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Adjuvant therapy in hyperthyroidism
, P. Bhatt
Published in Nova Science Publishers, Inc.
2010
Pages: 159 - 178
Abstract
Adjuvant therapy in hyperthyroidism is commonly advocated. Increased expression of beta adrenoceptors in thyrotoxicosis, significant blockade in cardiac symptoms and efficacy in normalizing metabolic demand justifies the use of beta blockers (propranolol, atenolol, metoprolol, acebutolol, oxprenolol, nadolol and timolol). Carvedilol, an alpha beta blocker, is used in hyperthyroidism associated with hyperinsulinemia because of favourable effects on insulin sensitivity and glycemic control. Hyperthyroidism is associated with increased inotropy and chronotropy because of increased calcium uptake and storage capacity. Calcium channel blockers particularly diltiazem and verapamil attenuate these effects. Successive thyroid storms have been treated with L-carnitine as it inhibits thyroid hormone entry into the cell and nucleus. Coenzyme Q10, an antioxidant, prevents ultrastructural disorganisation and decreases the nitric oxide synthase increment in the hyperthyroid heart. Iopanoic acid, a 5'-deiodinase inhibitor, is used to manage amiodarone-induced thyrotoxicosis. Cholestyramine in a clinical trial decreased serum T3 and T4 levels. Lithium carbonate can be used safely preoperatively or prior to radioiodide therapy in circumstances where antithyroid medications are contraindicated or ineffective. Preclinical models using knockout mice showed that vitamin D directly affects thyroid function. Vitamin E protects apo B-containing lipoproteins from copperinduced oxidation in hyperthyroidism. Supplementation of vitamin C, E, beta carotene and selenium, when evaluated on erythrocytes from patients with Graves’ disease achieved euthyroid state faster. Hence an armamentarium of adjuvant therapy in hyperthyroidism warrants therapeutic efficacy. © 2010 Nova Science Publishers, Inc.
About the journal
JournalHandbook of Hyperthyroidism: Etiology, Diagnosis and Treatment
PublisherNova Science Publishers, Inc.
Open AccessNo
Authors (1)