Effect of universal salt iodization on antithyroid drugs

Iodine deficiency disease （IDD） is common in China. An universal salt iodization （USl） program has been implemented by the Chinese government since 1996. As a result, the goiter rate in 8- to 10-year old children decreased from 20.4% in 1995 to 5.8% in 2002.1 But the adverse effects of iodine excess such as iodine-induced hyperthyroidism, iodine-induced goiters, iodine-induced hypothyroidism, etc. have become a great concern to healthcare professionals as well as the general population. The impact of USI on antithyroid drugs （ATDs） might become a potential challenge to address. With a special grant from the Department of Disease Control, the Health Ministry of China, we conducted a prospective study on the effects of USI on ATDs at the thyroid section of the Endocrinology Clinic of Peking Union Medical College Hospital （PUMCH）, Beijing.

Resistance to Anti-Thyroid Drugs in Graves’ Disease: Clinical-Biological Characteristics and Alternative Therapy in Tropical Area

Background: Resistance to anti-thyroid drugs (ATDs) is a rare entity recently described. We report two African observations in the treatment of Graves’ disease. Case 1: A 19-year-old Senegalese woman presented on admission with thyrotoxicosis syndrome associated with diffuse goitre and Grave’s orbitopathy. TSH levels were low (0.005 mIU/ml;N = 0.27 - 4.20) and fT4 elevated (60 pmol/L;N = 12 - 22]. Combination therapy with propranolol (40 mg/day) and carbimazole (starting dose of 45 mg/day and increased to 60 mg/day) was initiated. In view of the persistence of symptoms despite good therapeutic compliance, carbimazole was replaced by methimazole with an initial starting dose of 40 mg/day, followed by 60 mg/day. Despite the change in therapy, clinical symptoms of thyrotoxicosis persisted, and fT4 levels remained elevated. The patient was diagnosed with resistance to ATDs in Graves’ disease. Total thyroidectomy following 10 days of preoperative preparation with 1% Lugol’s solution was performed successfully. Case 2: A 22-year-old woman was referred for continued management of Graves’ disease with elevated thyroid-stimulating hormone receptor antibody (TRAb) levels (34 UI/mL;N < 1.75). Treatment included propranolol (80 mg/day) and carbimazole at an unusual dose of 80 mg/day. Combined therapy was clinically and biologically ineffective, with an fT4 level of 100 pmol/L [N: 12 - 22]. Upon admission, methimazole (40 mg/day) followed by propylthiouracil (800 mg/day) replaced carbimazole. Despite good patient compliance, the patient’s symptoms remained unaltered and fT4 levels elevated. A total robot thyroidectomy using the right axillary approach was performed successfully after 10 days of preoperative preparation, including prednisone (40 mg/day) combined with 1% Lugol’s solution. Conclusion: Resistance to ATDs complicates the management of Graves’ disease. Total thyroidectomy following preoperative preparation with Lugol’s solution and/or corticosteroids was shown to be successful.

Impact of carbimazole combined with vitamin E on testicular injury induced by experimental hyperthyroidism in adult albino rats:oxidative/inflammatory/apoptotic pathways

Thyroid hormones play essential roles in spermatogenesis,but their effects on infertile males remain poorly understood.This study aimed to evaluate the impact of combining carbimazole(CBZ)with vitamin E(VE)on testicular injury induced by experimental hyperthyroidism in adult albino rats,focusing on oxidative,inflammatory,and apoptotic pathways.In this experimental study,64 adult male albino Wistar rats were divided into eight groups:Group I(control-untreated),Group II(CBZ-control),Group III(VE-control),Group IV(CBZ+VE-control),Group V(levothyroxine-induced testicular injury),Group VI(levothyroxine+CBZ-treated),Group VII(levothyroxine+VE-treated),and Group VIII(levothyroxine+CBZ+VE-treated).The study was conducted in the Faculty of Medicine,Suez Canal University(Ismailia,Egypt).After cervical decapitation,both testes and epididymis were examined histopathologically and immunohistochemically.Significant differences were observed among groups concerning malondialdehyde(MDA),glutathione(GSH),superoxide dismutase(SOD),and catalase(CAT;all P<0.001).Polymerase chain reaction analysis showed significant differences in tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),Bcl-2-associated X protein(BAX),B-cell lymphoma 2 protein(Bcl2),p53,Caspase-3,Caspase-8,Caspase-9,and nuclear factor-kappa B(NF-κB)mRNA levels(all P<0.001).Hyperthyroid group treated with CBZ alone(Group VI)exhibited testicular side effects,affecting seminiferous tubules and spermatogenesis.However,the Group VIII showed improved spermatogenesis and a decrease in testicular side effects.The addition of VE to the treatment of hyperthyroid rats with CBZ reduced testicular side effects and seminiferous tubular affection when potentially improving spermatogenesis.Further research is needed to elucidate the underlying mechanisms fully.