eMedicine Specialties > Endocrinology > Thyroid

Goiter, Diffuse Toxic: Follow-up

Author: Bernard Corenblum, MD, FRCP(C), Professor of Medicine, Director, Endocrine-Metabolic Testing and Treatment Unit, Ovulation Induction Program, Department of Internal Medicine, Division of Endocrinology, University of Calgary, Canada
Coauthor(s): Oluyinka S Adediji, MD, Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama; Paul Killian, MD, Former Chief of Endocrine Service, Former Associate Professor, Department of Internal Medicine, Harlem Hospital, Harlem Hospital Center
Contributor Information and Disclosures

Updated: Jun 4, 2009

Follow-up

Further Inpatient Care

  • Hospitalization is rarely necessary. Severe disease with cardiac or other organ compensation, or thyroid storm may require more intense and controlled therapy.
  • Complications, such as agranulocytosis, may need specialized hospital care.
  • Thyroidectomy, if uncomplicated, requires a short hospital stay from 1-3 days.

Further Outpatient Care

  • Regardless of the therapy used, long-term follow-up is needed to monitor thyroid status, especially with a high risk of becoming hypothyroid in the near and distant future or relapse again into hyperthyroidism.
  • Ophthalmopathy runs its own course, independent of the thyroid course. Although generally benign, it may become symptomatic years after the thyroid status has been rendered normal.

Deterrence/Prevention

  • Cessation of smoking has a beneficial effect on the course of ophthalmopathy.
  • The strong familial nature dictates that first-degree relatives, especially siblings and children, be aware of the increased risk of developing this or associated disorders. Routine testing is not recommended, but consideration for this risk is needed with new symptom development.
  • Associated autoimmune disease in other glands is uncommon but is of increased incidence and may clinically occur at presentation or in the near or distant future. New symptoms dictate consideration for these.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Missed or delayed diagnosis in patients with symptoms dominant in one system
  • Failure to recognize the different presentation in elderly patients
  • Lack of informed consent regarding therapeutic choices, advantages, and risks of each
  • Inadequate monitoring of the disease process and of its treatment
  • Premorbid conditions may modify the symptoms and may continue to be symptomatic even after treatment of the hyperthyroid state. Patient education is important here.
  • Failure to do a pregnancy test before administration of radioiodine or to counsel the patient not to get pregnant soon after
 


More on Goiter, Diffuse Toxic

Overview: Goiter, Diffuse Toxic
Differential Diagnoses & Workup: Goiter, Diffuse Toxic
Treatment & Medication: Goiter, Diffuse Toxic
Follow-up: Goiter, Diffuse Toxic
References
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References

  1. Nakamura H, Noh JY, Itoh K, Fukata S, Miyauchi A, Hamada N. Comparison of methimazole and propylthiouracil in patients with hyperthyroidism caused by Graves' disease. J Clin Endocrinol Metab. Jun 2007;92(6):2157-62. Epub 2007 Mar 27. [Medline].

  2. FDA MedWatch Safety Alerts for Human Medical Products. Propylthiouracil (PTU). US Food and Drug Administration. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm164162.htm. Accessed June 3, 2009.

  3. Vanderpump M. Cardiovascular and cancer mortality after radioiodine treatment of hyperthyroidism. J Clin Endocrinol Metab. Jun 2007;92(6):2033-5. [Medline].

  4. Cawood T, Moriarty P, O'Shea D. Recent developments in thyroid eye disease. BMJ. Aug 14 2004;329(7462):385-90. [Medline].

  5. Cooper DS. Antithyroid drugs. N Engl J Med. Mar 3 2005;352(9):905-17. [Medline].

  6. deGroot LJ, Larsen RP, Hennemann G. The Thyroid and Its Diseases. 1996;371-489.

  7. Franklyn JA, Maisonneuve P, Sheppard M, et al. Cancer incidence and mortality after radioiodine treatment for hyperthyroidism: a population-based cohort study. Lancet. Jun 19 1999;353(9170):2111-5. [Medline].

  8. Mestman JH. Hyperthyroidism in pregnancy. Best Pract Res Clin Endocrinol Metab. Jun 2004;18(2):267-88. [Medline].

  9. Sarlis NJ, Gourgiotis L. Thyroid emergencies. Rev Endocr Metab Disord. May 2003;4(2):129-36. [Medline].

  10. Schwartz KM, Fatourechi V, Ahmed DD, Pond GR. Dermopathy of Graves' disease (pretibial myxedema): long-term outcome. J Clin Endocrinol Metab. Feb 2002;87(2):438-46. [Medline].

  11. Weetman AP. Graves' disease. N Engl J Med. Oct 26 2000;343(17):1236-48. [Medline].

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Further Reading

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Keywords

Graves’ disease, Graves disease, Basedow disease, diffuse toxic goiter, thyroid hormone, overproduction of thyroid hormone, Hashimoto’s thyroiditis, Hashimoto thyroiditis, autoimmune thyroid disease, thyroid gland, hyperthyroidism, apathetic thyrotoxicosis

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Contributor Information and Disclosures

Author

Bernard Corenblum, MD, FRCP(C), Professor of Medicine, Director, Endocrine-Metabolic Testing and Treatment Unit, Ovulation Induction Program, Department of Internal Medicine, Division of Endocrinology, University of Calgary, Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Oluyinka S Adediji, MD, Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama
Oluyinka S Adediji, MD is a member of the following medical societies: American College of Physicians and American Medical Association
Disclosure: Nothing to disclose.

Paul Killian, MD, Former Chief of Endocrine Service, Former Associate Professor, Department of Internal Medicine, Harlem Hospital, Harlem Hospital Center
Paul Killian, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Diabetes Association, and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Steven R Gambert, MD, MACP, Chairman, Department of Medicine, Physician-in-Chief, Sinai Hospital of Baltimore; Professor of Medicine, Program Director, Internal Medicine Program, Johns Hopkins University School of Medicine
Steven R Gambert, MD, MACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American Geriatrics Society, Association of Professors of Medicine, Endocrine Society, and Gerontological Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Yoram Shenker, MD, Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison
Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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