Thyrotoxicosis: Diagnosis and Treatment
DIAGNOSIS
Laboratory found elevated T4, uptake of radioactive iodine and resin T3.
Radioactive iodine uptake is high and can not be suppressed by the administration of T3.
In toxic nodular goiter, a high uptake of radioactive iodine in the nodule can establish the diagnosis when combined with elevated T4 or T3 and low TSH.
In Graves’ disease is often the thyroid stimulating immunoglobulins (IET) and serum tests for thyroid antibodies (thyroglobulin and microsomes) are also positive.
Radiographic abnormalities are diffuse skeletal demineralization that include or sometimes changes by resorption (osteitis). There may also be osteoarthropathy, especially in the hands (finger clubbing).
Graves’ ophthalmopathy in the CT or MRI of the orbit showed swelling of the extraocular muscles.TREATMENT AND RECOMMENDATIONS
Treatment aims to stop the excessive secretion of thyroid hormone, and there are three methods to achieve it.
1) Medical treatment based on thiourea, iodine, propranolol.
2) Surgery: subtotal thyroidectomy.
3) ablation of the gland with radioactive iodine.
To date, discussing which of the three methods is the choice, although widely accepted subtotal thyroidectomy after adequate preparation. The truth is that the treatment will depend on each patient, taking into account age, history, the desire for reproduction. As the size of the gland, because if there is too big to think of a subtotal thyroidectomy.
Preoperative use of thiouracil and similar drugs:
Propylthiouracil .- It is the least toxic, decreased T4 and requires 4 to 6 weeks to normalize T4. In severe cases of administration of 100 to 200 mg four times daily.
Metamizol (Tapazole): The average dose is 10 to 15 mg every eight hours.
Preoperative use of iodine: 5 to 10 drops of strong solution of iodine (iodine) or saturated solution of potassium iodide.
Propranolol: Can be used as a single agent for the preoperative preparation of patients at doses of 80 to 240 mg daily. It is the fastest way to reverse some of the toxic manifestations of the disease apparently mediated by catecholamines. It should not be used in patients with bronchial asthma.