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Luigi Bartalena Department of Medicine and Surgery, University of Insubria, Varese, Italy

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Fausto Bogazzi Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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Luca Chiovato Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri and University of Pavia, Pavia, Italy

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Alicja Hubalewska-Dydejczyk Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland

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Thera P. Links Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

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Mark Vanderpump Physicians’ Clinic, London, United Kingdom

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initial therapeutic choice. Fig. 2. Algorithm for the management of amiodarone-induced thyrotoxicosis (AIT). AIT 1, type 1 AIT; AIT 2, type 2 AIT. The iodine-replete thyroid gland of AIT patients is less responsive to thionamides, so very

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John H. Lazarus Centre for Endocrine and Diabetes Sciences, Cardiff University, Cardiff, UK

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recommendation that PTU should only be used for the first trimester. It is preferred in the first trimester to carbimazole or methimazole due to the occurrence of so-called methimazole embryopathy in patients on a thionamide drug in the first trimester during

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Claire L Wood Department of Paediatric Endocrinology, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK

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Niamh Morrison Department of Paediatric Endocrinology, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK

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Michael Cole Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, UK

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Malcolm Donaldson Department of Child Health, University of Glasgow School of Medicine, Glasgow, UK

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David B Dunger Department of Paediatrics, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
Wellcome Trust-MRC Institute of Metabolic Sciences, University of Cambridge, Cambridge, UK

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Ruth Wood Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK

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Simon H S Pearce Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
Department of Endocrinology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK

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Timothy D Cheetham Department of Paediatric Endocrinology, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK

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on behalf of the British Society for Paediatric Endocrinology and Diabetes (BSPED)

Introduction Thyrotoxicosis affects around 100 children under the age of 15 years in the UK every year ( 1 ) although the incidence may be increasing ( 2 ). Management typically involves the administration of thionamide anti-thyroid drug (ATD

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Bruno Bouça Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

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Ana Cláudia Martins Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

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Paula Bogalho Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

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Lídia Sousa Cardiology Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

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Tiago Bilhim Interventional Radiology Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

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Filipe Veloso Gomes Interventional Radiology Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

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Élia Coimbra Interventional Radiology Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

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Ana Agapito Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

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José Silva-Nunes Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

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dysfunction ( 5 ). Restoration of euthyroidism is of paramount importance in heart failure (HF) patients; it may be difficult to achieve with medication and it can also be refractory to a combination therapy of thionamides and glucocorticoids, making this a

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Peter N. Taylor Thyroid Research Group, Institute of Experimental and Molecular Medicine, School of Medicine, Cardiff University, Cardiff
London School of Hygiene and Tropical Medicine, London

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Bijay Vaidya Department of Endocrinology, Royal Devon and Exeter Hospital and Peninsula Medical School, Exeter, UK

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considerations when selecting which ATD to use in pregnancy and in those planning pregnancy. Search Strategy Various combinations of ‘anti-thyroid drugs’, ‘thionamide’, ‘carbimazole’, ‘methimazole’, ‘propylthiouracil’, ‘pregnancy’, ‘side effects

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Megumi Fujikawa M Fujikawa, Fujikawa-Megumi Clinic, Fukuoka, Japan

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Ken Okamura K Okamura, Department of Medicine and Clinical Science, Kyushu University, Fukuoka, Japan

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Objective: As thionamide is associated with various adverse effects, we reevaluated the practical efficacy of potassium iodide (KI) therapy for Graves’ hyperthyroidism (GD).

Methods: We administered KI (mainly 100 mg/day) to 324 untreated GD patients, and added methimazole (MMI) only to those remaining thyrotoxic even at 200 mg/day. When the patient became hypothyroid, MMI if taken was stopped, then levothyroxine (LT4) was added without reducing the KI dose. Radioactive iodine (RI) therapy or thyroidectomy was performed whenever required. We evaluated the early effects of KI at 2-4 weeks, and followed patients for 2 years.

Results: At 2 weeks, serum thyroid hormone decreased in all 324 patients. At 4 weeks, fT4, fT3, and both fT4 and fT3 levels became normal or low in 74.7%, 50.6%, and 50.6%, respectively. In a cross-sectional survey over 2-years, GD was well-controlled with KI or KI+LT4 (KI-effective) in >50% of patients at all time points. Among 288 patients followed for 2 years, 42.7% remained ‘KI-effective’ throughout 2 years (KI Group), 30.9% were well-controlled with additional MMI given for 1-24 months, and 26.4% were successfully treated with ablative therapy (mainly RI). Among ‘KI-effective’ patients at 4 weeks, 76.5% were classified into KI Group. No patients experienced adverse effects of KI.

Conclusion: KI therapy was useful in the treatment of GD. A sufficient dose of KI was effective in >50% of GD patients from 4 weeks to 2 years, and 42.7% (76.5% of ‘KI effective’ patients at 4 weeks) remained ‘KI-effective’ throughout 2 years.

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Christiaan F. Mooij Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

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Nitash Zwaveling-Soonawala Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

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Eric Fliers Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

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A.S. Paul van Trotsenburg Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

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. According to current guidelines, pre­operative treatment of (refractory) hyperthyroidism consists of the administration of a thionamide (e.g., methimazole), beta-blocker, glucocorticoid, and an iodine-containing preparation [ 1 ]. These treatment protocols

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Annelies Tonnelier Departments of Endocrinology and General Internal Medicine, Algemeen Ziekenhuis Sint-Elisabeth Zottegem, Zottegem, Belgium

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Jeroen de Filette Departments of Endocrinology and General Internal Medicine, Algemeen Ziekenhuis Sint-Elisabeth Zottegem, Zottegem, Belgium

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Ann De Becker Departments of Hematology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels

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Sophie Deweer Department of Endocrinology and Diabetology, Algemeen Ziekenhuis Sint-Elisabeth Zottegem, Zottegem, Belgium

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Brigitte Velkeniers Departments of Endocrinology and General Internal Medicine, Algemeen Ziekenhuis Sint-Elisabeth Zottegem, Zottegem, Belgium

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]. Medical treatment consists of thionamide plus potassium perchlorate (type 1) or glucocorticosteroids (type 2) [ 1 , 2 , 3 ]. Worldwide, multiple treatment algorithms have been proposed [ 2 ]. Combination therapy with glucocorticoids and thionamide, with or

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N. Papanikolaou Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK

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P. Perros Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK

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thyrotoxicosis: report of three cases and a literature review. Dysphagia 2004;19:120–124. 15382800 12 Burch WM Jr: Pseudothyrotoxic myopathy: a complication of thionamide therapy in hyperthyroidism. South Med J 1979;72:1494–1495. 10

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Georgios K. Markantes Division of Endocrinology – Department of Internal Medicine, University of Patras Medical School, Patras, Greece

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Marina A. Michalaki Division of Endocrinology – Department of Internal Medicine, University of Patras Medical School, Patras, Greece

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George A. Vagenakis Department of Pediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Athens, Greece

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Fotini N. Lamari Laboratory of Pharmacognosy and Chemistry of Natural Products, Department of Pharmacy, University of Patras, Patras, Greece

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Efthymia Pitsi Laboratory of Pharmacognosy and Chemistry of Natural Products, Department of Pharmacy, University of Patras, Patras, Greece

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Maria Eliopoulou Endocrinology Unit, Karamandanio Hospital, Patras, Greece

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Nicholas G. Beratis Department of Pediatrics, University of Patras Medical School, Patras, Greece

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Kostas B. Markou Division of Endocrinology – Department of Internal Medicine, University of Patras Medical School, Patras, Greece

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mechanisms contribute to thyroid dysfunction [ 2 ]. Thionamides is the treatment of choice in AIT1, while AIT2 is treated with oral glucocorticoids [ 3 ]. Although the diagnosis of thyrotoxicosis is easy, based on the findings of increased thyroid hormone

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