, she developed multiorgan failure and died. Our goals are to identify risk factors common to elderly patients and hopefully improve outcomes in this population when prescribed thionamides...
July 17, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28702139/ramipril-associated-cholestasis-in-the-setting-of-recurrent-drug-induced-liver-injury
#2
David Forner, Tasha Kulai, Thomas Arnason, Steven E Gruchy, Magnus MacLeod
Aim: Angiotensin-converting enzyme inhibitors (ACEIs) are commonly used to treat hypertension. Although generally well tolerated, the adverse effects of ACEIs include hypotension, cough, acute kidney injury and hyperkalemia. Rare reports of ACEI-induced hepatotoxicity have been described, most notably a cholestatic pattern of injury related to captopril. A 67-year-old male presented to the emergency department with a three-week history of jaundice, pruritis and weakness. Eight weeks before, he began taking ramipril and clopidogrel...
2017: Gastroenterology and Hepatology From Bed to Bench
https://www.readbyqxmd.com/read/28690956/thyrotoxicosis-mimicking-st-elevation-myocardial-infarction
#3
Ingrid Rymer De Marchena, Anna Gutman, Julie Zaidan, Harout Yacoub, Wissam Hoyek
Hyperthyroidism is well known to be associated with cardiac disease. Delay in making the diagnosis and occurrence of complications are common and are associated with a worse outcome. A 54-year-old male, non-smoker, with no past medical history and no significant family history presented to our hospital with severe left sided chest pain, "crushing" in nature. Electrocardiogram showed ST-segment elevations in the inferior leads. Troponin I level was 0.32 ng/mL (normal range 0-0.05 ng/mL) on presentation. The patient underwent an emergent coronary angiography which showed no evidence of occlusive coronary artery disease...
June 7, 2017: Curēus
https://www.readbyqxmd.com/read/28685517/free-thyroxine-anti-thyroid-stimulating-hormone-receptor-antibody-titers-and-absence-of-goiter-were-associated-with-responsiveness-to-methimazole-in-patients-with-new-onset-graves-disease
#4
Hoon Sung Choi, Won Sang Yoo
BACKGROUND: Anti-thyroid drug therapy is considered a treatment of choice for Graves' disease; however, treatment response varies among individuals. Although several studies have reported risk factors for relapse after initial treatment, few have assessed responsiveness during the early treatment period. Our study aimed to identify the clinical characteristics for responsiveness to methimazole. METHODS: We included 99 patients diagnosed with Graves' disease for the first time...
June 2017: Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28679141/impaired-metabolism-of-selenomethionine-in-graves-disease-a-biokinetics-study-of-soft-gel-capsule-formulation
#5
Leonidas H Duntas, Anastasios Boutsiadis, Athanasios Tsakris
Patients with Graves' disease are known to have low selenium (Se) status, Se supplementation resulting in clinical and biochemical improvement. Selenomethionine (SeMet) in a new soft gel capsule formulation was used in a pilot study in 6 patients with acute Graves' disease and low selenium levels (61.3±12.9 μg/l) before and in 4/6 patients 3 months after combined treatment with methimazole and SeMet 200 μg/day (113.3±46.3 μg/l), as well as in 6 euthyroid controls (82±11.8 μg/l). The biokinetics were studied following ingestion of 200 μg SeMet (single dose) soft gel capsule, Se serum concentrations being measured at various time points within 24 h...
July 5, 2017: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
https://www.readbyqxmd.com/read/28671971/effects-of-methimazole-and-propylthiouracil-exposure-during-pregnancy-on-the-risk-of-neonatal-congenital-malformations-a-meta-analysis
#6
Rongjing Song, Hepu Lin, Yue Chen, Xiuying Zhang, Wanyu Feng
OBJECTIVE: The aim of this study was to determine the effect of exposure to different antithyroid drugs during pregnancy on the incidence of neonatal congenital malformations. METHODS: A meta-analysis was performed to compare the incidence of neonatal congenital malformations after exposure to different antithyroid drugs during pregnancy. Twelve studies that met the inclusion criteria were included in this meta-analysis. PubMed, Embase, and CENTRAL databases were searched from inception until January 2017...
2017: PloS One
https://www.readbyqxmd.com/read/28653416/design-of-anti-thyroid-drugs-binding-studies-and-structure-determination-of-the-complex-of-lactoperoxidase-with-2-mercaptoimidazole-at-2-30-%C3%A3-resolution
#7
Harsh V Sirohi, Prashant K Singh, Naseer Iqbal, Pradeep Sharma, Amit K Singh, Punit Kaur, Sujata Sharma, Tej P Singh
Lactoperoxidase (LPO) belongs to mammalian heme peroxidase superfamily which also includes myeloperoxidase (MPO), eosinophil peroxidase (EPO) and thyroid peroxidase (TPO). LPO catalyzes the oxidation of a number of substrates including thiocyanate while TPO catatalyzes the biosynthesis of thyroid hormones. LPO is also been shown to catalyze the biosynthesis of thyroid hormones indicating similar functional and structural properties. The binding studies showed that 2-mercaptoimidazole (MZY) bound to LPO with a dissociation constant of 0...
June 27, 2017: Proteins
https://www.readbyqxmd.com/read/28639966/risk-of-embryopathies-with-use-of-antithyroidal-medications
#8
Stine L Andersen
PURPOSE OF REVIEW: Hyperthyroidism in pregnant women should be adequately treated to prevent maternal and fetal complications. The treatment of choice in pregnancy is antithyroidal medications (ATDs). The risk of embryopathies associated with the use of Methimazole (MMI) and Propylthiouracil (PTU) in early pregnancy is a matter of clinical attention and concern. This review describes current evidence and how scientific findings are reflected in current clinical guidelines. RECENT FINDINGS: Embryopathies after the use of ATDs were previously mainly described in case reports and considered rare...
July 20, 2017: Current Opinion in Endocrinology, Diabetes, and Obesity
https://www.readbyqxmd.com/read/28620500/lugol-s-solution-induced-painless-thyroiditis
#9
Ji Wei Yang, Jacques How
Lugol's solution is usually employed for a limited period for thyroidectomy preparation in patients with Graves' disease and for the control of severe thyrotoxicosis and thyroid storm. We describe a rare case of Lugol's solution-induced painless thyroiditis. In November 2014, a 59-year-old woman was prescribed Lugol's solution four drops per day for the alleviation of menopausal symptoms. She was referred to our clinic in June 2015 for fatigue, hair loss, and a 20-lb weight loss without thyroid pain or discomfort...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/28616438/drug-reaction-with-eosinophilia-and-systemic-symptom-in-a-patient-with-pneumonia-and-hyperthyroidism
#10
Hualiang Jin, Limin Wang, Jian Ye
Drug rash with eosinophilia and systemic symptoms syndrome is an idiosyncratic drug reaction characterized by fever, skin eruption, lymph node enlargement, and internal organ involvement. We report a case of a patient with pneumonia who developed clinical manifestations of fever, rash, lymphadenopathy, hypereosinophilia, and visceral involvement (renal failure and eosinophilic pneumonitis) caused by methimazole. The patient improved remarkably with drug withdrawal. A high index of clinical suspicion is emphasized to facilitate prompt diagnosis of medication-related adverse effect and its discontinuation...
April 2017: Journal of Research in Pharmacy Practice
https://www.readbyqxmd.com/read/28608527/perfect-storm-therapeutic-plasma-exchange-for-a-patient-with-thyroid-storm
#11
Andrea M McGonigle, Aaron A R Tobian, Jennifer L Zink, Karen E King
Thyroid storm is a potentially lethal complication of hyperthyroidism with increased thyroid hormones and exaggerated symptoms of thyrotoxicosis. First-line therapy includes methimazole (MMI) or propylthiouracil (PTU) to block production of thyroid hormones as a bridge toward definitive surgical treatment. Untreated thyroid storm has a mortality rate of up to 30%; this is particularly alarming when patients cannot tolerate or fail pharmacotherapy, especially if they cannot undergo thyroidectomy. Therapeutic plasma exchange (TPE) is an ASFA category III indication for thyroid storm, meaning the optimum role of this therapy is not established, and there are a limited number of cases in the literature...
June 13, 2017: Journal of Clinical Apheresis
https://www.readbyqxmd.com/read/28577555/intake-of-boron-cadmium-and-molybdenum-enhances-rat-thyroid-cell-transformation
#12
Emilia Luca, Laura Fici, Anna Ronchi, Ferdinando Marandino, Esther Diana Rossi, Maria Emiliana Caristo, Pasqualino Malandrino, Marco Russo, Alfredo Pontecorvi, Riccardo Vigneri, Fabiola Moretti
BACKGROUND: Epidemiologic data in volcanic areas suggest that environmental factors might be involved in the increase of thyroid cancer (TC) incidence. Recent reports indicate that several heavy metals and metalloids are increased in volcanic areas. This study aims to evaluate the combined effect of three of these elements Boron (B), Cadmium (Cd), and Molybdenum (Mo) - all increased in the volcanic area of Mt. Etna, in Italy - on thyroid tumorigenesis in the rat. METHODS: Female Wistar rats prone to develop thyroid tumors by low-iodine diet and methimazole treatment received ad libitum drinking water supplemented with B, Cd, and Mo at concentrations in the range found in the urine samples of residents of the volcanic area...
June 2, 2017: Journal of Experimental & Clinical Cancer Research: CR
https://www.readbyqxmd.com/read/28486791/rare-nox3-variants-confer-susceptibility-to-agranulocytosis-during-thyrostatic-treatment-of-graves-disease
#13
T S Plantinga, P Arts, G H Knarren, A H Mulder, I M Wakelkamp, A R Hermus, L A Joosten, M G Netea, P H Bisschop, W W de Herder, H J Beijers, I J de Bruin, C Gilissen, J A Veltman, A Hoischen, J W Smit, R T Netea-Maier
Agranulocytosis is a rare and serious adverse effect of antithyroid drugs, with unknown etiology. The present study aimed to uncover genetic susceptibility and underlying mechanisms of antithyroid drug-induced agranulocytosis (ATDAC). We studied two independent families with familial Graves' disease, of which several members developed ATDAC. In addition, six sporadic ATDAC patients with Graves' disease were investigated. Whole exome sequencing analysis of affected and unaffected family members was performed to identify genetic susceptibility variants for ATDAC, followed by functional characterization of primary granulocytes from patients and unrelated healthy controls...
May 9, 2017: Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28458701/is-herbal-therapy-safe-in-obesity-a-case-of-apium-graveolens-celery-induced-hyperthyroidism
#14
Hojjat Rouhi-Boroujeni, Masih Hosseini, Mojgan Gharipour, Hamid Rouhi-Boroujeni
BACKGROUND: Apium graveolens is one of the well-known herbs used for the treatment of different; however, allergic reactions have been reported after its use. This report aimed to demonstrate the A. graveolens induced hyperthyroidism after its oral consumption for weight loss. CASE REPORT: Mr. A, 48-year-old, with no history of any thyroid diseases, was diagnosed with hyperthyroidism due to daily consumption of 4 g of dried celery leaves for 45 days. After cessation of consumption and treatment with methimazole, the symptoms remitted...
September 2016: ARYA Atherosclerosis
https://www.readbyqxmd.com/read/28458607/novel-application-of-quantitative-single-photon-emission-computed-tomography-computed-tomography-to-predict-early-response-to-methimazole-in-graves-disease
#15
Hyun Joo Kim, Ji-In Bang, Ji-Young Kim, Jae Hoon Moon, Young So, Won Woo Lee
OBJECTIVE: Since Graves' disease (GD) is resistant to antithyroid drugs (ATDs), an accurate quantitative thyroid function measurement is required for the prediction of early responses to ATD. Quantitative parameters derived from the novel technology, single-photon emission computed tomography/computed tomography (SPECT/CT), were investigated for the prediction of achievement of euthyroidism after methimazole (MMI) treatment in GD. MATERIALS AND METHODS: A total of 36 GD patients (10 males, 26 females; mean age, 45...
May 2017: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
https://www.readbyqxmd.com/read/28437154/prediction-of-relapse-from-hyperthyroidism-following-antithyroid-medication-withdrawal-using-technetium-thyroid-uptake-scanning
#16
Manouchehr Nakhjavani, Soraya Abdollahi, Saeed Farzanefar, Mohammadtagi Abousaidi, Alireza Esteghamati, Maryam Naseri, Mohamad Eftekhari, Mehrshad Abbasi
OBJECTIVE: Technetium thyroid uptake (TTU) is not inhibited by antithyroid drugs (ATD) and reflects the degree of thyroid stimulation. We intended to predict the relapse rate from hyperthyroidism based on TTU measurement. METHODS: Out of 44 initially enrolled subjects, 38 patients aged 41.6 ± 14.6 with Graves disease (duration: 84 ± 78 months) completed the study. TTU was performed with 40-second imaging of the neck and mediastinum 20 minutes after injection of 1 mCi technetium-99m pertechnetate...
April 2, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28394842/struma-ovarii-with-hyperthyroidism
#17
Lynn P Ang, Anca M Avram, Richard W Lieberman, Nazanene H Esfandiari
We report the case of a 61-year-old woman with persistent thyrotoxicosis for 7 years despite low thyroidal radioiodine uptake and methimazole treatment. Her initial I whole-body scan (WBS) was read as negative. Upon evaluation in our institution, she remained hyperthyroid after discontinuation of methimazole. Repeat WBS with SPECT/CT revealed low 24-hour thyroidal uptake (RAIU = 2%) and intensely focal radioiodine uptake in a large heterogeneous left pelvic mass, consistent with left adnexal struma ovarii. Resection of this mass confirmed benign struma ovarii...
June 2017: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/28393327/an-observational-study-of-110-elderly-lithium-treated-patients-followed-up-for-6%C3%A2-years-with-particular-reference-to-renal-function
#18
Alberto Bocchetta, Francesca Cabras, Martina Pinna, Antonio Poddighe, Claudia Sardu, Raffaella Ardau, Caterina Chillotti, Maria Del Zompo
BACKGROUND: Recent observational studies have focused on lithium treatment in the elderly, with particular reference to safety in terms of thyroid and renal functions. The purpose of this study was to compare the clinical characteristics of patients starting lithium treatment before (N = 79) or after (N = 31) the age of 65 years. Patients were followed up for 6 years with focus on renal function and prescription of levothyroxine and methimazole. RESULTS: At baseline, median lithium serum concentration was 0...
December 2017: International Journal of Bipolar Disorders
https://www.readbyqxmd.com/read/28381452/management-of-endocrine-disease-arguments-for-the-prolonged-use-of-antithyroid-drugs-in-children-with-graves-disease
#19
REVIEW
Juliane Léger, Jean-Claude Carel
Graves' disease is an autoimmune disorder. It is the leading cause of hyperthyroidism, but is rare in children. Patients are initially managed with antithyroid drugs (ATDs), such as methimazole/carbimazole. A major disadvantage of treatment with ATD is the high risk of relapse, exceeding 70% of children treated for duration of 2 years, and the potential major side effects of the drug reported in exceptional cases. The major advantage of ATD treatment is that normal homeostasis of the hypothalamus-pituitary-thyroid axis may be restored, with periods of drug treatment followed by freedom from medical intervention achieved in approximately 40-50% of cases after prolonged treatment with ATD, for several years, in recent studies...
August 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28357106/persistent-arthralgia-vomiting-and-hypercalcemia-as-the-initial-manifestations-of-hyperthyroidism-a-case-report
#20
Jingfang Liu, Xulei Tang, Jianguo Cheng, Xiaomei Yang, Yan Wang
A 53-year-old woman presented with persistent edema and pain of the metacarpophalangeal and proximal interphalangeal joints and the wrist, knee and ankle joints, with more recent intermittent nausea and vomiting. Treatment for rheumatoid arthritis and osteoarthritis was ineffective. No clinical manifestations typical of hyperthyroidism were observed. The results of the thyroid function tests were as follows: Thyroid-stimulating hormone, 0.003 µIU/ml; triiodothyronine (T3), 4.44 ng/ml;, thyroxine (T4) >30 µg/dl; free T3, 14...
February 2017: Molecular and Clinical Oncology
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