2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis

Ross, Douglas S.; Burch, Henry B.; Cooper, David S.; Greenlee, M. Carol; Laurberg, Peter; Maia, Ana Luiza; Rivkees, Scott A.; Samuels, Mary H.; Sosa, Julie Ann; Stan, Marius N.; Walter, Martin A.

doi:10.1089/thy.2016.0229

Cited by 2,136 publications

(2,705 citation statements)

References 673 publications

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“…High-dose glucocorticoids are indicated in the treatment of thyroid storm but are often recommended to decrease T4 to T3 conversion by altering deiodinase activity, with less focus on the potential need for steroid replacement (8).…”

Section: Discussionmentioning

confidence: 99%

Adrenal Crisis Triggered by Endogenous Thyrotoxicosis: Case Series

Mushref¹,

Caldwell²,

Harris³

2018

AACE Clinical Case Reports

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Objective: Describe a group of patients who presented with thyrotoxicosis and were also found to have adrenal insufficiency.Methods: Patient cases were collected over the past year at University of North Carolina at Chapel Hill. Their clinical, laboratory, exam, and imaging findings are presented along with a review of the literature.Results: Four patients presented to the emergency room with thyrotoxicosis and were diagnosed with concomitant adrenal insufficiency; three of the four were found to have adrenal crisis at presentation. Patient 1 was diagnosed with recurrent Graves thyrotoxicosis, then was subsequently diagnosed with secondary adrenal insufficiency due to lymphocytic hypophysitis. Patients 2 through 4 were given a new diagnosis of Graves thyrotoxicosis, then were subsequently found to also have primary adrenal insufficiency. Conclusion:It is important to recognize the possibility of adrenal insufficiency in patients with autoimmune hyperthyroidism who have an atypical presentation. Thyrotoxicosis can trigger adrenal crisis in patients with concomitant adrenal insufficiency; thus, any delay in diagnosis is potentially life threatening. (AACE Clinical Case Rep. 2018;4:e346-e349) Abbreviations: ACTH = adrenocorticotropic hormone; T3 = triiodothyronine; T4 = thyroxine; TSH = thyroid-stimulating hormone

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Section: Discussionmentioning

confidence: 99%

Adrenal Crisis Triggered by Endogenous Thyrotoxicosis: Case Series

Mushref¹,

Caldwell²,

Harris³

2018

AACE Clinical Case Reports

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“…Treatment options for hyperthyroidism in older patients include anti-thyroid drugs, radioiodine therapy and surgery (81). Interestingly, as observed in a prospective observational population-based study of 1036 subjects treated with anti-thyroid drugs or radioiodine, mortality was only increased during periods of thionamide treatment and after radioiodine not resulting in hypothyroidism (82).…”

Section: Hyperthyroidism In the Elderlymentioning

confidence: 98%

MECHANISMS IN ENDOCRINOLOGY: Aging and anti-aging: a Combo-Endocrinology overview

Diamanti-Kandarakis

Dattilo²,

Macut

et al. 2017

European Journal of Endocrinology

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Aging and its underlying pathophysiological background has always attracted the attention of the scientific society. Defined as the gradual, time-dependent, heterogeneous decline of physiological functions, aging is orchestrated by a plethora of molecular mechanisms, which vividly interact to alter body homeostasis. The ability of an organism to adjust to these alterations, in conjunction with the dynamic effect of various environmental stimuli across lifespan, promotes longevity, frailty or disease. Endocrine function undergoes major changes during aging, as well. Specifically, alterations in hormonal networks and concomitant hormonal deficits/excess, augmented by poor sensitivity of tissues to their action, take place. As hypothalamic-pituitary unit is the central regulator of crucial body functions, these alterations can be translated in significant clinical sequelae that can impair the quality of life and promote frailty and disease. Delineating the hormonal signaling alterations that occur across lifespan and exploring possible remedial interventions could possibly help us improve the quality of life of the elderly and promote longevity.

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“…The issues with such treatment are the side-effects of radioiodine, hypothyroidism and the potential carcinogenic effects of radiation. The latest USA guidelines suggest that the aim should be total ablation with replacement thyroid hormone therapy [19]. However, many patients would prefer to be euthyroid without medication for life.…”

Section: Benign Thyroid Diseasementioning

confidence: 99%

“…The American Thyroid Association recommends a fixed activity of 10-15 mCi (370-555 MBq). A 15 mCi (555 MBq) administration results in an 81 % success rate [19]. The EANM guidelines indicate that complete ablation requires an absorbed dose of 200-300 Gy [20].…”

Section: Benign Thyroid Diseasementioning

confidence: 99%