With regards to treatment of thyrotoxicosis of Grave's disease, consider the following statements: 1. Propylthiouracil is suitable in breastfeeding patients. 2. Large goitre is an indication for thyroidectomy. 3. Radioiodine is recommended for management in pregnancy. 4. Agranulocytosis is a complication associated with carbimazole. Which of the statements given above are correct?
Grave's Disease Treatment: Statement Analysis
This question requires evaluating the suitability of different treatments for thyrotoxicosis in Grave's disease based on specific clinical scenarios.
Statement 1: PTU and Breastfeeding
Propylthiouracil (PTU) is considered suitable for breastfeeding patients with thyrotoxicosis. It crosses into breast milk at lower levels compared to other anti-thyroid drugs and is often preferred, particularly if the mother is also taking it during pregnancy.
Conclusion: Statement 1 is correct.
Statement 2: Large Goitre and Thyroidectomy
A significantly enlarged thyroid gland (large goitre) in Grave's disease can be an indication for thyroidectomy, especially if it causes compressive symptoms (like difficulty swallowing or breathing) or significant cosmetic concerns that don't resolve with medication.
Conclusion: Statement 2 is correct.
Statement 3: Radioiodine in Pregnancy
Radioactive iodine (RAI) therapy is contraindicated during pregnancy. It can cross the placenta and permanently damage the fetal thyroid gland. Management during pregnancy typically involves anti-thyroid drugs.
Conclusion: Statement 3 is incorrect.
Statement 4: Carbimazole and Agranulocytosis
Agranulocytosis, a dangerous decrease in white blood cells, is a known rare side effect of anti-thyroid medications, including carbimazole (and its active metabolite methimazole). Patients on these drugs require monitoring.
Conclusion: Statement 4 is correct.
Final Answer Determination
Based on the analysis:
- Statement 1 is correct.
- Statement 2 is correct.
- Statement 3 is incorrect.
- Statement 4 is correct.
Therefore, the correct statements are 1, 2, and 4.
Important Questions from Thyroid Disorders
- Which one of the following diseases is characterized by destructive lymphoid infiltration of the thyroid gland leading to fibrosis and enlargement of the thyroid gland with an increased risk of developing thyroid lymphoma?
With regard to management of hypothyroidism, consider the following statements:
1. Treatment is with levothyroxine replacement.
2. It is taken as a single daily dose.
3. Average dose is 1.6 $\mu$gm/kg/day.
4. Full dose per weight should be started in those with coronary artery disease.
Which of the statements given above are correct?
- Low serum thyroglobulin levels are seen in
- A 27-year lady underwent thyroidectomy for thyroid carcinoma. Post-operatively she started developing muscle cramps, perioral and peripheral paresthesia, and carpopedal spasm. Which one of the following interventions will be appropriate for this patient?
- Iodine has complex effects on thyroid function. Very high concentrations of iodine inhibit thyroid hormone synthesis and release. This effect is known as
