IntraMed - Artículos - Hipertiroidismo
Prevención, diagnóstico y tratamiento | 20 AGO 12


Revisión de la evidencia actual sobre la prevención, diagnóstico y tratamiento del hipertiroidismo
Autor: Dr. Michael T. McDermott. Ann Intern Med. 3 July 2012;157(1):ITC1-
INDICE:  1. Artículo | 2. Referencia

1. Singer PA, Cooper DS, Levy EG, et al. Treatment guidelines for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA. 1995;273:808-12.
2. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87:489-99.
3. Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21:593-646).
4. Newman CM, Price A, Davies DW, Gray TA, Weetman AP. Amiodarone and the thyroid: a practical guide to the management of thyroid dysfunction induced by amiodarone therapy. Heart. 1998;79:121-7.
5. Piga M, Serra A, Boi F, Tanda ML, Martino E, Mariotti S. Amiodaroneinduced thyrotoxicosis. A review. Minerva Endocrinol. 2008;33:213-28.
6. Dumoulin FL, Leifeld L, Sauerbruch T, Spengler U. Autoimmunity induced by interferon-alpha therapy for chronic viral hepatitis. Biomed Pharmacother. 1999;53:242-54.
7. Vialettes B, Guillerand MA, Viens P, et al. Incidence rate and risk factors for thyroid dysfunction during recombinant interleukin-2 therapy in advanced malignancies. Acta Endocrinol (Copenh). 1993;129:31-8.
8. Miller KK, Daniels GH. Association between lithium use and thyrotoxicosis caused by silent thyroiditis. Clin Endocrinol (Oxf ). 2001;55:501-8.
9. Stanbury JB, Ermans AE, Bourdoux P, et al. Iodine-induced hyperthyroidism: occurrence and epidemiology. Thyroid. 1998;8:83-100.
10. U.S. Preventive Services Task Force. Screening for thyroid disease: recommendation statement. Ann Intern Med. 2004;140:125-7.
11. Trivalle C, Doucet J, Chassagne P, et al. Differences in the signs and symptoms of hyperthyroidism in older and younger patients. J Am Geriatr Soc. 1996;44:50-3.
12. Martin FI, Deam DR. Hyperthyroidism in elderly hospitalized patients. Clinical features and treatment outcomes. Med J Aust. 1996;164:200-3.
13. Dydek GJ, Blue PW. Human breast milk excretion of iodine-131 following diagnostic and therapeutic administration to a lactating patient with Graves’ disease. J Nucl Med. 1988;29:407-10.
14. Morita S, Umezaki N, Ishibashi M, Kawamura S, Inada C, Hayabuchi N. Determining the breastfeeding interruption schedule after administration of 123I-iodide. Ann Nucl Med. 1998;12:303-6.
15. Gorman CA. Radioiodine and pregnancy. Thyroid. 1999;9:721-6
16. Abalovich M, Amino N, Barbour LA, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2007;92:s1-7.
17. Spencer C, Eigen A, Shen D, Duda M, Qualls S, Weiss S, et al. Specificity of sensitive assays of thyrotropin (TSH) used to screen for thyroid disease in hospitalized patients. Clin Chem. 1987;33:1391-6.
18. Manji N, Carr-Smith JD, Boelaert K, et al. Influences of age, gender, smoking, and family history on autoimmune thyroid disease phenotype. J Clin Endocrinol Metab. 2006;91:4873-80.
19. Eckstein A, Quadbeck B, Mueller G, et al. Impact of smoking on the response to treatment of thyroid associated ophthalmopathy. Br J Ophthalmol. 2003;87:773-6.
20. Cooper DS. Antithyroid drugs. N Engl J Med. 2005;352:905-17.
21. Nakamura H, Noh JY, Itoh K, et al. Comparison of methimazole and propylthiouracil in patients with hyperthyroidism caused by Graves’ disease. J Clin Endocrinol Metab. 2007;92:2157-62
22. Abraham P, Avenell A, Watson WA, Park CM, Bevan JS. Antithyroid drug regimen for treating Graves’ hyperthyroidism. Cochrane Database Syst Rev. 2005:CD003420.
23. Benker G, Reinwein D, Kahaly G, et al. Is there a methimazole dose effect on remission rate in Graves’ disease? Results from a longterm prospective study. The European Multicentre Trial Group of the Treatment of Hyperthyroidism with Antithyroid Drugs. Clin Endocrinol (Oxf ). 1998;49:451-7.
24. Rittmaster RS, Abbott EC, Douglas R, et al. Effect of methimazole, with or without L-thyroxine, on remission rates in Graves’ disease. J Clin Endocrinol Metab.1998;83:814-8.
25. Maugendre D, Gatel A, Campion L, et al. Antithyroid drugs and Graves’ disease– prospective randomized assessment of long-term treatment. Clin Endocrinol (Oxf ]. 1999;50:127-32.
26. McDermott MT, Kidd GS, Dodson LE Jr, Hofeldt FD. Radioiodine-induced thyroid storm. Case report and literature review. Am J Med. 1983;75:353-9.
27. Cooper DS. Antithyroid drugs in the management of patients with Graves’ disease: an evidence-based approach to therapeutic controversies. J Clin Endocrinol Metab. 2003;88:3474-81.
28. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am. 1993;22:263-77.
29. Langley RW, Burch HB. Perioperative management of the thyrotoxic patient. Endocrinol Metab Clin North Am. 2003;32:519-34.
30. Fatourechi V, Aniszewski JP, Fatourechi GZ, Atkinson EJ, Jacobsen SJ. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. J Clin Endocrinol Metab. 2003;88: 2100-5.
31. Williams KV, Nayak S, Becker D, Reyes J, Burmeister LA. Fifty years of experience with propylthiouracilassociated hepatotoxicity: what have we learned? J Clin Endocrinol Metab. 1997;82:1727-33.
32. Cooper DS, Rivkees SA. Putting propylthiouracil in perspective. J Clin Endocrinol Metab. 2009;94:1881-2. 33. Meyer-Gessner M, Benker G, Lederbogen S, Olbricht T, Reinwein D. Antithyroid drug-induced agranulocytosis: clinical experience with ten patients treated at one institution and review of the literature. J Endocrinol Invest. 1994;17:29-36.
34. Sheng WH, Hung CC, Chen YC, et al. Antithyroid-druginduced agranulocytosis complicated by life-threatening infections. QJM. 1999;92:455-61.
35. Cooper DS, Goldminz D, Levin AA, et al. Agranulocytosis associated with antithyroid drugs. Effects of patient age and drug dose. Ann Intern Med. 1983;98:26-9.
36. Takata K, Kubota S, Fukata S, et al. Methimazoleinduced agranulocytosis in patients with Graves’ disease is more frequent with an initial dose of 30 mg daily than with 15 mg daily. Thyroid. 2009; 19:559-63.
37. Noh JY, Asari T, Hamada N, Makino F, Ishikawa N, Abe Y, et al. Frequency of appearance of myeloperoxidaseantineutrophil cytoplasmic antibody (MPO-ANCA) in Graves’ disease patients treated with propylthiouracil and the relationship between MPO-ANCA and clinical manifestations. Clin Endocrinol (Oxf). 2001;54:651-4.
38. Chen YX, Yu HJ, Ni LY, et al. Propylthiouracilassociated antineutrophil cytoplasmic autoantibodypositive vasculitis: retrospective study of 19 cases. J Rheumatol. 2007; 34:2451-6.
39. Abraham-Nordling M, Wallin G, Lundell G, Torring O. Thyroid hormone state and quality of life at long-term follow-up after randomized treatment of Graves’ disease. Eur J Endocrinol. 2007; 156:173-9.
40. Bartalena L, Marcocci C, Bogazzi F, et al. Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. N Engl J Med. 1998;338:73-8.
41. Tallstedt L, Lundell G, Tørring O, et al. Occurrence of ophthalmopathy after treatment for Graves’ hyperthyroidism. The Thyroid Study Group. N Engl J Med. 1992;326:1733-8.
42. Träisk F, Tallstedt L, Abraham-Nordling M, et al; Thyroid Study Group of TT 96. Thyroid-associated ophthalmopathy after treatment for Graves’ hyperthyroidism with antithyroid drugs or iodine-131. J Clin Endocrinol Metab. 2009;94:3700-7.
43. Acharya SH, Avenell A, Philip S, Burr J, Bevan JS, Abraham P. Radioiodine therapy (RAI) for Graves’ disease (GD) and the effect on ophthalmopathy: a systematic review. Clin Endocrinol (Oxf ). 2008;69:943-50.
44. Ron E, Doody MM, Becker DV, Brill AB, et al. Cancer mortality following treatment for adult hyperthyroidism. Cooperative Thyrotoxicosis Therapy Follow-up Study Group. JAMA. 1998;280:347-55.
45. Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228:320-30.
46. Feldt-Rasmussen U, Schleusener H, Carayon P. Metaanalysis evaluation of the impact of thyrotropin receptor antibodies on long term remission after medical therapy of Graves’ disease. J Clin Endocrinol Metab. 1994;78:98-102.
47. Uy HL, Reasner CA, Samuels MH. Pattern of recovery of the hypothalamicpituitary- thyroid axis following radioactive iodine therapy in patients with Graves’ disease. Am J Med. 1995;99:173-9.
48. Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291:228-38.
49. Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT. Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society. J Clin Endocrinol Metab. 2005;90:581-5; discussion 586-7.
50. Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994;331:1249- 52.
51. Gammage MD, Parle JV, Holder RL, Roberts LM, Hobbs FD, Wilson S, et al. Association between serum free thyroxine concentration and atrial fibrillation. Arch Intern Med. 2007;167:928-34.
52. Foldes J, Tarjan G, Szathmari M, Varga F, Krasznai I, Horvath C. Bone mineral density in patients with endogenous subclinical hyperthyroidism: is this thyroid status a risk factor for osteoporosis? Clin Endocrinol (Oxf ). 1993;39:521-7.
53. Bauer DC, Ettinger B, Nevitt MC, Stone KL; Study of Osteoporotic Fractures Research Group. Risk for fracture in women with low serum levels of thyroid-stimulating hormone. Ann Intern Med. 2001; 134:561-8.


Usted debe estar registrado para expresar su opinión. Si ya es usuario de IntraMed o desea registrase como nuevo usuario, ingrese aquí
Dra. Olinda Santos   Hace 1 año
Despejó todas mis dudas. Excelente. Gracias.
Dr. Jorge Alberto Flores Vega   Hace 1 año
Excelentisisisimo! no me imagine que estuviera tan completo al leer hasta recordé y aprendí el tratamiento con litio.
Dra. flor de maria Z. Lozano   Hace 1 año
esta muy bien este articulo ,me sirvió para desarrollar un caso clínico ¡¡¡¡
Dr. maikel ferrer alfaro   Hace 1 año
muy bueno el tema gustei muito
Dr. Ruben Martinez Martinez   Hace más de un año
El tema abordado es muy ilustrativo gracias intramed
Dr. Juan Pablo Camargo Mendoza   Hace más de un año
Es importante aclarar cuando solicitar estudio gamagrafico en cuanto el inicio de medicamentos
Dra. Magdalena Sqnchez Texcucano   Hace más de un año
Interesante!!! Me ha gustado, podrían profundizar más en el diagnóstico y tratamiento.
Dra. Yaquelín González Ricardo   Hace más de un año
Útil y bastante actualizado, gracias .
Dr. LUCIANO JORGE sanchez vazquez   Hace más de un año
me parecio claro y concreto, muy bueno
Dra. Esmirna Sanchez Aristy   Hace más de un año
Excelente articulo y actualizado.
Dr. Walter Pozzi   Hace más de un año
Muy claro. Felicito a INTRAMED por publicarlo.-
Sr. Daniel Oscar Vitella   Hace más de un año
¿Puede ser que el OTC "Cartilago de Tiburon" desencadene hipertiroidosmo? Su contenido en Iodo es altísmo. Mi esposa, luego de tomarlo 10 días empezó con sintomas y a los 3 meses se lo diagnosticaron. Ni hablar de la falta de experiencia de clínicos y medicos de urgencia sobre esta enfermedad. Piel caliente, hiperfagia, temblores, nerviosismo, TA diastolica baja, perdida de peso, taquicardia y siempre salia de la guardia o el consultorio con diagnostico de crisis de ansiedad. Ok, no tuvo exoftalmia, pero del resto tenía todo. Por eso, pregunten a sus pacientes hipertiroideos si no tomaron Cartilago de Tiburón un tiempo antes de empezar con los sintomas
Dra. CITLALI ARTEAGA VALENCIA   Hace más de un año
Dr. Mario Alberto Espinosa Vidal   Hace más de un año
Hay algunas imprecisiones. El isótopo de Yodo 131 es efectivamente utilizado como diagnóstico, pero el que es usado como tratamiento es el isótopo 123.

Por otro lado la TSH disminuida ocurre tanto en el hipertiroidismo por disfunción de la tiroides (primario), pero también en los hipotiroidismos secundiario y terciario.

Recordemos que las condiciones tiroideas se diagnostican y controlan a partir de la clínica y aun en pacientes subclínicos hay una relación demostrada con cardiopatías. Por esto el problema tiroideo debe ser investigado ante problemas cardiológicos de cualquier índole.

Srta. Miurell Y Vega Silva   Hace más de un año
muy bueno el articulo e interezante conocer a profundidad esta enfermedad que me tenia con algunas dudas que aclare grasias al articulo porque un familiar la padece.
Términos y condiciones de uso | Todos los derechos reservados | Copyright 1997-2017