Recurrence of hyperthyroidism in multinodular goiter after long-term drug therapy: A comparison with Graves’ disease

Soestbergen, M. J. M. van; Vijver, J. C. M. Van Der; Graafland, A. D.

doi:10.1007/bf03348807

Cited by 48 publications

(21 citation statements)

References 10 publications

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“…The main factor in the development of hyperthyroidism is time, with TMG being the final phase in its evolution, while nodules acquire autonomy. 1,2,[18][19][20] According to our multivariate analysis, the most characteristic feature of TMG is its greater evolution time. The long preoperative evolution time explains why more than 40% of our patients with TMG had an associated intrathoracic component and a high incidence of compressive symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Surgery is the treatment of choice because it achieves fast and permanent relief of symptoms. 3,4 Most studies have shown that hyperthyroidism produces the highest rate of complications, in the form of hypoparathyroidism (3.8%-14%) or recurrent lesions (4%-13%), [5][6][7] Moreover, it usually occurs in older patients, who often have high surgical risk, which is why alternative nonsurgical therapy is being sought.…”

Section: Introductionmentioning

confidence: 99%

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Results of Surgery for Toxic Multinodular Goiter

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Results of Surgery for Toxic Multinodular Goiter

et al. 2005

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“…All three therapeutic options would be effective in the treatment of patients with Graves’ disease, whereas patients with toxic adenoma or toxic multinodular goitre should have either radioactive iodine therapy or surgery, since these patients rarely go into remission. 54 In patients with toxic nodular goitre, ATDs are generally used to restore euthyroidism before definitive treatment with surgery or radioactive iodine, and infrequently used as long-term treatment when the other two therapies are contraindicated or the patient has a short life expectancy.…”

Section: Treatmentmentioning

confidence: 99%

Hyperthyroidism

2016

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Hyperthyroidism is characterised by increased thyroid hormone synthesis and secretion from the thyroid gland, whereas thyrotoxicosis refers to the clinical syndrome of excess circulating thyroid hormones, irrespective of the source. The most common cause of hyperthyroidism is Graves’ disease, followed by toxic nodular goitre. Other important causes of thyrotoxicosis include thyroiditis, iodine-induced and drug-induced thyroid dysfunction, and factitious ingestion of excess thyroid hormones. Treatment options for Graves’ disease include antithyroid drugs, radioactive iodine therapy, and surgery, whereas antithyroid drugs are not generally used long term in toxic nodular goitre, because of the high relapse rate of thyrotoxicosis after discontinuation. β blockers are used in symptomatic thyrotoxicosis, and might be the only treatment needed for thyrotoxicosis not caused by excessive production and release of the thyroid hormones. Thyroid storm and hyperthyroidism in pregnancy and during the post-partum period are special circumstances that need careful assessment and treatment.

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“…Three treatment options are available for hyperthyroidism: antithyroid drugs, radioiodine-131 (I-131), and thyroidectomy. Antithyroid drugs are highly effective in controlling hyperthyroidism, but are known to have relapse rates up to 70% after 1 year treatment in Graves' disease, whereas toxic multinodular goiter rarely resolves with drug treatment (4). Radioiodine treatment has been widely used as a definitive treatment of hyperthyroidism for over 60 years and has proven to be safe and costeffective (5).…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes after estimated versus calculated activity of radioiodine for the treatment of hyperthyroidism: systematic review and meta-analysis

Rooij¹,

Vandenbroucke²,

Smit³

et al. 2009

European Journal of Endocrinology

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Background: Despite the long experience with radioiodine for hyperthyroidism, controversy remains regarding the optimal method to determine the activity that is required to achieve long-term euthyroidism. Objectives: To compare the effect of estimated versus calculated activity of radioiodine in hyperthyroidism. Design: Systematic review and meta-analysis. Methods: We searched the databases Medline, EMBASE, Web of Science, and Cochrane Library for randomized and nonrandomized studies, comparing the effect of activity estimation methods with dosimetry for hyperthyroidism. The main outcome measure was the frequency of treatment success, defined as persistent euthyroidism after radioiodine treatment at the end of follow-up in the dose estimated and calculated dosimetry group. Furthermore, we assessed the cure rates of hyperthyroidism. Results: Three randomized and five nonrandomized studies, comparing the effect of estimated versus calculated activity of radioiodine on clinical outcomes for the treatment of hyperthyroidism, were included. The weighted mean relative frequency of successful treatment outcome (euthyroidism) was 1.03 (95% confidence interval (CI) 0.91-1.16) for estimated versus calculated activity; the weighted mean relative frequency of cure of hyperthyroidism (eu-or hypothyroidism) was 1.03 (95% CI 0.96-1.10). Subgroup analysis showed a relative frequency of euthyroidism of 1.03 (95% CI 0.84-1.26) for Graves' disease and of 1.05 (95% CI 0.91-1.19) for toxic multinodular goiter. Conclusion: The two main methods used to determine the activity in the treatment of hyperthyroidism with radioiodine, estimated and calculated, resulted in an equally successful treatment outcome. However, the heterogeneity of the included studies is a strong limitation that prevents a definitive conclusion from this meta-analysis.

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Recurrence of hyperthyroidism in multinodular goiter after long-term drug therapy: A comparison with Graves’ disease

Cited by 48 publications

References 10 publications

Results of Surgery for Toxic Multinodular Goiter

Results of Surgery for Toxic Multinodular Goiter

Hyperthyroidism

Clinical outcomes after estimated versus calculated activity of radioiodine for the treatment of hyperthyroidism: systematic review and meta-analysis

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