- Thyroid
- Refractory Graves' Disease Successfully Cured by Adjunctive Cholestyramine and Subsequent Total Thyroidectomy
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Yeoree Yang, Seawon Hwang, Minji Kim, Yejee Lim, Min-Hee Kim, Sohee Lee, Dong-Jun Lim, Moo-Il Kang, Bong-Yun Cha
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Endocrinol Metab. 2015;30(4):620-625. Published online December 31, 2015
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DOI: https://doi.org/10.3803/EnM.2015.30.4.620
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Abstract
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The three major forms of treatment for Graves thyrotoxicosis are antithyroid drugs, radioactive iodine therapy and thyroidectomy. Surgery is the definitive treatment for Graves thyrotoxicosis that is generally recommended when other treatments have failed or are contraindicated. Generally, thyrotoxic patients should be euthyroid before surgery to minimize potential complications which usually requires preoperative management with thionamides or inorganic iodine. But several cases of refractory Graves' disease have shown resistance to conventional treatment. Here we report a 40-year-old female patient with Graves' disease who complained of thyrotoxic symptoms for 7 months. Her thyroid function test and thyroid autoantibody profiles were consistent with Graves' disease. One kind of thionamides and β-blocker were started to control her disease. However, she was resistant to nearly all conventional medical therapies, including β-blockers, inorganic iodine, and two thionamides. She experienced hepatotoxicity from the thionamides. What was worse is her past history of serious allergic reaction to corticosteroids, which are often used to help control symptoms. A 2-week regimen of high-dose cholestyramine improved her uncontrolled thyrotoxicosis and subsequent thyroidectomy was successfully performed. In conclusion, cholestyramine could be administered as an effective and safe adjunctive agent for preoperative preparation in patients with severe hyperthyroid Graves's disease that is resistant to conventional therapies.
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Citations
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- Enhanced predictive validity of integrative models for refractory hyperthyroidism considering baseline and early therapy characteristics: a prospective cohort study
Xinpan Wang, Tiantian Li, Yue Li, Qiuyi Wang, Yun Cai, Zhixiao Wang, Yun Shi, Tao Yang, Xuqin Zheng Journal of Translational Medicine.2024;[Epub] CrossRef - Refractory Graves’ Disease in an Adolescent Successfully Treated With Cholestyramine and Subsequent Thyroidectomy
Raghad Alsaidalani, Hesham Eltomy, Alaa B Aljuhani, Moutaz Osman Cureus.2024;[Epub] CrossRef - Non-thionamide antithyroid drug options in Graves’ hyperthyroidism
Aliya Ruslan, Onyebuchi E Okosieme Expert Review of Endocrinology & Metabolism.2023; 18(1): 67. CrossRef - Gestione clinica dell’ipertiroidismo refrattario
Daniela Gallo, Federica Martina Bianchi, Francesca Manzella La Barbera, Ilaria Clementi, Adriana Lai, Eliana Piantanida, Maria Laura Tanda L'Endocrinologo.2023; 24(2): 167. CrossRef - Carbimazole-Resistant Grave’s Thyrotoxicosis is a Diagnostic and Therapeutic Dilemma, Case Report with Literature Review
Fateen Ata, Adeel Ahmad Khan, Shuja Tahir, Zaina Al Amer International Medical Case Reports Journal.2023; Volume 16: 783. CrossRef - Medical treatment of thyrotoxicosis
Lorenzo SCAPPATICCIO, Giuseppe BELLASTELLA, Maria I. MAIORINO, Luca GIOVANELLA, Katherine ESPOSITO The Quarterly Journal of Nuclear Medicine and Molecular Imaging.2021;[Epub] CrossRef - THERAPEUTIC EFFECTS OF COMBINATION REGIMENS INCLUDING METHIMAZOLE ON GRAVES HYPERTHYROIDISM: A NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Maorong Wang, Yerong Yu Endocrine Practice.2020; 26(6): 675. CrossRef - Cholestyramine alters bile acid amounts and the expression of cholesterol‐related genes in rabbit intestinal and hepatic tissues
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Douglas S. Ross, Henry B. Burch, David S. Cooper, M. Carol Greenlee, Peter Laurberg, Ana Luiza Maia, Scott A. Rivkees, Mary Samuels, Julie Ann Sosa, Marius N. Stan, Martin A. Walter Thyroid.2016; 26(10): 1343. CrossRef - Cholestyramine Use for Rapid Reversion to Euthyroid States in Patients with Thyrotoxicosis
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- Thyroid
- Accelerated Disease Progression after Discontinuation of Sorafenib in a Patient with Metastatic Papillary Thyroid Cancer
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Kyung-Jin Yun, Woohyeon Kim, Eun Hee Kim, Min-Hee Kim, Dong-Jun Lim, Moo-Il Kang, Bong-Yun Cha
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Endocrinol Metab. 2014;29(3):388-393. Published online September 25, 2014
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DOI: https://doi.org/10.3803/EnM.2014.29.3.388
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3,996
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Abstract
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Distant metastases from papillary thyroid carcinoma (PTC) are rare and are associated with a poor prognosis. Here, we describe a patient with metastatic PTC who was treated with a tyrosine kinase inhibitor (TKI, sorafenib) for several months that was acutely exacerbated by discontinuation. A 43-year-old male was diagnosed with PTC in February 2004 and underwent total thyroidectomy followed by two courses of high-dose radioactive iodine (RAI) therapy. Despite two additional courses of high-dose RAI therapy, lung and muscle metastases were developed. Treatment with sorafenib was begun in September 2010. After 11 months treatment of sorafenib, newly developed metastatic lesions were found in mediastinal lymph nodes, liver, and bones. Considered as treatment failure, the administration of sorafenib was discontinued. Two weeks after sorafenib treatment was stopped, the disease progressed abruptly and caused death of the patient by respiratory failure. In our patient, PTC progressed rapidly after the cessation of sorafenib treatment. Patients with several other types of cancer have also experienced such rapid disease progression, termed "flare-ups." Physicians should be aware that flare-ups may occur in advanced PTC patients following the cessation of TKI therapy.
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