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Thyrotoxicosis

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Thyroid Disease and Reproduction

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Abstract

Thyrotoxicosis results from excess thyroid hormone due to either excess production (hyperthyroidism) or release of preformed thyroid hormone from the gland (thyroiditis). The prevalence of thyrotoxicosis is 1–2% in women and 0.1–0.2% in men. Graves’ disease, which is caused by activating thyrotropin receptor antibodies, is the most common cause of hyperthyroidism. Nodular thyroid disease is the second most common cause with multinodular goiter being more common than toxic adenoma. Thyroiditis is caused by inflammation of the thyroid gland from various etiologies that results in the release of stored thyroid hormone. Classic symptoms of thyrotoxicosis include palpitations, tremor, diaphoresis, restlessness, insomnia, anxiety, heat intolerance, weight loss, and hyperdefecation. Graves’ orbitopathy may also be present in 25–70% of patients with Graves’ disease. Treatment of Graves’ disease and nodular thyroid disease focuses on reducing the symptoms of hyperthyroidism with beta-blockade and decreasing further production of thyroid hormone. The latter can be done with antithyroid drugs (methimazole, propylthiouracil) and/or definitive therapy with radioactive iodine or surgery. On the other hand, treatment of thyroiditis focuses on symptomatic management with beta-blockers and does not require antithyroid drugs. Long-term prognosis is generally favorable if the condition is recognized and treated appropriately.

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Abbreviations

AIT:

Amiodarone-induced thyrotoxicosis

ATA:

American Thyroid Association

ATD:

Antithyroid drugs

FT3:

Free triiodothyronine

FT4:

Free thyroxine

GO:

Graves’ orbitopathy

LFTs:

Liver function tests

MMI:

Methimazole

MNG:

Multinodular goiter

PTU:

Propylthiouracil

RAI:

Radioactive iodine

SSKI:

Saturated solution of potassium iodide

TA:

Toxic adenoma

TBG:

Thyroxine-binding globulin

TFTs:

Thyroid function tests

TMNG :

Toxic multinodular goiter

TRAb:

Thyrotropin receptor antibody

TSH:

Thyroid-stimulating hormone

WBC:

White blood cell

References

  1. Laurberg P, Cerqueira C, Ovesen L, Rasmussen LB, Perrild H, Andersen S, et al. Iodine intake as a determinant of thyroid disorders in populations. Best Pract Res Clin Endocrinol Metab. 2010;24(1):13–27.

    Article  CAS  Google Scholar 

  2. Vanderpump MPJ. The epidemiology of thyroid disease. Br Med Bull. 2011;99(1):39–51.

    Article  Google Scholar 

  3. WHO. Guideline: fortification of food-grade salt with iodine for the prevention and control of iodine deficiency disorders. Geneva: World Health Organization; 2014. [cited 2017 10/4/2017]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK254243/.

    Google Scholar 

  4. Melmed S, Polonsky KS, Reed Larsen P, Kronenberg HM. Williams textbook of endocrinology. 13th ed. Philadelphia: Elsevier Health Sciences; 2016.

    Google Scholar 

  5. Weetman A. Immune reconstitution syndrome and the thyroid. Best Pract Res Clin Endocrinol Metab. 2009;23(6):693–702.

    Article  CAS  Google Scholar 

  6. Thornton J, Kelly S, Harrison R, Edwards R. Cigarette smoking and thyroid eye disease: a systematic review. Eye. 2007;21(9):1135.

    Article  CAS  Google Scholar 

  7. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21(10):1081–125.

    Article  Google Scholar 

  8. Longo D, Fauci A, Kasper D. Harrison’s principles of internal medicine. 18th ed. New York: The McGraw-Hill Company; 2011. Available at: /accessmedicine com/content aspx.

    Google Scholar 

  9. Tonacchera M, Chiovato L, Pinchera A, Agretti P, Fiore E, Cetani F, et al. Hyperfunctioning thyroid nodules in toxic multinodular goiter share activating thyrotropin receptor mutations with solitary toxic adenoma. J Clin Endocrinol Metabol. 1998;83(2):492–8.

    CAS  Google Scholar 

  10. Basaria S, Cooper DS. Amiodarone and the thyroid. Am J Med. 2005;118(7):706–14.

    Article  CAS  Google Scholar 

  11. Wei S, Baloch ZW, LiVolsi VA. Pathology of struma ovarii: a report of 96 cases. Endocr Pathol. 2015;26(4):342–8.

    Article  Google Scholar 

  12. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American thyroid association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343–421.

    Article  Google Scholar 

  13. Rotermund R, Riedel N, Burkhardt T, Matschke J, Schmidt NO, Aberle J, et al. Surgical treatment and outcome of TSH-producing pituitary adenomas. Acta Neurochirurgica. 2017;159(7):1219–26.

    Article  Google Scholar 

  14. Kahaly GJ, Dillmann WH. Thyroid hormone action in the heart. Endocr Rev. 2005;26(5):704–28.

    Article  CAS  Google Scholar 

  15. Devidi M, Buddam A, Dacha S, Rao DS. Atrial fibrillation and its association with endocrine disorders. J Atr Fibrillation. 2014;6(5):959.

    PubMed  PubMed Central  Google Scholar 

  16. Mooradian AD. Asymptomatic hyperthyroidism in older adults. Drugs Aging. 2008;25(5):371–80.

    Article  CAS  Google Scholar 

  17. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin N Am. 1993;22(2):263–77.

    Article  CAS  Google Scholar 

  18. Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin. 2006;35(4):663–86.

    Article  CAS  Google Scholar 

  19. Hiromatsu Y, Eguchi H, Tani J, Kasaoka M, Teshima Y. Graves’ ophthalmopathy: epidemiology and natural history. Intern Med. 2014;53(5):353–60.

    Article  Google Scholar 

  20. Menconi F, Marcocci C, Marinò M. Diagnosis and classification of Graves’ disease. Autoimmun Rev. 2014;13(4):398–402.

    Article  Google Scholar 

  21. Bahn RS. Graves’ ophthalmopathy. N Engl J Med. 2010;362(8):726–38.

    Article  CAS  Google Scholar 

  22. Koulouri O, Moran C, Halsall D, Chatterjee K, Gurnell M. Pitfalls in the measurement and interpretation of thyroid function tests. Best Pract Res Clin Endocrinol Metab. 2013;27(6):745–62.

    Article  CAS  Google Scholar 

  23. Barbesino G, Tomer Y. Clinical utility of TSH receptor antibodies. J Clin Endocrinol Metabol. 2013;98(6):2247–55.

    Article  CAS  Google Scholar 

  24. Samarasinghe S, Meah F, Singh V, Basit A, Emanuele N, Emanuele MA, et al. Biotin interference with routine clinical immunoassays: understand the causes and mitigate the risks. Endocr Pract. 2017;23(8):989–98.

    Article  Google Scholar 

  25. Burch HB, Cooper DS. Management of Graves disease: a review. JAMA. 2015;314(23):2544.

    Article  CAS  Google Scholar 

  26. Cooper DS. Antithyroid drugs. N Engl J Med. 2005;352(9):905–17.

    Article  CAS  Google Scholar 

  27. Weiss M, Hassin D, Bank H. Propylthiouracil-induced hepatic damage. Arch Intern Med. 1980;140(9):1184–5.

    Article  CAS  Google Scholar 

  28. Waseem M, Seshadri KG, Kabadi UM. Successful outcome with methimazole and lithium combination therapy for propylthiouracil-induced hepatotoxicity. Endocr Pract. 1998;4(4):197–200.

    Article  CAS  Google Scholar 

  29. Huang MJ, Liaw Y. Clinical associations between thyroid and liver diseases. J Gastroenterol Hepatol. 1995;10(3):344–50.

    Article  CAS  Google Scholar 

  30. Cooper DS, Kaplan MM, Ridgway EC, Maloof F, Daniels GH. Alkaline phosphatase isoenzyme patterns in hyperthyroidism. Ann Intern Med. 1979;90(2):164–8.

    Article  CAS  Google Scholar 

  31. Carella C, Mazziotti G, Sorvillo F, Piscopo M, Cioffi M, Pilla P, et al. Serum thyrotropin receptor antibodies concentrations in patients with Graves’ disease before, at the end of methimazole treatment, and after drug withdrawal: evidence that the activity of thyrotropin receptor antibody and/or thyroid response modify during the observation period. Thyroid. 2006;16(3):295–302.

    Article  CAS  Google Scholar 

  32. Laurberg P, Wallin G, Tallstedt L, Abraham-Nordling M, Lundell G, Tørring O. TSH-receptor autoimmunity in Graves’ disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study. Eur J Endocrinol. 2008;158(1):69–75.

    Article  CAS  Google Scholar 

  33. McDermott MT, Kidd GS, Dodson LE, Hofeldt FD. Radioiodine-induced thyroid storm: case report and literature review. Am J Med. 1983;75(2):353–9.

    Article  CAS  Google Scholar 

  34. Stan MN, Durski JM, Brito JP, Bhagra S, Thapa P, Bahn RS. Cohort study on radioactive iodine–induced hypothyroidism: implications for Graves’ ophthalmopathy and optimal timing for thyroid hormone assessment. Thyroid. 2013;23(5):620–5.

    Article  CAS  Google Scholar 

  35. Ponto KA, Zang S, Kahaly GJ. The tale of radioiodine and Graves’ orbitopathy. Thyroid. 2010;20(7):785–93.

    Article  CAS  Google Scholar 

  36. Eckstein AK, Plicht M, Lax H, Neuhäuser M, Mann K, Lederbogen S, et al. Thyrotropin receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease. J Clin Endocrinol Metabol. 2006;91(9):3464–70.

    Article  CAS  Google Scholar 

  37. Stan MN, Garrity JA, Bahn RS. The evaluation and treatment of graves ophthalmopathy. Med Clin N Am. 2012;96(2):311–28.

    Article  CAS  Google Scholar 

  38. Lai A, Sassi L, Compri E, Marino F, Sivelli P, Piantanida E, et al. Lower dose prednisone prevents radioiodine-associated exacerbation of initially mild or absent Graves’ orbitopathy: a retrospective cohort study. J Clin Endocrinol Metabol. 2010;95(3):1333–7.

    Article  CAS  Google Scholar 

  39. Stoll SJ, Pitt SC, Liu J, Schaefer S, Sippel RS, Chen H. Thyroid hormone replacement after thyroid lobectomy. Surgery. 2009;146(4):554–60.

    Article  Google Scholar 

  40. Kaykhaei MA, Shams M, Sadegholvad A, Dabbaghmanesh MH, Omrani GR. Low doses of cholestyramine in the treatment of hyperthyroidism. Endocrine. 2008;34(1–3):52–5.

    Article  CAS  Google Scholar 

  41. Muller C, Perrin P, Faller B, Richter S, Chantrel F. Role of plasma exchange in the thyroid storm. Ther Apher Dial. 2011;15(6):522–31.

    Article  CAS  Google Scholar 

  42. Houghton SG, Farley DR, Brennan MD, van Heerden JA, Thompson GB, Grant CS. Surgical management of amiodarone-associated thyrotoxicosis: Mayo Clinic experience. World J Surg. 2004;28(11):1083–7.

    Article  Google Scholar 

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Authors and Affiliations

  1. Duke University Medical Center, Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Durham, NC, USA

    Adva Eisenberg, Rebecca Herbst & Tracy L. Setji

Authors
  1. Adva Eisenberg
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  2. Rebecca Herbst
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  3. Tracy L. Setji
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Correspondence to Adva Eisenberg .

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Editors and Affiliations

  1. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA

    Jennifer L. Eaton

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Eisenberg, A., Herbst, R., Setji, T.L. (2019). Thyrotoxicosis. In: Eaton, J. (eds) Thyroid Disease and Reproduction. Springer, Cham. https://doi.org/10.1007/978-3-319-99079-8_3

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  • DOI: https://doi.org/10.1007/978-3-319-99079-8_3

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