DOCSLIB.ORG

New Insights Into Declining Kidney Function in Hyperthyroid Cats After Treatment with 131I

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
New Insights Into Declining Kidney Function in Hyperthyroid Cats After Treatment with 131I NEW INSIGHTS INTO DECLINING KIDNEY FUNCTION IN HYPERTHYROID CATS AFTER TREATMENT WITH 131I Ingrid van Hoek Thesis submitted in fulfillment of the requirements for the degree of doctor (Ph.D.) in Veterinary Sciences, Faculty of Veterinary Medicine, Ghent University, 2008 Promotor: Prof. Dr. S. Daminet Department of Medicine and Clinical Biology of Small Animals Faculty of Veterinary Medicine Ghent University Salisburylaan 133, B-9820, Merelbeke, België This PhD was financed by the Bijzonder Onderzoeks Fonds of Ghent University. The study in § 2.3 was possible through the generous support from Royal Canin S.A., Aimargues, France. Printing and distribution of the thesis was enabled through the support from: Royal Canin S.A., Aimargues, France Janssen Animal Health, Beerse, Belgium Intervet/Schering-Plough Animal Health, Boxmeer, The Netherlands Idexx Laboratories, Hoofddorp, The Netherlands Vetoquinol S.A., Aartselaar, Belgium van Hoek, Ingrid New insights into declining kidney function in hyperthyroid cats after treatment with 131I. Ingrid van Hoek Universiteit Gent, Faculteit Diergeneeskunde Vakgroep Geneeskunde en Klinische Biologie van de Kleine Huisdieren ISBN: 9789058641571 Illustraties: Wiebe en Lisa, Bert van de Wijgert, 2008. “Far too noisy, my dear Mozart. Far too many notes.” Emperor Ferdinand of Austria commenting on "The Marriage of Figaro" 1786 CONTENTS LIST OF ABBREVIATIONS GENERAL INTRODUCTION .......................................................................................... 1 SCIENTIFIC AIMS ............................................................................................................ 7 CHAPTER 1: REVIEW OF THE LITERATURE ....................................................... 11 Adapted from 2 articles: I. van Hoek, K. Peremans, T. Waelbers, E. Vandermeulen, S. Daminet (2007). Non-surgical treatment of feline hyperthyroidism: options and considerations. Vlaams Diergeneeskundig Tijdschrift 76:69-80. and I. van Hoek, S. Daminet. Interactions between thyroid and kidney function in pathological conditions of these organ systems: a review. General and Comparative Endocrinology. In press. 1.1 Thyroid physiology .............................................................................................................. 13 1.2 Feline hyperthyroidism ...................................................................................................... 16 1.3 Treatment of feline hyperthyroidism .............................................................................. 17 1.3.1 Anti-thyroid medication ........................................................................................... 18 1.3.2 Radioactive iodine (131I) ........................................................................................... 19 1.4 Direct and indirect effects of thyroid hormones on kidney function ...................... 20 1.4.1 Cardiac output ............................................................................................................ 21 1.4.2 Systemic vascular resistance .................................................................................... 22 1.4.3 Renal blood flow ........................................................................................................ 23 1.4.4 Renal tubules .............................................................................................................. 24 1.4.5 Glomerular filtration rate .......................................................................................... 25 1.4.6 Proteinuria ................................................................................................................... 28 1.5 Evaluation of kidney function in hyperthyroid cats .................................................... 29 1.5.1 Measurement of glomerular filtration rate .............................................................. 29 1.5.2 Retinol binding protein as an urinary marker ......................................................... 30 1.5.3 Hyperthyroidism and kidney failure ........................................................................ 31 1.5.4 Hyperthyroidism masking co-existing disease....................................................... 33 1.6 Diagnostic challenges with non-thyroidal illness .......................................................... 34 1.6.1 Concurrent hyperthyroidism and CKD ................................................................... 34 1.6.2 Post-treatment renal azotemia and low serum TT4 concentration ...................... 35 1.7 Conclusion ............................................................................................................................. 36 CONTENTS CHAPTER 2: EVALUATION OF GFR TECHNIQUES .............................................. 47 § 2.1 COMPARISON AND REPRODUCIBILITY OF GFR MEASUREMENTS IN YOUNG ADULT AND AGED HEALTHY CATS ............................................................... 51 Adapted from: I. van Hoek, E. Vandermeulen, L. Duchateau, H.P. Lefebvre, S. Croubels, K. Peremans, I. Polis, S. Daminet (2007). Comparison and reproducibility of plasma clearance of exogenous creatinine, exo- iohexol, endo-iohexol and 51Cr-EDTA in young adult and aged healthy cats. Journal of Veterinary Internal Medicine 21:950-958. § 2.2 EVALUATION OF GFR MEASUREMENTS IN HYPERTHYROID CATS BEFORE AND AFTER TREATMENT WITH RADIOIODINE ..................................... 73 Adapted from: I. van Hoek, H.P. Lefebvre, H.S. Kooistra, S. Croubels, D. Binst, K. Peremans, S. Daminet (2008). Plasma clearance of exogenous creatinine, exo-iohexol, and endo-iohexol in hyperthyroid cats before and after treatment with radioiodine. Journal of Veterinary Internal Medicine 22:879-885. § 2.3 EVALUATION OF GFR MEASUREMENTS IN HEALTHY CATS, CATS WITH HYPERTHYROIDISM AND CATS WITH CHRONIC KIDNEY DISEASE 95 Adapted from: I. van Hoek, H.P. Lefebvre, D. Paepe, S. Croubels, V. Biourge, S. Daminet. Plasma clearance of exogenous creatinine, exo-iohexol, and endo-iohexol in healthy cats, cats with hyperthyroidism and cats with chronic kidney disease. Journal of Feline Medicine and Surgery. In review. CHAPTER 3: EVALUATION OF URINARY RETINOL BINDING PROTEIN AS AN EARLY MARKER OF RENAL DAMAGE IN CATS ........................................ 113 § 3.1 VALIDATION OF URINARY RETINOL BINDING PROTEIN IN CATS .... 117 Adapted from: I. van Hoek, S. Daminet, S. Notebaert, I. Janssens, E. Meyer (2008). Immunoassay of urinary retinol binding protein as a putative renal marker in cats. Journal of Immunological Methods 329:208-213. § 3.2 RETINOL BINDING PROTEIN IN SERUM AND URINE OF HYPERTHYROID CATS BEFORE AND AFTER TREATMENT WITH RADIOIODINE .......................................................................................................................... 131 Adapted from: I. van Hoek, E. Meyer, L. Duchateau, K. Peremans, S. Daminet. Retinol binding protein in serum and urine of hyperthyroid cats before and after treatment with radioiodine. Journal of Veterinary Internal Medicine. In review. CONTENTS CHAPTER 4: FOLLOW UP OF KIDNEY FUNCTION IN HYPERTHYROID CATS AFTER TREATMENT WITH RADIOIODINE ............................................. 149 Adapted from: I. van Hoek, H.P. Lefebvre, K. Peremans, E. Meyer, S. Croubels, E. Vandermeulen, H. Kooistra, J.H. Saunders, D. Binst, S. Daminet (2009). Short and long term follow up of glomerular and tubular renal markers of kidney function in hyperthyroid cats after treatment with radioiodine. Domestic Animal Endocrinology 36:45-56. CHAPTER 5: EVALUATION OF rhTSH STIMULATION IN CATS ..................... 181 § 5.1 SERUM THYROXINE AND THYROID SCINTIGRAPHY IN EUTHYROID CATS ............................................................................................................................................ 185 Adapted from: I. van Hoek, K. Peremans, E. Vandermeulen, L. Duchateau, K. Gommeren, S. Daminet. Effect of recombinant human thyroid stimulating hormone on serum thyroxin and thyroid scintigraphy in euthyroid cats. Journal of Feline Medicine and Surgery. In press. § 5.2 COMPARISON BETWEEN HEALTHY CATS, CATS WITH NON- THYROIDAL ILLNESS AND CATS SUSPECTED OF IATROGENIC HYPOTHYROIDISM WITH POST-TREATMENT RENAL AZOTEMIA .............. 201 Adapted from: I. van Hoek, E. Vandermeulen, K. Peremans, S. Daminet. Thyroid stimulation with recombinant human thyrotropin in cats with low serum thyroxin and renal azotemia after treatment of hyperthyroidism with 131I. Journal of Feline Medicine and Surgery. In review. GENERAL DISCUSSION ............................................................................................. 217 1. Evaluation of plasma clearance methods ............................................................. 219 2. Evaluation of urinary RBP as a marker of kidney function ................................ 221 3. Long term effects of 131I treatment on kidney function and possible prediction of post-treatment renal azotemia ......................................................................... 223 4. Evaluation of rhTSH stimulation test to measure thyroid function in cats with post-treatment renal azotemia suspected of iatrogenic hypothyroidism .............. 225 SUMMARY ..................................................................................................................... 229 SAMENVATTING ......................................................................................................... 235 DANKWOORD ..............................................................................................................
Load more

Recommended publications
  • Evaluation of Thyroid to Background Ratios in Hyperthyroid Cats Ann Bettencourt
    Evaluation of Thyroid to Background Ratios in Hyperthyroid Cats Ann Bettencourt Thesis submitted to the faculty of the Virginia Polytechnic Institute and State University in partial fulfillment of the requirements for the degree of Master of Science In Biomedical and Veterinary Sciences Gregory Daniel David Panciera Marti Larson July 2, 2014 Blacksburg, VA Keywords: Pertechnetate, Radioiodine, Thyroid:Background Ratio, Scintigraphy, Feline, Thyroid Evaluation of Thyroid to Background Ratios in Hyperthyroid Cats Ann Bettencourt Abstract Hyperthyroidism is the most common feline endocrinopathy. 131I is the treatment of choice, and over 50,000 cats have been treated using an empirical fixed dose. Better treatment responses could be achieved by tailoring the dose based on the severity of disease. Scintigraphy is the best method to quantify the severity of the disease. Previously established scintigraphic quantitative methods, thyroid to salivary ratio (T:S ratio) and % dose uptake, are the most widely recognized measurements. Recently, the thyroid to background ratio (T:B ratio) has been proposed as an alternate method to assess function and predict 131I treatment response. The purpose of this study was to determine the best location of a background ROI, which should be reflective of blood pool activity. We also hypothesized that the T:B ratio using the determined background ROI would provide improved correlation to T4 when compared to T:S ratio and % dose uptake in hyperthyroid cats. Fifty-six hyperthyroid cats were enrolled. T4 was used as the standard measure of thyroid function and was obtained prior to thyroid scintigraphy and 131I therapy. Blood samples were collected at the time of scintigraphy and radioactivity within the sample was measured.
    [Show full text]
  • Pharmacy Reengineering (PRE) V.0.5 Pre-Release Implementation
    PHARMACY REENGINEERING (PRE) Version 0.5 Pre-Release Implementation Guide PSS*1*129 & PSS*1*147 February 2010 Department of Veterans Affairs Office of Enterprise Development Revision History Date Revised Patch Description Pages Number 02/2010 All PSS*1*147 Added Revision History page. Updated patch references to include PSS*1*147. Described files, fields, options and routines added/modified as part of this patch. Added Chapter 5, Additive Frequency for IV Additives, to describe the steps needed to ensure correct data is in the new IV Additive REDACTED 01/2009 All PSS*1*129 Original version REDACTED February 2010 Pharmacy Reengineering (PRE) V. 0.5 Pre-Release i Implementation Guide PSS*1*129 & PSS*1*147 Revision History (This page included for two-sided copying.) ii Pharmacy Reengineering (PRE) V. 0.5 Pre-Release February 2010 Implementation Guide PSS*1*129 & PSS*1*147 Table of Contents Introduction ................................................................................................................................. 1 Purpose ....................................................................................................................................1 Project Description ....................................................................................................................1 Scope ........................................................................................................................................3 Menu Changes ..........................................................................................................................4
    [Show full text]
  • Fate of Sodium Pertechnetate-Technetium-99M
    JOURNAL OF NUCLEAR MEDICINE 8:50-59, 1967 Fate of Sodium Pertechnetate-Technetium-99m Dr. Muhammad Abdel Razzak, M.D.,1 Dr. Mahmoud Naguib, Ph.D.,2 and Dr. Mohamed El-Garhy, Ph.D.3 Cairo, Egypt Technetium-99m is a low-energy, short half-life iostope that has been recently introduced into clinical use. It is available as the daughter of °9Mowhich is re covered as a fission product or produced by neutron bombardement of molyb denum-98. The aim of the present work is to study the fate of sodium pertechnetate 9OmTc and to find out any difference in its distribution that might be caused by variation in the method of preparation of the parent nuclide, molybdenum-99. MATERIALS & METHODS The distribution of radioactive sodium pertechnetate milked from 99Mo that was obtained as a fission product (supplied by Isocommerz, D.D.R.) was studied in 36 white mice, weighing between 150 and 250 gm each. Normal isotonic saline was used for elution of the pertechnetate from the radionuclide generator. The experimental animals were divided into four equal groups depending on the route of administration of the radioactive material, whether intraperitoneal, in tramuscular, subcutaneous or oral. Every group was further subdivided into three equal subgroups, in order to study the effect of time on the distribution of the pertechnetate. Thus, the duration between administration of the radio-pharma ceutical and sacrificing the animals was fixed at 30, 60 and 120 minutes for the three subgroups respectively. Then the animals were dissected and the different organs taken out.Radioactivityin an accuratelyweighed specimen from each organ was estimated in a scintillation well detector equipped with one-inch sodium iodide thallium activated crystal.
    [Show full text]
  • Package Insert TECHNETIUM Tc99m GENERATOR for the Production of Sodium Pertechnetate Tc99m Injection Diagnostic Radiopharmaceuti
    NDA 17693/S-025 Page 3 Package Insert TECHNETIUM Tc99m GENERATOR For the Production of Sodium Pertechnetate Tc99m Injection Diagnostic Radiopharmaceutical For intravenous use only Rx ONLY DESCRIPTION The technetium Tc99m generator is prepared with fission-produced molybdenum Mo99 adsorbed on alumina in a lead-shielded column and provides a means for obtaining sterile pyrogen-free solutions of sodium pertechnetate Tc99m injection in sodium chloride. The eluate should be crystal clear. With a pH of 4.5-7.5, hydrochloric acid and/or sodium hydroxide may have been used for Mo99 solution pH adjustment. Over the life of the generator, each elution will provide a yield of > 80% of the theoretical amount of technetium Tc99m available from the molybdenum Mo99 on the generator column. Each eluate of the generator should not contain more than 0.0056 MBq (0.15 µCi) of molybdenum Mo99 per 37 MBq, (1 mCi) of technetium Tc99m per administered dose at the time of administration, and not more than 10 µg of aluminum per mL of the generator eluate, both of which must be determined by the user before administration. Since the eluate does not contain an antimicrobial agent, it should not be used after twelve hours from the time of generator elution. PHYSICAL CHARACTERISTICS Technetium Tc99m decays by an isomeric transition with a physical half-life of 6.02 hours. The principal photon that is useful for detection and imaging studies is listed in Table 1. Table 1. Principal Radiation Emission Data1 Radiation Mean %/Disintegration Mean Energy (keV) Gamma-2 89.07 140.5 1Kocher, David C., “Radioactive Decay Data Tables,” DOE/TIC-11026, p.
    [Show full text]
  • Survey of the Actual Administration of Thiamazole for Hyperthyroidism in Japan by the Japan Thyroid Association
    doi:10.1507/endocrj.EJ21-0238 Original Survey of the actual administration of thiamazole for hyperthyroidism in Japan by the Japan Thyroid Association Natsuko Watanabe, Jaeduk Yoshimura Noh, Takashi Akamizu, Masanobu Yamada and the study group members of the Japan Thyroid Association The Japan Thyroid Association, Tokyo, Japan Abstract. To clarify the actual administration of thiamazole (MMI), the first choice of antithyroid drugs, the actual therapy provided by the Japan Thyroid Association (JTA) members for the following conditions was surveyed. The subjects included adult patients, pregnant women, and pediatric patients with Graves’ disease who visited each medical institution from September 2019 to February 2020. Initial doses, frequency of administration, maintenance doses, maximum doses, consultation intervals for pregnant women, and dosages administrated to breastfeeding mothers were surveyed. The total number of cases collected was 11,663. Administration of 15 mg once a day was the most common initial therapy, constituted 74.4% (2,526/3,397 cases) of adults, 33.8% (44/130) of pregnant women, and 50.8% (61/120) of children. The maintenance dose before discontinuation was equivalent to 2.5 mg/day in 52.3% (3,147/6,015). The most common maximum dose for adults and children was 30 mg/day, administrated to 57.5% of adults (223/388) and 59.6% (28/47) of children; for pregnant women, it was 15 mg/day, administrated to 71.1% (27/38). The most common consultation interval for pregnant women was every four weeks (32.1%, 341/1,063). In lactating mothers, the dose was 10 mg/day or less in 366 of 465 cases (78.7%).
    [Show full text]
  • Resistance to Thyroid Hormone with a Mutation of the Thyroid B Receptor
    Case report/opis przypadku Endokrynologia Polska DOI: 10.5603/EP.a2018.0082 Tom/Volume 70; Numer/Number 1/2019 ISSN 0423–104X Resistance to thyroid hormone with a mutation of the thyroid b receptor gene in an eight-month-old infant — a case report Zespół oporności na hormony tarczycy spowodowany mutacją w genie kodującym podjednostkę b receptora hormonów tarczycy u 8-miesięcznego niemowlęcia: opis przypadku Elżbieta Foryś-Dworniczak, Carla Moran, Barbara Kalina-Faska, Ewa Małecka-Tendera, Agnieszka Zachurzok Department of Paediatrics and Paediatric Endocrinology, School of Medicine in Katowice, Katowice, Poland Abstract Introduction: Resistance to thyroid hormone (RTHb) is a rare syndrome of impaired tissue responsiveness to thyroid hormones (THs). The disorder has an autosomal dominant or recessive pattern of inheritance. Most of the reported mutations have been detected in the thyroid hormone receptor b gene (THRB). Case report: Authors present an eight-month-old infant with poor linear growth, decreased body weight, tachycardia, positive family history, and neonatal features suggestive of RTHb. Both our patient and his mother had elevated free thyroxine, free triiodothyronine, and non-suppressed thyrotropin (TSH) concentration. The fluorescent sequencing analysis showed a heterozygous mutation c.728G>A in TRb gene. This pathogenic variant is known to be associated with THR. Conclusions: The clinical presentation of RTHb is variable, ranging from isolated biochemical abnormalities to symptoms of thyrotoxicosis or hypothyroidism. The
    [Show full text]
  • EANM Practice Guideline/SNMMI Procedure Standard for RAIU and Thyroid Scintigraphy
    European Journal of Nuclear Medicine and Molecular Imaging (2019) 46:2514–2525 https://doi.org/10.1007/s00259-019-04472-8 GUIDELINES EANM practice guideline/SNMMI procedure standard for RAIU and thyroid scintigraphy Luca Giovanella 1,2 & Anca M. Avram3 & Ioannis Iakovou4 & Jennifer Kwak5 & Susan A. Lawson3 & Elizabeth Lulaj6 & Markus Luster7 & Arnoldo Piccardo8 & Matthias Schmidt9 & Mark Tulchinsky10 & Frederick A. Verburg7 & Ely Wolin11 Received: 11 July 2019 /Accepted: 29 July 2019 / Published online: 7 August 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Introduction Scintigraphic evaluation of the thyroid gland enables determination of the iodine-123 iodide or the 99mTc-pertechnetate uptake and distribution and remains the most accurate method for the diagnosis and quantification of thyroid autonomy and the detection of ectopic thyroid tissue. In addition, thyroid scintigraphy and radioiodine uptake test are useful to discriminate hyperthyroidism from destructive thyrotoxicosis and iodine-induced hyperthyroidism, respectively. Methods Several radiopharmaceuticals are available to help in differentiating benign from malignant cytologically indeterminate thyroid nodules and for supporting clinical decision-making. This joint practice guideline/procedure standard from the European Association of Nuclear Medicine (EANM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) provides recommendations based on the available evidence in the literature. Conclusion The purpose of this practice guideline/procedure standard is to assist imaging specialists and clinicians in recommending, performing, and interpreting the results of thyroid scintigraphy (including positron emission tomography) with various radiopharmaceuticals and radioiodine uptake test in patients with different thyroid diseases. Keywords Thyroid . Scintigraphy . Radioiodine uptake test . 99mTc-sestaMIBI, 18F-fluorodeoxyglucose Preamble approval of the Committee on Guidelines and Board of Directors of both organizations.
    [Show full text]
  • Hypothyroidism
    Hypothyroidism Alejandro Diaz, MD,*† Elizabeth G. Lipman Diaz, PhD, CPNP‡ *Miami Children’s Hospital, Miami, FL †The Herbert Wertheim College of Medicine, Florida International University, Miami, FL ‡University of Miami School of Nursing and Health Studies, Miami, FL Educational Gap Congenital hypothyroidism is one the most common causes of preventable intellectual disability. Awareness that not all cases are detected by the newborn screening is important, particularly because early diagnosis and treatment are essential in preserving cognitive abilities. Objectives After completing this article, readers should be able to: 1. Identify the causes of congenital and acquired hypothyroidism in infants and children. 2. Interpret an abnormal newborn screening result and understand indications for further evaluation and treatment. 3. Recognize clinical signs and symptoms of hypothyroidism. 4. Understand the importance of early diagnosis and treatment of congenital hypothyroidism. 5. Understand the presentation, diagnostic process, treatment, and prognosis of Hashimoto thyroiditis. 6. Differentiate thyroid-binding globulin deficiency from central hypothyroidism. AUTHOR DISCLOSURE Drs Diaz and Lipman Diaz have disclosed no financial relationships 7. Identify sick euthyroid syndrome and other causes of abnormal thyroid relevant to this article. This commentary does function test results. not contain a discussion of an unapproved/ investigative use of a commercial product/ device. ABBREVIATIONS CH congenital hypothyroidism BACKGROUND FT3 free triiodothyronine FT4 free thyroxine The thyroid gland produces hormones that have important functions related to energy HT Hashimoto thyroiditis metabolism, control of body temperature, growth, bone development, and maturation LT4 levothyroxine of the central nervous system, among other metabolic processes throughout the body. rT3 reverse triiodothyronine The thyroid gland develops from the endodermal pharynx.
    [Show full text]
  • IRENAT 300 Mg/Ml, Solution Buvable En Gouttes
    1. NAME OF THE MEDICINAL PRODUCT Irenat Drops 300 mg sodium perchlorate, oral drops Sodium perchlorate monohydrate 2. QUALITATIVE AND QUANTITATIVE COMPOSITION 1 ml solution (approximately 15 drops) contains 344.2 mg sodium perchlorate monohydrate (equivalent to 300 mg sodium perchlorate) For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Oral drops 4. CLINICAL PARTICULARS 4.1 Therapeutic indications For the treatment of hyperthyroidism, for thyroid blockade in the context of radionuclide studies of other organs using radioactively labelled iodine or of immunoscintigraphy to detect tumours using antibodies labelled with radioiodine. For the detection of a congenital iodine organification defect (perchlorate discharge test). 4.2 Posology and method of administration Posology Adults receive 4-5 x 10 Irenat drops daily (equivalent to 800-1000 mg sodium perchlorate) or, exceptionally, 5 x 15 Irenat drops daily (equivalent to 1500 mg sodium perchlorate) as an initial dose for the first 1-2 weeks. The mean maintenance dose is 4 x 5 Irenat drops (equivalent to 400 mg sodium perchlorate) per day. Children between the ages of 6 and 14 are treated throughout with a dose of 3-6 x 1 or 4-6 x 2 Irenat drops (equivalent to 60-240 mg sodium perchlorate) daily. When used for the perchlorate discharge test following administration of the dose of radioiodine tracer, a single dose is given of 30-50 Irenat drops (equivalent to 600-1000 mg sodium perchlorate) or 300 mg-600 mg/m 2 body surface area in children. As pretreatment for radionuclide studies not involving the thyroid itself and using radioactively labelled drugs or antibodies containing iodine or technetium, Irenat drops should be administered at doses of 10 – 20 drops (equivalent to 200-400 mg sodium perchlorate) and, in isolated cases, up to 50 drops (equivalent to 1000 mg sodium perchlorate) so as to reduce exposure of the thyroid to radiation and to block uptake of radionuclide into certain compartments.
    [Show full text]
  • Neo-Mercazole
    NEW ZEALAND DATA SHEET 1 NEO-MERCAZOLE Carbimazole 5mg tablet 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains 5mg of carbimazole. Excipients with known effect: Sucrose Lactose For a full list of excipients see section 6.1 List of excipients. 3 PHARMACEUTICAL FORM A pale pink tablet, shallow bi-convex tablet with a white centrally located core, one face plain, with Neo 5 imprinted on the other. 4 CLINICAL PARTICULARS 4.1 Therapeutic indications Primary thyrotoxicosis, even in pregnancy. Secondary thyrotoxicosis - toxic nodular goitre. However, Neo-Mercazole really has three principal applications in the therapy of hyperthyroidism: 1. Definitive therapy - induction of a permanent remission. 2. Preparation for thyroidectomy. 3. Before and after radio-active iodine treatment. 4.2 Dose and method of administration Neo-Mercazole should only be administered if hyperthyroidism has been confirmed by laboratory tests. Adults Initial dosage It is customary to begin Neo-Mercazole therapy with a dosage that will fairly quickly control the thyrotoxicosis and render the patient euthyroid, and later to reduce this. The usual initial dosage for adults is 60 mg per day given in divided doses. Thus: Page 1 of 12 NEW ZEALAND DATA SHEET Mild cases 20 mg Daily in Moderate cases 40 mg divided Severe cases 40-60 mg dosage The initial dose should be titrated against thyroid function until the patient is euthyroid in order to reduce the risk of over-treatment and resultant hypothyroidism. Three factors determine the time that elapses before a response is apparent: (a) The quantity of hormone stored in the gland. (Exhaustion of these stores usually takes about a fortnight).
    [Show full text]
  • Summary of Product Characteristics
    Health Products Regulatory Authority Summary of Product Characteristics 1 NAME OF THE MEDICINAL PRODUCT Ultra-TechneKow FM 2.15-43.00 GBq radionuclide generator 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Sodium pertechnetate (99mTc) injection is produced by means of a (99Mo/99mTc) generator. Technetium (99mTc) decays with the emission of gamma radiation with a mean energy of 140 keV and a half-life of 6.01 hours to technetium (99Tc) which, in view of its long half-life of 2.13 x 105 years can be regarded as quasi stable. The radionuclide generator containing the parent isotope 99Mo, adsorbed on a chromatographic column delivers sodium pertechnetate (99mTc) injection in sterile solution. The 99Mo on the column is in equilibrium with the formed daughter isotope 99mTc. The generators are supplied with the following 99Mo activity amounts at activity reference time which deliver the following technetium (99mTc) amounts, assuming a 100% theoretical elution yield and 24 hours time from previous elution and taking into account that branching ratio of 99Mo is about 87%: 99mTc activity (maximum theoretical elutable 1.90 3.81 5.71 7.62 9.53 11.43 15.24 19.05 22.86 26.67 30.48 38.10 GBq activity at ART, 06.00 h CET) 99Mo activity (at ART, 06.00 h 2.15 4.30 6.45 8.60 10.75 12.90 17.20 21.50 25.80 30.10 34.40 43.00 GBq CET) The technetium (99mTc) amounts available by a single elution depend on the real yields of the kind of generator used itself declared by manufacturer and approved by National Competent Authority.
    [Show full text]
  • Thyroid Crisis Following Interstitial Nephritis
    □ CASE REPORT □ Thyroid Crisis following Interstitial Nephritis Toshio Kahara 1, Miyako Yoshizawa 1, Izaya Nakaya 1, Akio Uchiyama 2,AtsuoMiwa2, Yasunori Iwata 1, Muneyoshi Torita 1, Rika Usuda 1 and Hiroyuki Iida 1 Abstract A 54-year-old man with Graves’ disease had been treated with thiamazole (5 mg/day). His thyroid hor- mone level was increased after exodontia in February 2006. Although his prescribed dose of thiamazole was increased after exodontia on the fourth day, he developed thyroid crisis on exodontia 52nd day. Laboratory findings also showed renal dysfunction (from Cr 1.0 mg/dL in July 2005 to Cr 1.8 mg/dL on exodontia 37th day). His thyroid hormone level was normalized after subtotal thyroidectomy; however, serum Cr level was still high. He was diagnosed with interstitial nephritis as a result of renal biopsy, and he was treated with prednisolone 30 mg/day. This present case developed thyroid crisis even though the quantity of thiamazole was increased after exodontia. It seems that interstitial nephritis, as well as exodontia, is an aggravation fac- tor of thyroid function. After a poor response to anti-thyroid drugs, it is necessary to prevent thyroid crisis by determining the aggravating factor and to then provide appropriate treatment. Key words: interstitial nephritis, thyroid crisis, hyperthyroidism, Graves’ disease (Inter Med 47: 1237-1240, 2008) (DOI: 10.2169/internalmedicine.47.0947) 4.7% are due to tubulointerstitial nephritis and uveitis syn- Introduction drome (TINU) (2). There are case reports of transient hyper- thyroidism in TINU (3, 4), and interstitial nephritis may Thyroid crisis is defined as thyroid function that is ex- contribute to aggravation of the thyroid function.
    [Show full text]