vrijdag 14 juli 2017

Drie behandelopties ziekte van Graves met elkaar vergeleken

In dit onderzoek zijn de drie belangrijkste behandelopties van de ziekte van Graves met elkaar vergeleken. Belangrijk is wel dat genoemd wordt dat pas gekozen kan worden voor een behandeling na een gesprek tussen arts en patiënt. Een gesprek waarin de patiënt uitleg krijgt over welke behandelingen mogelijk zijn en wat de voor- en nadelen zijn. Helaas blijft de keus beperkt. Nieuwe behandelingen zouden heel welkom zijn.

Comparative effectiveness of treatment choices for Graves’ hyperthyroidism — a historical cohort study
V Sundaresh | Thyroid. Apr 2017, 27(4): 497-505

Radioactive iodine therapy has the most favorable profile for the treatment of Graves’ disease at the Mayo Clinic
Clinical Thyroidology for the Public

Als je schildklier te veel hormoon maakt

The optimum therapy for Graves' disease (GD) is chosen following discussion between physician and patient regarding benefits, drawbacks, potential side effects, and logistics of the various treatment options, and it takes into account patient values and preferences. This cohort study aimed to provide useful information for this discussion regarding the usage, efficacy, and adverse-effect profile of radioactive iodine (RAI), antithyroid drugs (ATDs), and thyroidectomy in a tertiary healthcare facility.


The cohort included consecutive adults diagnosed with GD from January 2002 to December 2008, who had complete follow-up after treatment at the Mayo Clinic, Rochester, Minnesota. Data on treatment modalities, disease relapses, and adverse effects were extracted manually and electronically from the electronic medical records. Kaplan-Meier analyses were performed to evaluate the association of treatments with relapse-free survival.


The cohort included 720 patients with a mean age of 49.3 years followed for a mean of 3.3 years. Of these, 76.7% were women and 17.1% were smokers. The initial therapy was RAI in 75.4%, ATDs in 16.4%, and thyroidectomy in 2.6%, while 5.6% opted for observation. For the duration of follow-up, ATDs had an overall failure rate of 48.3% compared with 8% for RAI (hazard ratio = 7.6; p < 0.0001). Surgery had a 100% success rate; 80% of observed patients ultimately required therapy. Adverse effects developed in 43 (17.3%) patients treated with ATDs, most commonly dysgeusia (4.4%), rash (2.8%), nausea/gastric distress (2.4%), pruritus (1.6%), and urticaria (1.2%). Eight patients treated with RAI experienced radiation thyroiditis (1.2%). Thyroidectomy resulted in one (2.9%) hematoma and one (2.85%) superior laryngeal nerve damage, with no permanent hypocalcemia.


RAI was the most commonly used modality within the cohort and demonstrated the best efficacy and safety profile. Surgery was also very effective and relatively safe in the hands of experienced surgeons. While ATDs allow preservation of thyroid function, a high relapse rate combined with a significant adverse-effect profile was documented. These data can inform discussion between physician and patient regarding choice of therapy for GD.

maandag 3 juli 2017

Grote rol schildklierhormoon bij botontwikkeling, -groei en -onderhoud

Het skelet is uiterst gevoelig voor schildklierhormoon met verregaande gevolgen voor de botontwikkeling, -groei en -onderhoud. De plaatselijke omzetting van T4 naar T3 is hiervoor erg belangrijk. Die plaatselijke omzetting regelt de botontwikkeling. Hoe dat precies gaat is nog een vraagteken. Allerlei genen hebben hier mee te maken.

Role of thyroid hormones in skeletal development and bone maintenance
JH Duncan Bassett, Graham R Williams


The skeleton is an exquisitely sensitive and archetypal T3-target tissue that demonstrates the critical role for thyroid hormones during development, linear growth, and adult bone turnover and maintenance.

Thyrotoxicosis is an established cause of secondary osteoporosis, and abnormal thyroid hormone signaling has recently been identified as a novel risk factor for osteoarthritis. Skeletal phenotypes in genetically modified mice have faithfully reproduced genetic disorders in humans, revealing the complex physiological relationship between centrally regulated thyroid status and the peripheral actions of thyroid hormones.

Studies in mutant mice also established the paradigm that T3 exerts anabolic actions during growth and catabolic effects on adult bone. Thus, the skeleton represents an ideal physiological system in which to characterize thyroid hormone transport, metabolism, and action during development and adulthood and in response to injury. Future analysis of T3 action in individual skeletal cell lineages will provide new insights into cell-specific molecular mechanisms and may ultimately identify novel therapeutic targets for chronic degenerative diseases such as osteoporosis and osteoarthritis. This review provides a comprehensive analysis of the current state of the art.

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Raadpleeg altijd een arts als je twijfelt over je gezondheid. De informatie op dit blog kan niet worden beschouwd als vervanging van een consult of een behandeling.

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