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      Una complicación infrecuente del tratamiento de Graves Basedow Translated title: A rare complication of the treatment of Graves Basedow

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          Abstract

          RESUMEN La enfermedad de Graves Basedow es una enfermedad autoinmune ocasionada por una producción elevada de hormona tiroidea. El diagnóstico se fundamenta básicamente en la sospecha clínica y la determinación analítica de hormonas tiroideas y anticuerpos antitiroideos. El objetivo del tratamiento consiste en alcanzar un estado eutiroideo, y se puede lograr administrando fármacos antitiroideos, yodo radiactivo o tiroidectomía total o subtotal. Las complicaciones más frecuentes de la intervención quirúrgica son la disfonía, el hipoparatiroidismo y la hemorragia. La fístula traqueal es una complicación muy infrecuente y, a su vez, potencialmente mortal.

          Translated abstract

          ABSTRACT Graves Basedow disease is an autoimmune disease caused by increased production of thyroid hormone. Diagnosis is based on clinical suspicion and analytical determination of thyroid hormones and proven antithyroid drugs. The goal of treating this disease is to achieve a euthyroid state, which can be attained with antithyroid drugs, radioactive iodine or total or subtotal thyroidectomy. The most common complications of surgery are dysphonia, hypoparathyroidism and haemorrhage. Tracheal fistula is a very rare complication and potentially fatal.

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          Thyroid surgery for Graves' disease and Graves' ophthalmopathy.

          Graves' disease is an autoimmune disease caused by the production of auto-antibodies against the thyroid-stimulating hormone receptor, which stimulates follicular cell production of thyroid hormone. It is the commonest cause of hyperthyroidism and may cause considerable morbidity with increased risk of cardiovascular and respiratory adverse events. Five per cent of people with Graves' disease develop moderate to severe Graves' ophthalmopathy. Thyroid surgery for Graves' disease commonly falls into one of three categories: 1) total thyroidectomy, which aims to achieve complete macroscopic removal of thyroid tissue; 2) bilateral subtotal thyroidectomy, in which bilateral thyroid remnants are left; and 3) unilateral total and contralateral subtotal thyroidectomy, or the Dunhill procedure. Recent American Thyroid Association guidelines on treatment of Graves' hyperthyroidism emphasised the role of surgery as one of the first-line treatments. Total thyroidectomy removes target tissue for the thyroid-stimulating hormone receptor antibody. It controls hyperthyroidism at the cost of lifelong thyroxine replacement. Subtotal thyroidectomy leaves a thyroid remnant and may be less likely to lead to complications, however a higher rate of recurrent hyperthyroidism is expected and revision surgery would be challenging. The choice of the thyroidectomy technique is currently largely a matter of surgeon preference, and a systematic review of the evidence base is required to determine which option offers the best outcomes for patients.
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            Is Graves’ disease a primary immunodeficiency? New immunological perspectives on an endocrine disease

            Background Uncertainty about factors influencing the susceptibility and triggers for Graves’ disease persists, along with a wide variation in the response to anti-thyroid drugs, currently at approximately 50% of non-responders. The aim of this narrative review is to summarize immunological concepts, with a combined endocrine and immunological perspective, to highlight potential new areas of research. Main text Relevant studies were identified through a systematic literature search using the PubMed and EMBASE databases in March 2016. No cut-offs regarding dates were imposed. We used the terms “Graves’ Disease” or “Basedow” or “thyrotoxicosis” together with the terms “etiology”, “pathophysiology”, “immunodeficiency”, “causality”, and “autoimmunity”. The terms “orbitopathy”, “ophthalmopathy”, and “amiodarone” were excluded. Articles in English, French, German, Croatian, Spanish, and Italian were eligible for inclusion. Conclusions While concepts such as the impact of iodine, smoking, human leucocyte antigen, infections, and ethnicity are established, new ideas have emerged. Pertaining evidence suggests the involvement of autoimmunity and immunodeficiency in the pathophysiology of Graves’ disease. Recent studies point to specific immunological mechanisms triggering the onset of disease, which may also serve as targets for more specific therapies.
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              Radioiodine therapy versus antithyroid medications for Graves' disease.

              Graves' disease is the most common cause of hyperthyroidism. Both antithyroid medications and radioiodine are commonly used treatments but their frequency of use varies between regions and countries. Despite the commonness of the diagnosis, any possible differences between the two treatments with respect to long-term outcomes remain unknown.
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                Author and article information

                Journal
                albacete
                Revista Clínica de Medicina de Familia
                Rev Clin Med Fam
                Sociedad Española de Medicina de Familia y Comunitaria (Barcelona, Cataluña, Spain )
                1699-695X
                2386-8201
                2022
                : 15
                : 3
                : 168-170
                Affiliations
                [4] Toledo orgnameCentro de Salud de Santa Bárbara España
                [1] Toledo orgnameCentro de Salud de Santa Bárbara España
                [2] Toledo orgnameCentro de Salud de Santa Bárbara España
                [3] Puertollano orgnameCentro de Salud Barataria España
                Article
                S1699-695X2022000300009 S1699-695X(22)01500300009
                ac6d617b-0c64-43a0-a184-b8caa407b732

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 05 September 2021
                : 16 June 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 3
                Product

                SciELO Spain

                Categories
                Un paciente con...

                Fistula,tiroidectomía,fístula,hipertiroidismo,Thyroidectomy,Hyperthyroidism

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