Diffuse Toxic Goiter Follow-up

  • Author: Bernard Corenblum, MD, FRCP(C); Chief Editor: George T Griffing, MD   more...
 
Updated: Jul 25, 2011
 

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.
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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.
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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.
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Patient Education

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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.

Specialty Editor Board

Steven R Gambert, MD  Professor of Medicine, Johns Hopkins University School of Medicine; Director of Geriatric Medicine, University of Maryland Medical Center and R. Adams Cowley Shock Trauma Center

Steven R Gambert, MD 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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.

References

  1. Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinoloigists. Endocr Pract. May-Jun 2011;17(3):456-520. [Medline].

  2. 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].

  3. 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.

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

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

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

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

  8. 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].

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

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

  11. 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].

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

 
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