Toxic Nodular Goiter Medication

  • Author: Anu Bhalla Davis, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Sep 16, 2011
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity, prevent complications, and provide a bridge to definitive therapy.

Next

Antithyroid agents

Class Summary

Inhibition thyroid hormone production. PTU and methimazole are thionamide derivatives. PTU is a thiourea antithyroid drug that blocks the production of thyroid hormones. A high doses, this drug also inhibits the peripheral deiodination of T4 to T3 and is used (1) in the management of hyperthyroidism, including treatment of Graves disease; (2) in the preparation of patients who are hyperthyroid for thyroidectomy; (3) as an adjunct to radioiodine therapy[17] ; and (4) as treatment for thyroid storm. Unlike PTU, methimazole lacks the ability to block peripheral conversion of T4 to T3.

View full drug information

Propylthiouracil

 

Thiourea agent that blocks the synthesis of thyroid hormones and inhibits peripheral deiodination of T4 to T3.

View full drug information

Methimazole (Tapazole)

 

Active moiety of parent compound carbimazole. A thiourea agent that blocks production of thyroid hormones.

Previous
Next

Radioactive iodines

Class Summary

Radioisotopes that decay by beta and gamma emissions are used to destroy autonomously functioning follicular cells of the thyroid gland.

Sodium iodide-131 (Na131 I; Iodotope)

 

Used to treat hyperthyroidism by destroying follicular cells of the thyroid gland. The dose is determined by radioactivity calibration system just prior to administration.

Previous
Next

Beta-adrenergic receptor antagonists

Class Summary

These inhibit chronotropic, inotropic, and vasodilatory responses to beta-adrenergic activity observed in hyperthyroidism.

View full drug information

Propranolol (Inderal)

 

Nonselective, competitive beta-receptor antagonist with no intrinsic sympathetic activity.

Propranolol treats cardiac arrhythmias resulting from hyperthyroidism, controls cardiac and psychomotor manifestations immediately, and blocks conversion of T4 to T3.

View full drug information

Atenolol (Tenormin)

 

Selectively blocks beta-1 receptors with little or no effect on beta-2 types. Atenolol treats cardiac arrhythmias resulting from hyperthyroidism and controls cardiac and psychomotor manifestations within min.

View full drug information

Metoprolol, metoprolol succinate, metoprolol tartrate (Lopressor, Toprol XL)

 

Selective beta-1 – adrenergic receptor blocker that decreases automaticity of contractions. Helps to treat cardiac arrhythmias resulting from hyperthyroidism. Controls cardiac and psychomotor manifestations within min.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Anu Bhalla Davis, MD  Assistant Professor, Department of Internal Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Texas Medical School at Houston

Disclosure: Nothing to disclose.

Coauthor(s)

Philip R Orlander, MD  Assistant Dean for Educational Affairs, Vice-Chair of Medicine for Education, Director and Professor, Division of Endocrinology, University of Texas Health Science Center at Houston

Philip R Orlander, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Diabetes Association, Endocrine Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Asra Kermani, MBBS  Postdoctoral Fellow, Center for Human Nutrition, University of Texas Southwestern Medical School

Asra Kermani, MBBS is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert A Gabbay, MD, PhD  Associate Professor of Medicine, Division of Endocrinology, Diabetes and Metabolism, Laurence M Demers Career Development Professor, Penn State College of Medicine; Director, Diabetes Program, Penn State Milton S Hershey Medical Center; Executive Director, Penn State Institute for Diabetes and Obesity

Robert A Gabbay, MD, PhD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Diabetes Association, and Endocrine Society

Disclosure: Novo Nordisk Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching

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

Kent Wehmeier, MD  Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, St Louis University School of Medicine

Kent Wehmeier, MD is a member of the following medical societies: American Society of Hypertension, Endocrine Society, and International Society for Clinical Densitometry

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. Lado-Abeal J, Palos-Paz F, Perez-Guerra O, et al. Prevalence of mutations in TSHR, GNAS, PRKAR1A and RAS genes in a large series of toxic thyroid adenomas from Galicia, an iodine deficient area in NW Spain. Eur J Endocrinol. Aug 11 2008;[Medline].

  2. Abraham-Nordling M, Törring O, Lantz M, et al. Incidence of hyperthyroidism in Stockholm, Sweden, 2003-2005. Eur J Endocrinol. Jun 2008;158(6):823-7. [Medline].

  3. Basaria S, Salvatori R. Images in clinical medicine. Pemberton's sign. N Engl J Med. Mar 25 2004;350(13):1338. [Medline].

  4. Gabriel EM, Bergert ER, Grant CS, et al. Germline polymorphism of codon 727 of human thyroid-stimulating hormone receptor is associated with toxic multinodular goiter. J Clin Endocrinol Metab. Sep 1999;84(9):3328-35. [Medline]. [Full Text].

  5. Muhlberg T, Herrmann K, Joba W, et al. Lack of association of nonautoimmune hyperfunctioning thyroid disorders and a germline polymorphism of codon 727 of the human thyrotropin receptor in a European Caucasian population. J Clin Endocrinol Metab. Aug 2000;85(8):2640-3. [Medline]. [Full Text].

  6. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. Jan-Feb 2006;12(1):63-102. [Medline].

  7. Cerci C, Cerci SS, Eroglu E, et al. Thyroid cancer in toxic and non-toxic multinodular goiter. J Postgrad Med. Jul-Sep 2007;53(3):157-60. [Medline].

  8. van Soestbergen MJ, van der Vijver JC, Graafland AD. Recurrence of hyperthyroidism in multinodular goiter after long-term drug therapy: a comparison with Graves' disease. J Endocrinol Invest. Dec 1992;15(11):797-800. [Medline].

  9. Bahn Chair 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 Endocrinologists. Thyroid. Jun 2011;21(6):593-646. [Medline].

  10. Allahabadia A, Daykin J, Sheppard MC, et al. Radioiodine treatment of hyperthyroidism-prognostic factors for outcome. J Clin Endocrinol Metab. Aug 2001;86(8):3611-7. [Medline]. [Full Text].

  11. Zingrillo M, Urbano N, Suriano V, et al. Radioiodine treatment of Plummer and multinodular toxic and nontoxic goiter disease by the first approximation dosimetry method. Cancer Biother Radiopharm. Apr 2007;22(2):256-60. [Medline].

  12. Albino CC, Mesa CO Jr, Olandoski M, et al. Recombinant human thyrotropin as adjuvant in the treatment of multinodular goiters with radioiodine. J Clin Endocrinol Metab. May 2005;90(5):2775-80. [Medline].

  13. Duick DS, Baskin HJ. Utility of recombinant human thyrotropin for augmentation of radioiodine uptake and treatment of nontoxic and toxic multinodular goiters. Endocr Pract. May-Jun 2003;9(3):204-9. [Medline].

  14. Adamali HI, Gibney J, O'Shea D, et al. The occurrence of hypothyroidism following radioactive iodine treatment of toxic nodular goiter is related to the TSH level. Ir J Med Sci. Sep 2007;176(3):199-203. [Medline].

  15. Bonnema SJ, Bertelsen H, Mortensen J, et al. The feasibility of high dose iodine 131 treatment as an alternative to surgery in patients with a very large goiter: effect on thyroid function and size and pulmonary function. J Clin Endocrinol Metab. Oct 1999;84(10):3636-41. [Medline].

  16. FDA MedWatch Safety Alerts for Human Medical Products. Propylthiouracil (PTU). US Food and Drug Administration. Accessed: June 3, 2009. [Full Text].

  17. Bonnema SJ, Bennedbaek FN, Veje A, et al. Propylthiouracil before 131I therapy of hyperthyroid diseases: effect on cure rate evaluated by a randomized clinical trial. J Clin Endocrinol Metab. Sep 2004;89(9):4439-44. [Medline]. [Full Text].

  18. Azizi F, Khoshniat M, Bahrainian M, et al. Thyroid function and intellectual development of infants nursed by mothers taking methimazole. J Clin Endocrinol Metab. Sep 2000;85(9):3233-8. [Medline]. [Full Text].

  19. Momotani N, Yamashita R, Makino F, et al. Thyroid function in wholly breast-feeding infants whose mothers take high doses of propylthiouracil. Clin Endocrinol (Oxf). Aug 2000;53(2):177-81. [Medline].

  20. Aeschimann S, Kopp PA, Kimura ET, et al. Morphological and functional polymorphism within clonal thyroid nodules. J Clin Endocrinol Metab. Sep 1993;77(3):846-51. [Medline]. [Full Text].

  21. Aghini-Lombardi F, Antonangeli L, Martino E, et al. The spectrum of thyroid disorders in an iodine-deficient community: the Pescopagano survey. J Clin Endocrinol Metab. Feb 1999;84(2):561-6. [Medline]. [Full Text].

  22. Clark KJ, Cronan JJ, Scola FH. Color Doppler sonography: anatomic and physiologic assessment of the thyroid. J Clin Ultrasound. May 1995;23(4):215-23. [Medline].

  23. Cooper DS. Hyperthyroidism. Lancet. Aug 9 2003;362(9382):459-68. [Medline].

  24. Dumont JE, Lamy F, Roger P, et al. Physiological and pathological regulation of thyroid cell proliferation and differentiation by thyrotropin and other factors. Physiol Rev. Jul 1992;72(3):667-97. [Medline].

  25. Erem C, Kandemir N, Hacihasanoglu A, et al. Radioiodine treatment of hyperthyroidism: prognostic factors affecting outcome. Endocrine. Oct 2004;25(1):55-60. [Medline].

  26. Erickson D, Gharib H, Li H, et al. Treatment of patients with toxic multinodular goiter. Thyroid. Apr 1998;8(4):277-82. [Medline].

  27. Feit H. Thyroid function in the elderly. Clin Geriatr Med. Feb 1988;4(1):151-61. [Medline].

  28. Grubeck-Loebenstein B, Buchan G, Sadeghi R, et al. Transforming growth factor beta regulates thyroid growth. Role in the pathogenesis of nontoxic goiter. J Clin Invest. Mar 1989;83(3):764-70. [Medline]. [Full Text].

  29. Holzapfel HP, Fuhrer D, Wonerow P, et al. Identification of constitutively activating somatic thyrotropin receptor mutations in a subset of toxic multinodular goiters. J Clin Endocrinol Metab. Dec 1997;82(12):4229-33. [Medline]. [Full Text].

  30. Kang AS, Grant CS, Thompson GB, et al. Current treatment of nodular goiter with hyperthyroidism (Plummer's disease): surgery versus radioiodine. Surgery. Dec 2002;132(6):916-23; discussion 923. [Medline].

  31. Koornstra JJ, Kerstens MN, Hoving J, et al. Clinical and biochemical changes following 131I therapy for hyperthyroidism in patients not pretreated with antithyroid drugs. Neth J Med. Nov 1999;55(5):215-21. [Medline].

  32. Kraiem Z, Glaser B, Yigla M, et al. Toxic multinodular goiter: a variant of autoimmune hyperthyroidism. J Clin Endocrinol Metab. Oct 1987;65(4):659-64. [Medline].

  33. Krohn K, Paschke R. Clinical review 133: progress in understanding the etiology of thyroid autonomy. J Clin Endocrinol Metab. Jul 2001;86(7):3336-45. [Medline]. [Full Text].

  34. Lavard L, Sehested A, Brock Jacobsen B, et al. Long-term follow-up of an infant with thyrotoxicosis due to germline mutation of the TSH receptor gene (Met453Thr). Horm Res. 1999;51(1):43-6. [Medline].

  35. Maussier ML, D'Errico G, Putignano P, et al. Thyrotoxicosis: clinical and laboratory assessment. Rays. Apr-Jun 1999;24(2):263-72. [Medline].

  36. Pearce EN, Braverman LE. Hyperthyroidism: advantages and disadvantages of medical therapy. Surg Clin North Am. Jun 2004;84(3):833-47. [Medline].

  37. Reiners C, Schneider P. Radioiodine therapy of thyroid autonomy. Eur J Nucl Med Mol Imaging. Aug 2002;29 Suppl 2:S471-8. [Medline].

  38. Sato K, Miyakawa M, Eto M, et al. Clinical characteristics of amiodarone-induced thyrotoxicosis and hypothyroidism in Japan. Endocr J. Jun 1999;46(3):443-51. [Medline].

  39. Siegel RD, Lee SL. Toxic nodular goiter. Toxic adenoma and toxic multinodular goiter. Endocrinol Metab Clin North Am. Mar 1998;27(1):151-68. [Medline].

  40. Talbot JN, Duron F, Piketty ML, et al. Low thyrotropin (TSH) levels in goiter. Relationship with scintigraphic findings and other biological parameters. Thyroidology. Apr 1989;1(1):39-44. [Medline].

  41. Tonacchera M, Chiovato L, Pinchera A, et al. Hyperfunctioning thyroid nodules in toxic multinodular goiter share activating thyrotropin receptor mutations with solitary toxic adenoma. J Clin Endocrinol Metab. Feb 1998;83(2):492-8. [Medline]. [Full Text].

  42. Tonacchera M, Vitti P, Agretti P, et al. Activating thyrotropin receptor mutations in histologically heterogeneous hyperfunctioning nodules of multinodular goiter. Thyroid. Jul 1998;8(7):559-64. [Medline].

 
Previous
Next
 
Patchy uptake of iodine (123I) in a toxic multinodular goiter.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.