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The management of subclinical hyperthyroidism is controversial, especially in

asymptomatic patients because of limited treatment outcomes evidence.

87–89 Current

guidelines recommend treatment of subclinical hyperthyroidism (TSH levels <0.1

microunits/mL) in patients >65 years, postmenopausal woman not taking

antiresorptive therapy (see Chapter 110, Osteoporosis), and those with cardiac

disease and osteoporosis.

34,87,88 For patients with TSH levels of 0.1 to 0.45

microunits/mL, treatment of patients >65 years of age and those with cardiovascular

disease or hyperthyroid symptoms can be considered.

34 A recent review recommends

RAI or thioamide therapy only if the TSH level is <0.1 microunits/mL in

postmenopausal women, in those 60 years or older, and in patients with a history of

heart disease, osteoporosis, or hyperthyroid symptoms.

89 For patients with TSH

levels of 0.1 to 0.4 microunits/mL, treatment can be considered if they are in the

aforementioned groups; otherwise, therapy is not recommended because TSH

normalization may occur.

In J.C., his thyroid function tests should be repeated. An RAIU and scan should be

obtained to detect any hyperactive areas or nodules that might be responsible for the

suppressed TSH. Because J.C. is generally healthy, treatment can be considered if

there are concerns about cardiac disease or bone loss; otherwise, no therapy is

reasonable based on the available evidence. Close monitoring of thyroid function

tests is recommended every 6 months to 1 year. If hyperthyroid symptoms or changes

in cardiac or bone function occur, then RAI therapy is recommended.

HYPERTHYROIDISM IN PREGNANCY

CASE 52-18

QUESTION 1: N.N., a 32-year-old woman who is 3 months pregnant, is referred for management of her

Graves’ disease. What are the therapeutic ramifications of managing thyrotoxicosis during pregnancy?

Hyperthyroidism develops in 0.02% to 1.4% of pregnant women and often

precedes conception.

217 Symptoms of thyrotoxicosis are typically ameliorated during

the second and third trimesters and exacerbated early in the postpartum period.

Treatment is crucial to prevent damage to the fetus and to maintain the pregnancy.

RAI, chronic iodide therapy, and iodine-containing compounds are contraindicated

during pregnancy because they will cross the placenta to produce fetal goiter and

athyreosis.

217–219 As little as 12 mg/day of iodide has produced neonatal goiter and

death. The long-term use of β-adrenergic blockers should also be avoided because it

is associated with fetal respiratory depression, a small placenta, intrauterine growth

retardation, impaired response to anoxia, and postnatal bradycardia and

hypoglycemia.

217,218 However, if rapid control of hyperthyroidism is required, shortterm use (<1–4 weeks) of propranolol is safe.

102,105,217–219

Iodide use in pregnancy

should be limited to transient preoperative use prior to thyroidectomy or in the

management of thyroid storm.

105,220

Either surgery or thioamide is the treatment of choice for pregnant hyperthyroid

patient. Surgery is safe during the second trimester with adequate preoperative

preparation. During other trimesters, thioamides are preferred because surgery can

precipitate spontaneous abortion. PTU is preferable during the first trimester because

of rare reports of teratogenicity from methimazole, but methimazole is preferred

thereafter to reduce the risks of PTU-associated hepatitis. Both thioamides are

equally effacious,

221 demonstrate similar placental crossing properties,

222 and

produce similar thyroid hormone concentrations in fetal umbilical cord blood

samples.

223 Methimazole has been associated with anecdotal reports of congenital

scalp defects (e.g., aplasia cutis) and an embryopathy syndrome (esophageal and

choanal atresia).

224–227 However, the risks of reversible aplasia cutis were not greater

in women receiving methimazole (e.g., 2.7%) compared to PTU (e.g., 3%) or

hyperthyroid controls (e.g., 6%).

221,224,225 Therefore, methimazole can be considered

throughout pregnancy if there is intolerance or non-adherence to PTU217,218,221

(see

Chapter 49, Obstetric Drug Therapy).

Fetal hypothyroidism and goiter can develop when large doses of thioamides are

administered to the mother, even if the mother is still hyperthyroid.

217,218 Therefore, to

avoid goiter and suppression of the fetal thyroid gland, which begins to function at

about 12 to 14 weeks of gestation, the lowest effective thioamide dose should be

given. Normal FT4

levels occur in >90% of neonates when maternal FT4

is

maintained in the upper third of the normal range (1.5–1.9 ng/L).

105,220 Conversely,

over 30% of neonates exhibit a low FT4 when maternal levels are maintained in the

lower two-thirds of the normal range.

105 Control of maternal hyperthyroidism

increases the risk of fetal hypothyroidism. Start PTU (e.g., maximum of 300 mg/day

in three divided doses) or methimazole (e.g., maximum of 20–30 mg given once

daily) until control is achieved, then taper PTU to 50–150 mg/day, and after the first

trimester, change to 5 to 15 mg/day of methimazole for the remainder of the

pregnancy. In many patients, remission

p. 1064

p. 1065

of Graves’ disease occurs during pregnancy, and some patients can discontinue

thioamides in the second half of pregnancy.

217 Measurement of TRAb levels between

weeks 22 and 26 of gestation can be useful, because disappearance of TRAb

indicates that thioamide therapy may no longer be necessary.

34 Such modest doses of

thioamides provide satisfactory control of maternal hyperthyroidism and should not

cause clinically evident neonatal thyroid dysfunction. Patients requiring more than the

maximum recommended thioamide dosages for control may need to consider the

possibility of surgery in the second trimester.

Nevertheless, a small but significant reduction in neonatal serum T4 occurs even

when small (100–200 mg) doses of PTU are administered during pregnancy to

mothers with Graves’ disease.

217,218,226

It is unclear whether this mild, transient

reduction in serum T4 causes long-term impairment of mental development or is

otherwise detrimental to the newborn. To date, no significant differences in

intellectual development have been noted between children exposed to PTU or

methimazole in utero and their unexposed siblings.

228–230 However, children exposed

in utero to >300 mg/day of PTU had lower IQs.

228,229

Although transient fetal or neonatal hypothyroidism does not appear to be a major

threat to the baby, it is advisable to maintain the mother in a mildly hyperthyroid

state.

217,218 Mild maternal hyperthyroidism appears to be well tolerated, but maternal

hypothyroidism is poorly tolerated by both the mother and the fetus (see Case 52-8,

Question 1). T4

levels should be maintained in the upper third of the normal range to

decrease the risk of fetal hypothyroidism because normal thyroid function tests are

suggestive of hypothyroidism during pregnancy (high TBG and TBPA levels). The

goal of therapy is a suppressed maternal TSH level (0.1–0.4 microunits/mL) because

complete correction maternal hyperthyroidism increases the risk of fetal

hypothyroidism.

34,102

It is not rational to add thyroid hormone to the mother’s regimen to prevent fetal

goiter or hypothyroidism because thyroid hormones do not reach the fetal circulation.

Thyroid supplementation only complicates the treatment of maternal hyperthyroidism

by increasing thioamide requirements, which can further compromise fetal thyroid

hormone production.

217

If the mother has not been thyrotoxic throughout pregnancy, a

normal infant can be expected. All pregnant patients with a history of or active

Graves’ disease should be screened with a TSI during pregnancy to assess the risk of

neonatal hyperthyroidism.

217 Neonatal Graves’ disease occurs in 1% to 5% of infants

born to mothers with the disease; therefore, all newborns should be evaluated for the

condition.

105,220 Lastly, both thioamides can be safely used in the lactating mother if

the maximal dose of methimazole does not exceed 10 to 20 mg daily or less

preferably, if PTU does not exceed 200 mg/day (up to 750 mg/day in one

report).

231,232 Propranolol and iodides are secreted in breast milk and should be

avoided (see Chapter 49, Obstetric Drug Therapy).

Treatment with Radioactive Iodine

PRETREATMENT

CASE 52-19

QUESTION 1: B.J., a 35-year-old woman, has newly diagnosed Graves’ disease complicated by CHF and

angina. After a few days of treatment with methimazole 30 mg daily and Lugol’s solution, 5 drops/day, B.J.

received RAI therapy. Six months later, she is still symptomatic. Evaluate the influence of B.J.’s pretreatment

therapy on the efficacy of her RAI therapy.

Older or debilitated patients with severe hyperthyroidism and/or concomitant

cardiac disease should receive antithyroid pretreatment before RAI therapy to

deplete stored thyroid hormone and minimize post-RAI hyperthyroidism (occurring in

the first 10 days after

131

I administration) and thyroid storm caused by leakage of

hormones from the damaged thyroid gland.

176,192,233 Other hyperthyroid patients can

receive RAI safely without pre-therapy.

Lugol’s solution or other iodides should not be given before RAI because iodides

decrease the gland’s uptake of RAI and its effectiveness. This effect of iodides

persists for several weeks. Iodides can be given 1 to 7 days after RAI treatment if it

is needed to rapidly control symptoms of hyperthyroidism.

Prior to RAI, thioamides achieve a euthyroid state, but pretreatment may lower the

cure rate and increase the need for subsequent RAI.

176,184,234 A meta-analysis of 14

trials found that use of thioamides (e.g., PTU, methimazole, carbimazole) before and

after RAI was associated with an increased risk of treatment failure (relative risk of

1.28; 95% CI, 1.07–1.52) and a 32% reduced risk of hypothyroidism regardless of

the thioamide used.

184 To facilitate optimal uptake and retention of

131RAI by the

gland, thioamides should be stopped at least 2 to 3 days, before RAI

administration.

234–236

If necessary, thioamides can be restarted 3 to 7 days after RAI

administration without impairing its efficacy. β-Adrenergic blocking agents can be

used before, during, and after RAI therapy without interfering with its uptake.

B.J. remains symptomatic because methimazole and iodides decreased RAI’s

efficacy. Propranolol should be given to B.J. before RAI therapy to relieve

hyperthyroid symptoms because only a short course of thioamide was given. Iodides

might be preferable to propranolol following RAI therapy if B.J.’s CHF worsens.

For subsequent RAI doses, methimazole pretreatment should be stopped 2 to 3 days

before RAI, thereby allowing a shorter duration of hyperthyroidism.

ONSET OF EFFECTS

CASE 52-19, QUESTION 2: B.J. is still symptomatic 2 weeks after a second dose of RAI. When can she

expect to experience the therapeutic effects of RAI therapy? What educational precautions about radiation

safety should B.J. receive?

Although some benefits from RAI therapy are evident within 1 month, a period of 6

to 18 weeks is generally required for maximal effects.

164,184,233 Euthyroidism or, more

commonly, hypothyroidism occurs in approximately 80% to 90% of patients treated

with a single nonablative dose of RAI; the remaining 10% to 20% become euthyroid

or hypothyroid after two or more doses. This slow onset is a disadvantage, but

symptomatic control can be obtained quickly by administration of a β-adrenergic

blocking agent, or iodides starting 1 to 14 days after the

131

I dose. Iodides are less

preferable if a second dose of RAI is necessary. Thioamides can also be given,

although their therapeutic effects are delayed for 3 to 4 weeks.

At least 3 months should elapse before a second dose of RAI is administered, and

most recommend waiting 6 months before repeating RAI, unless the patient remains

severely thyrotoxic. It is inadvisable to give a second dose before the major effects

of the first dose have become apparent. Although the use of iodides before RAI in

B.J. may have decreased the amount of

131

I retained by her thyroid, it is still

advisable to wait at least 3 months before a second dose is given.

Safety precautions are not universal and vary across the United States depending

on the dose of RAI administered.

184 B.J. should avoid close contact (e.g. 6 ft) with

children for 5 days, with pregnant women for 10 days, and intimate contact with body

fluids for 5 days. B.J. should avoid airplane travels, public transportation, and work

if contact with others during these activities last more than 2 hours. Other

recommendations include sole use of bathroom facilities; sitting while urinating to

avoid splashing and to flush the toilet twice with the lid down.

p. 1065

p. 1066

IATROGENIC HYPOTHYROIDISM

CASE 52-20

QUESTION 1: S.D., a 54-year-old woman, returns to the thyroid clinic after being lost to follow-up for 6

months. She initially received RAI 3 years ago but required a repeat dose of RAI 1 year ago. She has no other

medical problems and is not taking any medications. She is a mildly obese, puffy-faced woman wearing several

layers of clothing who complains of fatigue and lack of energy. Her reflexes are delayed, and her skin is cool

and dry. What is a likely explanation for her symptoms?

S.D.’s clinical presentation and history are compatible with hypothyroidism

secondary to RAI therapy. A FT4 and a TSH level would confirm this diagnosis.

Iatrogenic hypothyroidism is the major complication of RAI therapy, although

transient hypothyroidism can occur in the first 3 to 6 weeks after therapy.

164 The

incidence of iatrogenic myxedema is often reported as 7% to 8%, but it increases at a

constant rate of 2.5% per year. The reported prevalence of this complication ranges

from 26% to 70% after 1 to 14 years.

233

The best predictor of eventual hypothyroidism is the total dose of RAI

administered. Prevention of iatrogenic hypothyroidism is directed toward calculation

of a dose that will produce neither recurrent hyperthyroidism nor hypothyroidism.

Unfortunately, when lower doses of RAI were used to avoid hypothyroidism, the cure

rate was reduced but the incidence of hypothyroidism was unaffected. Thus, the

appearance of iatrogenic hypothyroidism may be inevitable with time. However,

hypothyroidism is managed easily and is an acceptable therapeutic end point.

Because hypothyroidism after RAI therapy is latent and often insidious, patients

should be informed of this and monitored closely at monthly intervals for subsequent

hypothyroidism. Awareness of a transient hypothyroidism soon after RAI therapy

should minimize the institution of unnecessary hormone replacement.

Ophthalmopathy

CLINICAL PRESENTATION

CASE 52-21

QUESTION 1: H.R., a 50-year-old man, first developed “large eyes with stare” (Figure 52-3), weakness,

diaphoresis, and thyroid enlargement when he was diagnosed with Graves’ disease. RAI therapy caused some

worsening of his eye symptoms. Although he is clinically euthyroid, physical examination reveals severe bilateral

conjunctival edema and injection, proptosis of the right eye, incomplete lid closure, and decreased visual acuity.

He complains of photophobia, tearing, and extreme irritation, which is worse after smoking cigarettes. His other

medical problems include type 2 diabetes treated with metformin and pioglitazone. What is the association of

H.R.’s ocular changes with Graves’ disease?

H.R. presents with symptoms consistent with the infiltrative ophthalmopathy of

Graves’ disease.

237–239 The eye signs of Graves’ disease are the most striking

abnormality of this disorder. Rarely, ophthalmopathy can occur without any evidence

of hyperthyroidism. Fortunately, severe ophthalmopathy occurs in only 3% to 5% of

patients, while 25% to 50% have some eye findings. Eye disease is more severe in

older patients and in men than women. Smokers often have higher levels of TSI and

more severe ophthalmopathy.

212,238,240

It is unknown why the eye and its muscles are attacked in Graves’ disease but is

likely related to the presence of TSH receptor antibodies found in patients with

ophthalmopathy.

239 Histologic examination reveals lymphocytic infiltration, increased

mucopolysaccharides, fat (because of increased adipogenesis and

glycosaminoglycans), and water in all retrobulbar tissue. Ocular symptoms include

edema, chemosis, excessive lacrimation, photophobia, corneal protrusion

(proptosis), scarring, ulceration, extraocular muscle paralysis with loss of eye

movements, and blindness from retinal and optic nerve damage.

Figure 52-3 Graves’ disease ophthalmopathy. (Reprinted with permission from Goodheart HP. Photoguide of

Common Skin Disorders. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.)

The eye involvement can occur at any time and is usually bilateral. The ocular

symptoms usually subside or remain stable once the patient is euthyroid; however,

some cases will progress during the euthyroid period or following RAI treatment of

the hyperthyroidism (see Case 52-21, Question 2). Pioglitazone has been associated

with a 1 to 2 mm increase in eye protrusion by stimulating adipogenesis and

increasing retrobulbar fat production.

241 While eye changes were more common in

people with a history of thyroid disorders, the overall incidence of eye changes

associated with pioglitazone is unknown.

241

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