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Clinical Thyroidology for the Public Volume 13 | Issue 7 | July 2020 Clinical Thyroidology® for the Public EDITOR’S COMMENTS . 2 HYPERTHYROIDISM . 9 Amiodarone was the most common cause of GRAVES’ DISEASE . 3 thyroid storm in French intensive care units Most patients with Graves’ disease treated with Thyroid storm, while rare, is the extreme result of an overactive antithyroid drugs eventually require additional thyroid and has a high risk of death even when recognized and therapies treated appropriately. In this study, authors looked to evaluate There are three main options to treat Graves’ disease: antithyroid the presentation, management and death rate of patients with drugs (ATDs), radioactive iodine therapy and surgery. This thyroid storm causing admission to French ICUs. study examined the long-term effects of the three treatments in Bourcier S et al 2019. Thyroid storm in the ICU: a retrospective Swedish patients diagnosed with Graves’ disease multicenter study. Crit Care Med 48:83–90. PMID: 31714398. Sjölin G et al 2019 The long-term compared outcomes of treatment for Graves’ hyperthyroidism. Thyroid THYROID CANCER . 11 29:1545–1557 Patient preferences for surgery for low-risk thyroid cancer HYPOTHYROIDISM . 5 Most forms of thyroid cancer have an excellent prognosis Switching levothyroxine brands frequently (<5% death rate) whether they have a lobectomy or a total results in abnormal thyroid function tests thyroidectomy. However, many patients may overestimate the Hypothyroidism can be treated with levothyroxine, which is risk of death due to thyroid cancer, which may drive patient’s produced from different manufacturers. In 2016, the manu- willingness to undergo more aggressive surgery. This study was facturer of the levothyroxine brand Thyrax experienced an done to determine which risks patients would accept when interruption in production that required many Dutch patients evaluating the benefits and risks of a lobectomy vs a thyroidec- to change their levothyroxine supplier. The current study tomy for thyroid cancer. examined the effect of the shortage of the levothyroxine brand Ahmadi S et al 2020 Patient preferences around extent Thyrax in the Netherlands and subsequent switch to a different of surgery in low-risk thyroid cancer: A discrete-choice brand on TSH levels. experiment. Thyroid. Epub 2020 Mar 6. PMID: 32143553. Flinterman LE et al 2020 Impact of a forced dose-equivalent levothyroxine brand switch on plasma TSH: A cohort study. THYROID CANCER . 13 Thyroid. Epub 2020 Mar 18. PMID: 32188356 Extra-thyroidal extension in papillary thyroid cancer has an impact on the risk of recurrence HYPOTHYROIDISM . 7 and response to therapy Does the heart beat stronger with thyroid One factor that resulted in an increase of thyroid cancer to hormone treatment in older patients with mild stage III was whether the cancer was extending out from the hypothyroidism? thyroid into the neck muscles. With the 2017 AJCC update, The TRUST trial was designed as the largest multicenter cancer that was seen extending out from the thyroid only under randomized controlled trial comparing thyroid hormone the microscope was downgraded to stage II. The current study treatment with no treatment in patients over 65 with was done to compare the risk of recurrence and response to subclinical hypothyroidism. This is a study that is a treatment between these 2 groups of thyroid cancer patients. smaller part of the TRUST trial and the aim of this study Danilovic DLS et al 2020 Is there a difference between was to show the effect of thyroid hormone treatment on minimal and gross extension into the strap muscles for the heart function in patients over 65 years with subclinical risk of recurrence in papillary thyroid carcinoma? Thyroid. hypothyroidism. Epub 2020 Mar 17. PMID: 32059626. Gencer B et al 2020 The impact of levothyroxine on cardiac function in older adults with mild subclinical hypothyroid- ATA ALLIANCE FOR THYROID ism: A randomized clinical trial. Am J Med. Epub 2020 Mar PATIENT EDUCATION . 15 11. PMID: 32171774. Connect with the ATA on Social Media . 16 Friends of the ATA . 17 ATA Brochure: Graves' Disease . 19 A publication of the American Thyroid Association® Volume 13 | Issue 7 | July 2020 Clinical Thyroidology® for the Public www .thyroid .org EDITOR’S COMMENTS Editor Alan P. Farwell, MD, FACE Welcome to another issue of Clinical Thyroidology for the Public. In this journal, Boston Medical Center we will bring to you the most up-to-date, cutting edge thyroid research. We also Boston University School of Medicine 720 Harrison Ave., Boston, MA 02115 provide even faster updates of late-breaking thyroid news through Twitter at @ American Thyroid Association thyroidfriends and on Facebook. Our goal is to provide patients with the tools Email: [email protected] to be the most informed thyroid patient in the waiting room. Also check out our www.thyroid.org/patients/ct/index.html friends in the Alliance for Thyroid Patient Education. The Alliance Editorial Board Jessie Block-Galaraza, MD, Albany, NY member groups consist of: the American Thyroid Association, Bite Me Cancer, the Gary Bloom, New York, NY Graves’ Disease and Thyroid Foundation, the Light of Life Foundation, MCT8 – Susana Ebner, MD, New York, NY AHDS Foundation, ThyCa: Thyroid Cancer Survivors’ Association, Thyroid Cancer Alina Gavrila, MD, MMSC, Boston, MA Melanie Goldfarb, MD, MS, FACS, FACE, Canada, Thyroid Cancer Allianceand Thyroid Federation International. Santa Monica, CA Shirin Haddady, MD, MPH, Boston, MA We invite all of you to join our Friends of the ATA community. It is for you that Sun Lee, MD, Boston, MA the American Thyroid Association (ATA) is dedicated to carrying out our mission of Joshua Klopper, MD, Denver, CO Priya Mahajan, MD, Houston, TX providing reliable thyroid information and resources, clinical practice guidelines for Maria Papaleontiou, MD, Ann Arbor, MI thyroid detection and treatments, resources for connecting you with other patients Jason D. Prescott, MD PhD, Baltimore, MD affected by thyroid conditions, and cutting edge thyroid research as we search for Marjorie Safran, MD, Worcester, MA better diagnoses and treatment outcomes for thyroid disease and thyroid cancer. We Anna M. Sawka, MD, Toronto, ON, Canada Phillip Segal, MD, Toronto, ON, Canada thank all of the Friends of the ATA who support our mission and work throughout Vibhavasu Sharma, MD, Albany, NY the year to support us. We invite you to help keep the ATA mission strong by Ebru Sulanc, MD , Detroit, MI choosing to make a donation that suits you — it takes just one moment to give Whitney Woodmansee, MD, Gainesville, FL online at: www.thyroid.org/donate and all donations are put to good work. The ATA American Thyroid Association is a 501(c)3 nonprofit organization and your gift is tax deductible. President Martha Zeiger, MD (2019-2020) The Covid-19 pandemic has caused an unprecedented upheaval in our daily lives Secretary/Chief Operating Officer Jacqueline Jonklaas, MD (2019-2023) and presented extremely difficult challenges to our healthcare system. There is a lot Treasurer of information circulating around. We at the American Thyroid Association would Julie Ann Sosa, MD (2017-2021) like to make sure that you all have access to most accurate, reliable, fact-based and Past-President updated information. (https://www.thyroid.org/covid-19/) Elizabeth N. Pearce, MD, MSc (2019-2020) President-Elect July is Graves’ Disease Awareness Month. Victor J. Bernet, MD (2019-2020) Executive Director In this issue, the studies ask the following questions: Amanda K. Perl American Thyroid Association ● What is the best treatment for Graves’ disease? 6066 Leesburg Pike, Suite 550 ● Falls Church, VA 22041 Does changing brands of levothyroxine alter thyroid function tests? Telephone: 703-998-8890 ● Does the heart beat stronger with thyroid hormone treatment in older Fax: 703-998-8893 Email: [email protected] patients with mild hypothyroidism? ● Designed by Does amiodarone therapy increase the risk of developing thyroid storm? Karen Durland, [email protected] ● What are patient preferences for surgery in low risk thyroid cancer? Clinical Thyroidology for the Public ● Copyright © 2020 by the American Thyroid Does extension of thyroid cancer outside of the thyroid impact Association, Inc. All rights reserved. response to therapy? We welcome your feedback and suggestions. Let us know what you want to see in this publication. I hope you find these summaries interesting and informative. — Alan P. Farwell, MD, FACE A publication of the American Thyroid Association® Volume 13 | Issue 7 | July 2020 Clinical Thyroidology® for the Public GRAVES’ DISEASE Most patients with Graves’ disease treated with antithyroid drugs eventually require additional therapies BACKGROUND in Swedish patients diagnosed with Graves’ disease Graves’ disease is the most common cause of hyperthy- between 2003 and 2005. The study included nearly 1200 roidism (overactive thyroid). It usually affects people patients who were asked questions about their symptoms between 30-60 years of age and is much more common and satisfaction with their treatment choice. In addition, in women than men. Patients with Graves’ disease, often and the medical records, with follow up for up to ten have enlarged thyroids (goiter) and bulging eyes (exoph- years, were reviewed. The patients’ average age was 47 thalmos). There are three main options to treat Graves’ years and 82% were women. disease: antithyroid drugs (ATDs), radioactive iodine therapy and surgery. The majority (65%) of the patients
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