-Graves-Basedow disease: a diffuse enlargement of the gland is evident, with uniform and elevated uptake of the radioactive iodine (B).
-Toxic multinodular goiter: irregularity would be evident, with relatively diminished uptake areas and other areas of increased uptake. The total uptake would be slightly to moderately increased (C).
-Toxic adenoma: total uptake is normal and only one hypercaptant nodule is seen between the rest of the suppressed thyroid tissue (D).
-Subacute thyroiditis: a very low uptake of radioactive iodine would be evident (E).
-Graves-Basedow disease: there is a diffuse enlargement of the gland, which is observed hypervascularized.
-Toxic multinodular goiter: there is also an increase in the size of the gland but with the presence of several hypervascularized solid nodules.
-Toxic adenoma: a normal-sized gland is usually found with a single hypervascularized solid nodule.
-Subacute thyroiditis: an enlarged gland can be seen, with areas with a tendency to form nodules but with decreased vascularization.
It includes the relief of symptoms, treatment with antithyroid drugs, therapy with radioactive iodine-131 and surgery (thyroidectomy).
-Use of beta-blocking drugs for the relief of tremors, nervousness, palpitations. The most used is Propanolol.
-In cases of mild ophthalmopathy use artificial tears and sunglasses. In more severe cases, steroids, ocular decompression surgery and ocular radiations are used.
-These drugs block the production of thyroid hormones in the gland.
-The most commonly used are methimazole and propylthiouracil.
-They are not useful in the treatment of subacute thyroiditis (where the block is useless, since the previously formed hormone is already released).
-Useful for long-term control of hyperthyroidism in children and pregnant women. In adults, it is used to control hyperthyroidism until definitive therapy (radioactive iodine or surgery) is performed.
-The doses are adjusted every 4-6 weeks until the thyroid function normalizes.
-Some patients (20-30%) with Graves' disease experience remission of the disease after being treated for 12-18 months, although recurrences are common. In these cases of recurrences it is necessary to administer a definitive treatment (radioactive iodine or surgery). Patients with toxic multinodular goiter or toxic adenoma do not experience remission.
-Adverse effects: the most common are allergic reactions, however it may cause a decrease in the number of white blood cells, polyarthritis and hepatitis. Therefore, the patient must visit the endocrinologist every 3 months.
-Therapy of choice for hyperthyroidism.
-Thyroid hormones are made from iodine, therefore, the cells of the gland will take any form of iodine, radioactive or not.
-It is administered orally (in liquid or capsule).
-It causes fibrosis and destruction of the cells of the gland (no other organ or tissue will uptake the radioactive iodine).
-The response may take weeks to months.
-Adverse effects: in most cases the patient will develop hypothyroidism after treatment.
-Contraindicated in pregnancy, lactation and children younger than five years.
-It consists of the partial or complete removal of the thyroid.
-Preferably in pregnant women with intolerance to antithyroid drugs, in patients with large goiter and in patients with severe ophthalmopathy.
-Before performing the surgery, the patient must be controlled with antithyroid drugs.
-The patient subsequently develops hypothyroidism.
-Adverse effects: in addition to the risks inherent to surgery, there is a risk of damage to the recurrent laryngeal nerve and damage to the parathyroid glands, but these complications are rare.
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