Hyperthyroidism – American Thyroid Association

Horizon announces TEPEZZA® (teprotumumab-trbw) Has Resumed Production.

ATA — Wed, 21 Apr 2021 22:33:57 +0000

Patients who have been affected by the TEPEZZA supply disruption can talk with their doctor about their plan for starting or resuming treatment and share their plan with their infusion center. Patients can contact their infusion center directly to schedule their infusions or call their Horizon Patient Access Liaison (PAL) if they have questions about the process of starting or resuming treatment. Additional information is available in this FAQ document.

The post Horizon announces TEPEZZA® (teprotumumab-trbw) Has Resumed Production. appeared first on American Thyroid Association.

Thyroid Health Blog: Keeping an Eye Out for Thyroid Eye Disease

ATA — Wed, 17 Mar 2021 18:07:59 +0000

Keeping an Eye Out for Thyroid Eye Disease

Matthew Ettleson, MD
University of Chicago Medicine
Chicago, IL
March 16, 2021

The illustrative example of proptosis may be one of the more memorable images in the medical school textbook, but often the more subtle signs and symptoms of thyroid eye disease (also known as Graves’ orbitopathy or ophthalmopathy) can be overlooked. While severe thyroid eye disease is uncommon, up to 40% of patients with Graves’ disease have some signs or symptoms of thyroid eye disease (1). Most patients with mild eye disease have stable symptoms, but those that develop moderate-to-severe disease may benefit from more aggressive therapies, including glucocorticoids and anti-insulin-like growth factor-1 receptor (IGF-1R) therapy.

The diagnosis of thyroid eye disease relies on a focused history and exam of the eyes. Patients may complain of dry eyes or grittiness, excessive tearing, pain with eye movements and blurry or double vision. Patients may present classically with proptosis and lid retraction, but also redness and swelling of the eye lids or conjunctiva may be present. If several of these findings are present, it suggests the patient has active eye disease and thus may be more responsive to medical therapy. Any concern for visual impairment should prompt urgent evaluation by an endocrinologist and ophthalmologist for a more detailed assessment.

What are first steps to take once the diagnosis of thyroid eye disease is made? The patient’s thyroid function should be assessed and, if abnormal, should be treated promptly. Both hyperthyroid and hypothyroid states can contribute to worsening eye disease. For a patient with newly diagnosed Graves’ disease, this usually begins with antithyroid medication followed by more definite therapy, as discussed in the prior blog post by Dr. Oltmann. It is important to note that radioactive iodine (RAI) therapy has been associated with worsening of thyroid eye disease. Thus, RAI therapy should not be given to those with moderate-to-severe eye disease (2). Cigarette smoking has also been associated with progression of eye disease. For some patients, recognizing that smoking leads to worsening eye symptoms may help convince them it’s finally time to quit!

For patients with mild eye disease, local symptom management is key. Treatment strategies include artificial tears, cool compresses, humidifiers, and sunglasses for protection on excessively sunny or windy days. In over 50% of patients with mild eye disease at the time of diagnosis of Graves’ disease, symptoms will resolve over the following 1-2 years (3).

For those with active, moderate-to-severe disease, a course of pulse doses of IV methylprednisolone is first-line therapy, and can be safely done in the clinic. Often, patients will show improvement within the first 4 weeks of treatment, and most will have a good response after 6 months of therapy. Rarely, long-term glucocorticoid therapy is necessary to prevent clinical worsening. The most promising new therapy for moderate-to-severe disease is teprotumumab, a monoclonal antibody against IGF-1R. Teprotumumab was tested in two clinical trials demonstrating significant improvement in those with severe, active eye disease and was recently approved by the FDA for severe thyroid eye disease (4). In patients who do not respond to glucocorticoids, orbital decompression surgery may be necessary. Finally, after thyroidectomy for definitive treatment of Graves’ disease, there can be thyroid eye disease regression in the year following surgery. Therefore, patients may be able to avoid orbital decompression surgery.

Thyroid eye disease is a common complication of Graves’ disease and can contribute significantly to the morbidity of the disease. However, when recognized, thyroid eye disease in most cases can be treated effectively. This is why it’s so important to keep an eye out for thyroid eye disease!

References:
1. Chin YH, Ng CH, Lee MH, Koh JWH, Kiew J, Yang SP, Sundar G, Khoo CM 2020 Prevalence of thyroid eye disease in Graves’ disease: A meta-analysis and systematic review. Clin Endocrinol (Oxf) 93:363-374.
2. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA 2016 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 26:1343-1421.
3. Tanda ML, Piantanida E, Liparulo L, Veronesi G, Lai A, Sassi L, Pariani N, Gallo D, Azzolini C, Ferrario M, Bartalena L 2013 Prevalence and natural history of Graves’ orbitopathy in a large series of patients with newly diagnosed graves’ hyperthyroidism seen at a single center. J Clin Endocrinol Metab 98:1443-1449.
4. Kahaly GJ 2020 Management of Graves Thyroidal and Extrathyroidal Disease: An Update. J Clin Endocrinol Metab 105.

Disclaimer:
The ideas and opinions expressed on the ATA Blogs do not necessarily reflect those of the ATA. None of the information posted is intended as medical, legal, or business advice, or advice about reimbursement for health care services. The mention of any product, service, company, therapy or physician practice does not constitute an endorsement of any kind by ATA. ATA assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the material contained in, posted on, or linked to this site, or any errors or omissions.

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Thyroid Health Blog: Hyperthyroidism Awareness

ATA — Mon, 16 Nov 2020 17:08:56 +0000

Hyperthyroidism Awareness: Understanding the diagnosis and all treatment options

Sarah Oltmann, MD
University of Texas Southwestern, Dallas, TX
November 16, 2020

November marks hyperthyroidism awareness month, so what a fitting topic to discuss for our Thyroid Health Blog!

It is important to remember that hyperthyroidism can occur at any age. While most may present with a rather typical constellation of symptoms, many may present with exacerbation of pre-existing conditions which may make the diagnosis initially elusive. Worsening anxiety, insomnia, fatigue, panic attacks, palpitations, hypertension or diarrhea may not initially signal that the thyroid is involved. Clinicians must have a low threshold to check thyroid function early to rule out a component of hyperthyroidism.

Once a suppressed thyrotropin (TSH) has been detected, further investigation with serum triiodothyronine (T3) and free thyroxine (free T4) can help delineate overt from subclinical disease. A thorough history of past thyroid disease, as well as current medications and supplements, can help detect any pre-existing diagnoses or exogenous sources of thyroid hormone or over supplementation with iodine. More commonly, hyperthyroidism is due to either Graves disease, toxic multinodular goiter or toxic adenoma. Distinction between these can usually be made with the assistance of a thyroid uptake scan, TSH receptor antibody measurement, and thyroid ultrasound. An additional physical exam finding of exophthalmos can further support the diagnosis of Graves’ disease. Understanding the etiology can help guide patient expectations. A small percentage of patients with Graves’ Disease may undergo spontaneous remission after 1 to 2 years, which may prompt patients to wait before considering a definitive treatment option.

With confirmation of the diagnosis of hyperthyroidism, focus is on hormonal control with an antithyroid medication (ATM, most commonly Methimazole in the United States). This may be augmented with beta-blockade, steroids, cholestyramine or SSKI for those who are difficult to control.

Many patients may need further consideration for definitive management with either radioactive iodine ablation (RAI) or thyroidectomy. Your local resources may also influence these options, but it is critical to understand that all three treatments (ATM, RAI and thyroidectomy) are possible options. Certain patient factors and priorities may alter the preferred definitive treatment. Smaller gland size, easy to control hormones, and lack of eye symptoms are factors that may favor continued ATM management. A large goiter with compressive symptoms, difficult to control hormones requiring high dose medications/ multiple modalities, pregnancy, severe eye disease, multiple nodules within the thyroid with or without thyroid cancer, or desire for rapid and reliable hormone control may favor thyroidectomy. RAI is a good option for patients with a smaller gland size, and a desire to pursue definitive management but avoid surgery.

There are also relative contraindications for treatment options. ATMs may have serious side effects, like agranulocytosis or liver failure, which prevent further use, or may cause skin eruptions making long term use intolerable. Additionally, high dose requirements or fluctuating doses may make long term use of ATMs not reliable. Women who are pregnant, wanting to become pregnant in the next 6 months to 1 year, breast feeding or have small children in the home will want to avoid RAI. Patients with severe eye involvement, have a large goiter with compressive symptoms, or are smokers should also avoid RAI. Thyroidectomy will be a poor option for patients with multiple previous neck operations on or around the thyroid due to internal scarring, or who are high risk for general anesthesia. Additionally, if they have a history of previous gastric bypass surgery, they are higher risk for major complications from hypocalcemia/hypoparathyroidism after thyroidectomy.

To help the patient navigate these decisions, it is important to allow them the opportunity to discuss each treatment option with respective physician experts – medical management with endocrinology, RAI with endocrinology and potentially nuclear medicine as well, and thyroidectomy with the thyroid surgeon.

In summary, patients with hyperthyroidism require medical control, as well as a clear understanding of the etiology of their hyperthyroidism. Patients with Graves disease, toxic multinodular goiter and toxic adenoma have more than one treatment option, and it is important for patients to be educated and engaged in treatment decisions.

For Further Reference:
American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and other causes of Thyrotoxicosis| by the American Thyroid Association

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Disorders of Thyroid Function Presentations at American Thyroid Association: 88th Annual Meeting

ATA — Mon, 01 Oct 2018 22:38:38 +0000

October 2, 2018—The American Thyroid Association (ATA) will hold its 88^th Annual Meeting on October 3‒7, 2018, at the Marriott Marquis in Washington, DC. In addition to the major speeches and awards, a variety of smaller presentations will be accessible to attendees in the form of posters and oral abstracts. One group of these concerns disorders of thyroid function.

1. Dr. Maia Banige will give a presentation titled “Prediction of fetal and neonatal dysthyroidism,” showing how imperfect development and function of the thyroid in fetuses (FD) and newborns (ND) can be predicted from perinatal variables. Dr. Banige is from the Department of Pediatrics-Neonatology and Pediatric Emergency of the French-British Hospital Institute, Levallois-Perret, Ile-de-France.She and her colleagues conducted a retrospective, multicenter study using data from the medical records of all patients monitored for pregnancy from 2007 to 2014 in 10 obstetric centers of the Assistance Publique des Hôpitaux de Paris. Women with Graves’ disease who were positive for thyrotropin receptor antibodies (TRAb) at least once during pregnancy were included. Among 280,000 births, 2,288 medical records of women with thyroid dysfunction were selected and screened, and 417 women with Graves’ disease who were positive for TRAb during pregnancy (0.15%) were finally included in the study.
  Analysis revealed that the TRAb level in the mother and child was the strongest independent predictor of thyroid dysfunction. The risk of FD and ND increases with maternal hormonal imbalance and is also greater in the patients receiving antithyroid drugs (ATDs) during pregnancy. In pregnant women with TRAb levels ≥2.5 IU/L, fetal ultrasound monitoring is essential until delivery. All newborns with TRAb levels ≥6.8 IU/L should be examined by a pediatrician with special attention for thyroid dysfunction.

1. A presentation titled “Pre-conception thyroid stimulating hormone level and risk of preterm birth in over 4.3 million rural Chinese women aged 20-49 years: a population-based cohort study” will be given by Dr. Ying Yang of the National Research Institute for Health and Family Planning and the National Human Genetic Resources Center. Dr. Ying and his colleagues studied the association between the pre-conception thyroid stimulating hormone (TSH) levels of women planning for pregnancy and the risk of preterm births (PTB).Researchers conducted a historical cohort study of 4,320,584 rural reproductive-age women who had participated in free National Free Pre-pregnancy Checkups (NFPC) in 2013-2016 in China. Data on preconception TSH, history of pregnancy and diseases, and other variables were obtained from the physical examination record in NFPC. Successful conception and pregnancy outcomes were documented during the follow-up period, June 2013 to December 2017. PTB is defined as any birth within 28 to 37 weeks of gestational age. Participants who failed to become pregnant within 6 months, suffered from fetal death or stillbirth, or had multiple gestations during the period of study were excluded from the analysis. The data documented 283,854 PTB events (6.57%).
  The study identified a V-shaped relationship between maternal pre-conception TSH levels and PTB risk. Either decreasing or increasing pre-conception TSH levels can significantly increase the risk of preterm birth.

1. Dr. George Kahaly of the Department of Medicine at Johannes Gutenberg University Medical Center in Mainz, Germany, and colleagues have undertaken a three-phase clinical trial of the drug teprotumumab. Results from the first phase—a 24-week randomized, double-masked, placebo-controlled treatment trial of the drug, which is an insulin-like growth-factor-1 receptor inhibitory antibody—were reported in the New England Journal of Medicine (NEJM 2017; 376:1748). Compared with a placebo (69% versus 20%), teprotumumab reduced protopsis (protrusion of the eyeballs) significantly beginning at week 6 and continuing over the 24 weeks of the trial. This second-phase report is an assessment of clinical status at weeks 28 and 72.At week 28 (4 weeks after the treatment period), proptosis response was 73.8% in the teprotumumab group versus 13.3% in controls. At week 72 (48 weeks after treatment), 53% of week 24 teprotumumab proptosis responders maintained ≧ 2 mm improvement relative to baseline. Compared to baseline and placebo, clinical activity also decreased at week 28 and was relatively unchanged in the teprotumumab group at week 72. These results indicate no acute rebound of disease following the 24-week treatment.
  Dr. Kahaly’s group conclude that teprotumumab may represent a disease-modifying therapy in TAO by reducing proptosis and clinical activity, with sustained effects seen in most patients 48 weeks after treatment. In phase 3 of the trial, the research group will investigate whether patients would benefit from longer treatment or retreatment with teprotumumab.

Dr. Mats Holmberg of Institute of Medicine, Sahlgrenska Academy, and the Karolinska University Hospital, ANOVA, both in Stockholm, Sweden, will present a study titled “Structural brain changes in Graves’ hyperthyroidism may be of autoimmune origin.” During the hyperthyroid state of Graves’ disease (GD), the volumes of medial temporal lobe (MTL) structures, e.g., the hippocampi, are reduced. This has been attributed to high thyroid hormone levels, but Dr. Holmberg and his colleagues hypothesized that the structural changes and mental symptoms may be due to autoimmunity per se. The aim of their study was to determine the relationship between nonthyroid autoimmunity and MTL volumes during hyperthyroidism in GD.Dr. Holmberg’s project is a longitudinal, observational, prospective case-controlled study in which 65 premenopausal women were evaluated within 2 weeks after a diagnosis of GD and again after 15 months of antithyroid treatment. Thyroid-stimulating hormone receptor antibodies, thyroid-stimulating immunoglobulins, and several additional antibodies were measured in the hyperthyroid state. MTL structures were scanned to determine hippocampal and amygdala volumes. This presentation reports preliminary data on the nonthyroid antibodies at baseline. Data on the thyroid antibodies will be reported separately.
The data so far support the hypothesis that autoimmunity that is not directly connected to the thyroid may be involved in the impairment of brain function in GD, introducing a new concept that needs further study.

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The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 95^th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health. These efforts are carried out via several key endeavors:

The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
Annual scientific meetings
Biennial clinical and research symposia
Research grant programs for young investigators
Support of online professional, public, and patient educational programs
Development of guidelines for clinical management of thyroid disease and thyroid cancer

The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).

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American Thyroid Association Experts Debate Benefits and Challenges of New ATA Guidelines for Managing Hyperthyroidism and Thyrotoxicosis

ATA — Thu, 19 Jan 2017 23:25:18 +0000

In a stimulating new Roundtable Discussion, a distinguished panel of leading physicians and clinical researchers highlight the key changes, new topics, and areas of ongoing controversy in the “2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis.” The Roundtable Discussion and the American Thyroid Association (ATA) guidelines are available free on the website of Thyroid, the official peer-reviewed journal of the ATA, published by Mary Ann Liebert, Inc., publishers.

Led by Moderator Douglas S. Ross, MD, Harvard Medical School and Massachusetts General Hospital, Boston, the Roundtable features panelists Victor J. Bernet, MD, Mayo Clinic and Mayo Clinic College of Medicine, Jacksonville, FL; David S. Cooper, MD, The Johns Hopkins University School of Medicine, Baltimore, MD; Gilbert Daniels, MD, Harvard Medical School and Massachusetts General Hospital; Jacqueline Jonklaas, MD, PhD, Georgetown University, Washington, DC; John C. Morris, MD, Mayo Clinic, Rochester, MN; Elizabeth N. Pearce, MD, Boston University School of Medicine; Mary Samuels, MD, Oregon Health & Science University, Portland; and Julie Ann Sosa, MD, MA, Duke Cancer Institute and Duke Clinical Research Institute, Duke University, Durham, NC.

The panelists, all members of the American Thyroid Association and some of whom were on the task force that developed the previous management guidelines in 2011, highlighted the major changes in the 2016 guidelines, which included an increase in the number of recommendations from 100 to 124 and an expanded focus on more unusual cases of thyrotoxicosis. The spirited and informative discussion also focused on important changes in the new guidelines, including new paradigms for determining the etiology of thyrotoxicosis, new approaches to monitor response to anti-thyroid drugs such as measures of thyrotropin receptor antibodies, new data supporting the safety of long-term use of anti-thyroid drugs, and new approaches to manage hyperthyroidism in women who want to become pregnant.

“These guidelines provide a significant update compared to the previous version published in 2011 because they integrate recent studies and developments in practice trends. They form a detailed and balanced framework for the diagnosis and management of patients with different etiologies of thyrotoxicosis that is based on the currently available evidence,” says Peter A. Kopp, MD, Editor-in-Chief of Thyroid and Professor of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago.

“The updated guidelines have refined several important aspects of diagnosis and management of patients with hyperthyroidism based upon new knowledge and technology. The panel’s discussion focused upon several of the more common issues regarding application of new recommendations. I found it to be both simulating and informative.” says John C. Morris, MD, President of the American Thyroid Association, Professor of Medicine, Mayo Clinic, Rochester, Minnesota.

The Roundtable was supported by Quidel.

About the Journal
Thyroid, the official journal of the American Thyroid Association, is an authoritative peer-reviewed journal published monthly online with open access options and in print. The Journal publishes original articles and timely reviews that reflect the rapidly advancing changes in our understanding of thyroid physiology and pathology, from the molecular biology of the cell to clinical management of thyroid disorders. Complete tables of content and a sample issue may be viewed on the Thyroid website. The complete Thyroid Journal Program includes the highly valued abstract and commentary publication Clinical Thyroidology, led by Editor-in-Chief Jerome M. Hershman, MD and published monthly, and the groundbreaking videojournal companion VideoEndocrinology, led by Editor Gerard Doherty, MD and published quarterly. Complete tables of content and sample issues may be viewed on the Thyroid website.

About the Society
The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 94^th anniversary, the ATA delivers its mission — of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health — through several key endeavors: the publication of highly regarded professional journals, Thyroid, Clinical Thyroidology, and VideoEndocrinology; annual scientific meetings; research grant programs for young investigators, biennial clinical and research symposia; support of online professional, public and patient educational programs; and the development of guidelines for clinical management of thyroid disease and thyroid cancer. The ATA promotes thyroid awareness and information through its online Clinical Thyroidology for the Public (distributed free of charge to over 11,000 patients and public subscribers) and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet.

About the Publisher
Mary Ann Liebert, Inc., publishers is a privately held, fully integrated media company known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research, including Diabetes Technology & Therapeutics, Journal of Women’s Health, and Metabolic Syndrome and Related Disorders. Its biotechnology trade magazine, Genetic Engineering & Biotechnology News (GEN), was the first in its field and is today the industry’s most widely read publication worldwide. A complete list of the firm’s more than 80 journals, books, and newsmagazines is available on the Mary Ann Liebert, Inc., publishers website.

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American Thyroid Association in the News

ATA — Wed, 28 Sep 2016 22:03:48 +0000

Conference News
From Medscape Diabetes & Endocrinology
Coverage from the American Thyroid Association (ATA) 86th Annual Meeting

Lenvatinib: ‘Real-World’ Therapy for Differentiated Thyroid Cancer – September 23, 2016
Medscape
Nancy A Melville

Congenital Hypothyroidism Diagnosis Often Delayed – September 26, 2016
Medscape
Nancy A Melville

Subclinical Hypothyroidism in Pregnancy: Link to Premature Delivery
Medscape
Nancy A Melville

Long-term Results Support Low-Dose Radioiodine Efficacy for DTC – September 28, 2016
Medscape
Nancy A Melville

TPO-Antibody Positivity Often Falls Below Assay Cutoffs in Pregnancy – September 29, 2016
Medscape
Nancy A Melville

Meeting Highlights from American Thyroid Association 86th Annual Meeting
From EndocrineWeb
Presentation summaries provided to share emerging research and clinical advances in all aspects of thyroid patient care.

Circadian Rhythm Affects Outcome of FNA, May Impact Tumor Growth
Endocrine Web
Kathleen Doheny

Hyperthyroid Disease Linked to Higher Breast Cancer Risk
Endocrine Web
Kathleen Doheny

Managing Thyroid Nodules: Are Guidelines Being Met?
Endocrine Web
Kathleen Doheny

New Insights Regarding Thyroid-Obesity-Cancer Link
Endocrine Web
Kathleen Doheny

Precision Medicine: Evolving Rapidly
Endocrine Web
Kathleen Doheny

RAI: Beyond Evidence-Based Medicine to Manage Thyroid Cancer
Endocrine Web
Kathleen Doheny

Restraint Needed in Treating Thyroid Microcarcinomas
Endocrine Web
Kathleen Doheny

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New Guidelines for Managing Hyperthyroidism and Other Causes of Thyrotoxicosis

ATA — Wed, 17 Aug 2016 18:07:00 +0000

FOR IMMEDIATE RELEASE
FROM MARY ANN LIEBERT, INC., PUBLISHERS

New Rochelle, NY, August 17, 2016—New evidence-based recommendations from the American Thyroid Association (ATA) provide guidance to clinicians in the management of patients with all forms of thyrotoxicosis (excessively high thyroid hormone activity), including hyperthyroidism. Appropriate treatment of thyrotoxicosis requires an accurate diagnosis, and the 124 recommendations presented in the new 2016 Guidelines help define current best practices for patient evaluation, diagnosis, and treatment. The Guidelines, published in Thyroid, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers and the official journal of the ATA, are available free on the Thyroid website.

The “2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis” were coauthored by an international task force of expert clinicians and researchers in the field of thyroidology. Led by Chair Douglas Ross, MD, Massachusetts General Hospital, Boston, MA, the task force provides a solid foundation of knowledge on the scope, potential causes, and clinical consequences of thyrotoxicosis. The Guidelines include recommendations for evaluating patients and diagnosing and managing the different types of disease, how to handle thyrotoxicosis in pregnancy, and how to select and implement the various treatment options such as surgery, radioactivity, and antithyroid drugs.

Christmas Eve Discovery 100 Years Ago is Still Helping Millions

ATA — Tue, 23 Dec 2014 08:42:24 +0000

From Mayo Clinic – Some medical discoveries truly stand the test of time. The case of a dedicated Mayo Clinic chemist is a prime example. Feeling he was on the verge of a breakthrough that could help countless people, Edward Kendall spent Christmas Eve 1914 locked away in his lab. What he accomplished by Christmas morning was a gift to millions, one that is still improving lives 100 years later. Watch video…

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Subclinical Hyperthyroidism Not Associated with Overall or Cardiovascular Mortality

ATA — Thu, 20 Sep 2012 18:00:23 +0000

Falls Church, Virginia. Sep. 20, 2012—Subclinical hyperthyroidism is not associated with overall or cardiovascular mortality, according to new data presented at the 82nd Annual Meeting of the American Thyroid Association (ATA) in Québec City, Québec, Canada.

“Hyperthyroidism is associated with a number of health concerns, chief among them being cardiovascular disease. Though subclinical hyperthyroidism mimics some of the features of classic hyperthyroidism, new data show that a link to cardiovascular disease is not one of them,” said Douglas Forrest, PhD, of the National Institute of Diabetes and Digestive and Kidney Diseases, and Program Co-Chair of the ATA Annual Meeting.

Subclinical hyperthyroidism is a mild form of hyperthyroidism that affects approximately 1-2% of men and women ages 65 and older. Unlike classic hyperthyroidism, in which a person’s thyroid hormones are high, people with subclinical hyperthyroidism have low-levels of thyroid-stimulating hormone (TSH) levels but normal levels of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). The degree to which subclinical hyperthyroidism persists over time as well as its associated health risks were heretofore unknown.

A team of researchers led by Paige Fortinsky, MD, at the University of Pennsylvania Medical Center in Philadelphia thus undertook a study to examine transitions in the thyroid status over a 2–3-year period and determine the risks of cardiovascular and total mortality in older individuals with subclinical hyperthyroidism. They enrolled 5,009 men and women aged 65 and over who were enrolled in the Cardiovascular Health Study and not taking thyroid medications. They identified 70 subjects with subclinical hyperthyroidism (TSH < 0.45 mU/L with a normal free-T4 level) at their first TSH measurement and examined persistence, resolution, and progression of subclinical hyperthyroidism over 2–3 years.

Of the 70 individuals with subclinical hyperthyroidism, 60% were women, 24% were nonwhite, and their mean age was 73.7 years. Among those with subclinical hyperthyroidism who obtained follow-up thyroid testing or were taking thyroid medication at follow-up (n=44), 43% persisted, 41% reversed to normal levels of thyroid hormone, 5% progressed to overt hyperthyroidism, and 11% initiated thyroid medication. Researchers analyses’ found no association between subclinical hyperthyroidism and total or cardiovascular mortality.

About the ATA Annual Meeting   
The 82nd Annual Meeting of the American Thyroid Association is held Sept.19-23, in Québec City, Québec, Canada. This four-day creative and innovative scientific program, chaired by Elizabeth Pearce, MD, Boston Medical Center, and Douglas Forrest, PhD, National Institute of Diabetes and Digestive and Kidney Diseases, carefully balances clinical and basic science sessions on the latest advances in thyroidology. The ATA meeting is designed to offer continuing education for endocrinologists, internists, surgeons, basic scientists, nuclear medicine scientists, pathologists, endocrine fellows and nurses, physician assistants and other health care professionals. Visit www.thyroid.org for more information.

About the ATA   
The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis and treatment of thyroid disorders and thyroid cancer. ATA is an international individual membership organization with over 1,600 members from 43 countries around the world. Celebrating its 89th anniversary, ATA delivers its mission through several key endeavors: the publication of highly regarded monthly journals, THYROID, Clinical Thyroidology and Clinical Thyroidology for Patients; annual scientific meetings; biennial clinical and research symposia; research grant programs for young investigators, support of online professional, public and patient educational programs through www.thyroid.org; and the development of guidelines for clinical management of thyroid disease. Visit www.thyroid.org for more information.

Media Contact  
Bobbi Smith
Executive Director  of the American Thyroid Association
Email: thyroid@thyroid.org
Mobile Phone: 703-772-2462 (texts preferred)

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FAQ: Hyperthyroidism

ATA — Sat, 09 Jun 2012 15:57:26 +0000

What is the thyroid gland?

The thyroid gland located in the neck produces thyroid hormones which help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working normally.

1

Symptoms

What are the symptoms of hyperthyroidism?
Hyperthyroidism refers to any condition in which the body has too much thyroid hormone. Symptoms may include weight loss, nervousness, irritability, increased perspiration, a racing heart, hand tremors, anxiety, difficulty sleeping, increased bowel movements, fine brittle hair, and muscular weakness—especially in the upper arms and thighs. In Graves’ disease, a bulging of one or both eyes may occur.

2

Causes

What causes hyperthyroidism?
The most common cause is Graves’ disease (see Graves’ Disease brochure). Another cause is one or more overactive nodules or lumps in the thyroid, a condition known as toxic nodular or multinodular goiter. Finally, you may temporarily have hyperthyroid symptoms if you have thyroiditis, which causes the gland to leak thyroid hormone, or if you take too much thyroid hormone in tablet form.

3

Diagnosis

How is the diagnosis made?
A physical examination and laboratory tests that measure the amount of thyroid hormone (thyroxine, or T4, and triiodothyronine, or T3) and thyroid-stimulating hormone (TSH) in your blood are necessary. Your doctor may choose to obtain a picture of your thyroid (a thyroid scan). Measurement of antibodies in the blood that attack the thyroid (antithyroid antibodies) may help in diagnosing the cause of hyperthyroidism.

4

Treatment

How is hyperthyroidism treated?
Therapy for hyperthyroidism is generally safe and effective, but no one treatment is best for all patients with hyperthyroidism.

Antithyroid drugs. Methimazole (Tapazole®) or propylthiouracil (PTU) block the thyroid gland’s ability to make new thyroid hormone. These drugs allow prompt control of hyperthyroidism and do not cause permanent damage to the thyroid gland. Allergic reactions occur in about 5% of patients. Rarely (1 in 500 patients), a serious reaction (agranulocytosis) may lower your resistance to infection. If you develop a fever or sore throat while on an antithyroid drug, you should immediately stop taking the drug and have a white blood cell count that day.
Radioactive iodine. Radioiodine, which is administered by mouth, is quickly taken up by overactive thyroid cells and destroys them. The radioiodine that is not taken up by the thyroid cells disappears from the body within days. Radioiodine often takes several weeks to several months to control hyperthyroidism (during which time antithyroid drug treatment may be used to control hyperthyroid symptoms), and occasionally additional radioiodine treatments may be necessary. This is the most common therapy for hyperthyroidism in the United States.
Surgery. Before surgery an antithyroid drug or a beta-blocking drug is taken to control your hyperthyroidism. Major complications of thyroid surgery occur in less than 1% of patients operated on by an experienced thyroid surgeon. During surgery, most of the thyroid gland is removed to control the hyperthyroidism. Damage to the parathyroid glands that control your body’s calcium levels and damage to the nerves that control your vocal cords, which would cause you to have a hoarse voice, are rare.
Beta-blockers. These drugs may be helpful in reducing symptoms of a racing heart, the shakes, and nervousness, even though they do not change the high levels of thyroid hormone in your blood.