Q:

How long does a patient need to stay on antithyroid drugs?

waelhammad
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2022-11-18
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A 30-year-old woman presents with complaints of palpitations, tremulousness and weight loss of around 4 kg (despite a good appetite) over the last 2 months. On examination, she is anxious, has a pulse rate of 100/min, warm and moist peripheries, fine tremors of the outstretched hands and a visible goiter. No obvious abnormalities in the eyes. Her last menstrual period was 15 days ago. Her primary care physician orders for laboratory examination which reveals normal hemogram with an erythrocyte sedimentation rate of 25 mm in the first hour. Thyroid stimulating hormone (TSH) <0.001 mIU/L and total T4 28 mg/dL. A diagnosis of thyrotoxicosis is made. She is started on beta-blockers and she is asked to get a technetium uptake scan and review.

How long does a patient need to stay on antithyroid drugs?

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waelhammad
2022-11-18
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Once the patient is rendered euthyroid, the dose of antithyroid drug is tapered and continued for 12–18 months and discontinued if TSH is normal. The reasoning behind the recommendation is that the remission rates are not higher even, if ATD are continued for longer than 18 months. The patient is said to be in remission, if the TSH, TT4 and TT3 are normal one year after discontinuation of ATD. Patients with small goiters, mild disease and negative TSH receptor antibody (TRAb) are more likely to have remission. Males, smokers, patients with large goiters and persistently high TSH receptor antibody have higher relapse rates. Continued low-dose MMI treatment for longer than 12–18 months may be considered in patients not in remission who prefer this approach.

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