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Sympathetic Blockade in Hyperthyroidism: Preoperative Management Following Toxic Reaction to Antithyroid Drugs

Sympathetic Blockade in Hyperthyroidism: Preoperative Management Following Toxic Reaction to... Abstract The antithyroid drugs propylthiouracil and methimazole are commonly used in the treatment of hyperthyroidism. The incidence of overall toxic drug reactions to these antithyroid drugs have been reported to vary from 6% to 9%1-3; however, the incidence of serious side effects, including agranulocytosis, is approximately 0.3% to 0.6% in a large series.4 Subsequent management of the hyperthyroidism in those patients who develop drug toxic reaction becomes a problem, especially in the younger age group where alternative forms of treatment are limited. During the past few years sympathetic blocking drugs, including guanethidine sulfate5 and propranolol hydrochloride,6-9 have been advocated as ancillary agents in the treatment of hyperthyroidism. The use of propranolol as a means of preparing hyperthyroid patients for thyroidectomy has also been suggested.10 This report details the course of three hyperthyroid patients who developed toxic reactions to antithyroid drugs and in whom thyroidectomy was successfully References 1. Bartles EC: Hyperthyroidism: An evaluation of treatment with antithyroid drugs followed by subtotal thyroidectomy. Ann Intern Med 37:1123-1134, 1952.Crossref 2. Irwin GW, Van Vactor HD, Norris MS: Propylthiouracil and methimazole therapy. JAMA 149:1637-1640, 1952.Crossref 3. McClintock JC, Gassner FX, Bigelow N, et al: Antithyroid drugs in the treatment of hyperthyroidism. Surg Gynec Obstet 112:653-658, 1961. 4. Trotter WR: The relative toxicity of antithyroid drugs. J New Drugs 1:333-343, 1962.Crossref 5. Waldstein SS, West GH, Lee WY, et al: Guanethidine in hyperthyroidism. JAMA 189:609-612, 1964.Crossref 6. Turner P, Granville-Gross KL, Smart JV: Effect of adrenergic receptor blockade on the tachycardia of thyrotoxicosis and anxiety state. Lancet 2:1316-1318, 1965.Crossref 7. Singer W: Anabolic steroids and thyroxin. Brit Med J 1:677, 1966.Crossref 8. Howitt G, Rowlands DJ: Beta sympathetic blockade in hyperthyroidism. Lancet 1:628-631, 1966.Crossref 9. Parson V, Jewitt D: Beta-adrenergic blockade in the management of acute thyrotoxic crisis, tachycardia and arrhythmia. Postgrad Med J 43:756-762, 1967.Crossref 10. Vinik AI, Pimston BL, Hoffenberg R: Sympathetic blockage in hyperthyroidism. J Clin Endocr 28:725-728, 1968.Crossref 11. Best MM, Duncan CH: A lupus-like syndrome following propylthiouracil administration. J Kentucky Med Assoc 62:47-49, 1964. 12. Sheline GE, Lindsay S, McCormack DB, et al: Thyroid nodules occurring late after treatment of thyrotoxicosis with radioiodine. J Clin Endocr 22:8-18, 1962.Crossref 13. Baker HV: Anaplastic thyroid cancer 12 years after treatment of thyrotoxicosis with radioiodine. Cancer 22:885-890, 1969.Crossref 14. Lima JB, Catz B, Perzik SL: Thyroid cancer following 131I therapy of hyperthyroidism. J Nucl Med 11:46-48,1970. 15. Goldstein S, Killip T: Catecholamine depletion in thyrotoxicosis: Effects of guanethidine on cardiovascular dynamics. Circulation 31:219-227, 1965.Crossref 16. Kopin I, Gordon EK: Metabolism of administered and drug-released norepinephrine-7-H 3 in the rat. J Pharmacol Exp Ther 140:207-216, 1963. 17. Fielden R, Green AL: A comparative study of the noradrenaline-depleting and sympathetic-blocking actions of guanethidine and β-hydroxyphenethylguanidine. Brit J Pharmacol Chemother 30:155-165, 1967.Crossref 18. Riddle M, Schwartz TB: New tactics for hyperthyroidism: Sympathetic blockade. Ann Intern Med 71:749-751, 1970.Crossref 19. Emmelin N, Engstrom J: Supersensitivity of salivary glands following treatment with bretylium or guanethidine. Brit J Pharmacol Chemother 16:315-319, 1961.Crossref 20. Eckstein JW, Abboud FM: Circulatory effects of sympathomimetic amines. Amer Heart J 63:119-135, 1962.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Sympathetic Blockade in Hyperthyroidism: Preoperative Management Following Toxic Reaction to Antithyroid Drugs

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Publisher
American Medical Association
Copyright
Copyright © 1972 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1972.00320060115015
Publisher site
See Article on Publisher Site

Abstract

Abstract The antithyroid drugs propylthiouracil and methimazole are commonly used in the treatment of hyperthyroidism. The incidence of overall toxic drug reactions to these antithyroid drugs have been reported to vary from 6% to 9%1-3; however, the incidence of serious side effects, including agranulocytosis, is approximately 0.3% to 0.6% in a large series.4 Subsequent management of the hyperthyroidism in those patients who develop drug toxic reaction becomes a problem, especially in the younger age group where alternative forms of treatment are limited. During the past few years sympathetic blocking drugs, including guanethidine sulfate5 and propranolol hydrochloride,6-9 have been advocated as ancillary agents in the treatment of hyperthyroidism. The use of propranolol as a means of preparing hyperthyroid patients for thyroidectomy has also been suggested.10 This report details the course of three hyperthyroid patients who developed toxic reactions to antithyroid drugs and in whom thyroidectomy was successfully References 1. Bartles EC: Hyperthyroidism: An evaluation of treatment with antithyroid drugs followed by subtotal thyroidectomy. Ann Intern Med 37:1123-1134, 1952.Crossref 2. Irwin GW, Van Vactor HD, Norris MS: Propylthiouracil and methimazole therapy. JAMA 149:1637-1640, 1952.Crossref 3. McClintock JC, Gassner FX, Bigelow N, et al: Antithyroid drugs in the treatment of hyperthyroidism. Surg Gynec Obstet 112:653-658, 1961. 4. Trotter WR: The relative toxicity of antithyroid drugs. J New Drugs 1:333-343, 1962.Crossref 5. Waldstein SS, West GH, Lee WY, et al: Guanethidine in hyperthyroidism. JAMA 189:609-612, 1964.Crossref 6. Turner P, Granville-Gross KL, Smart JV: Effect of adrenergic receptor blockade on the tachycardia of thyrotoxicosis and anxiety state. Lancet 2:1316-1318, 1965.Crossref 7. Singer W: Anabolic steroids and thyroxin. Brit Med J 1:677, 1966.Crossref 8. Howitt G, Rowlands DJ: Beta sympathetic blockade in hyperthyroidism. Lancet 1:628-631, 1966.Crossref 9. Parson V, Jewitt D: Beta-adrenergic blockade in the management of acute thyrotoxic crisis, tachycardia and arrhythmia. Postgrad Med J 43:756-762, 1967.Crossref 10. Vinik AI, Pimston BL, Hoffenberg R: Sympathetic blockage in hyperthyroidism. J Clin Endocr 28:725-728, 1968.Crossref 11. Best MM, Duncan CH: A lupus-like syndrome following propylthiouracil administration. J Kentucky Med Assoc 62:47-49, 1964. 12. Sheline GE, Lindsay S, McCormack DB, et al: Thyroid nodules occurring late after treatment of thyrotoxicosis with radioiodine. J Clin Endocr 22:8-18, 1962.Crossref 13. Baker HV: Anaplastic thyroid cancer 12 years after treatment of thyrotoxicosis with radioiodine. Cancer 22:885-890, 1969.Crossref 14. Lima JB, Catz B, Perzik SL: Thyroid cancer following 131I therapy of hyperthyroidism. J Nucl Med 11:46-48,1970. 15. Goldstein S, Killip T: Catecholamine depletion in thyrotoxicosis: Effects of guanethidine on cardiovascular dynamics. Circulation 31:219-227, 1965.Crossref 16. Kopin I, Gordon EK: Metabolism of administered and drug-released norepinephrine-7-H 3 in the rat. J Pharmacol Exp Ther 140:207-216, 1963. 17. Fielden R, Green AL: A comparative study of the noradrenaline-depleting and sympathetic-blocking actions of guanethidine and β-hydroxyphenethylguanidine. Brit J Pharmacol Chemother 30:155-165, 1967.Crossref 18. Riddle M, Schwartz TB: New tactics for hyperthyroidism: Sympathetic blockade. Ann Intern Med 71:749-751, 1970.Crossref 19. Emmelin N, Engstrom J: Supersensitivity of salivary glands following treatment with bretylium or guanethidine. Brit J Pharmacol Chemother 16:315-319, 1961.Crossref 20. Eckstein JW, Abboud FM: Circulatory effects of sympathomimetic amines. Amer Heart J 63:119-135, 1962.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 1, 1972

References