Wednesday, May 5, 2010

cholestyramine and Grave's

this was a reference in uptodate.
Hyperthyroidism and the use of cholestyramine.
Treatment of hyperthyroidism with a combination of methimazole and cholestyramine.
Mercado M; Mendoza-Zubieta V; Bautista-Osorio R; Espinoza-de los Monteros AL
J Clin Endocrinol Metab 1996 Sep;81(9):3191-3.
The entero-hepatic circulation of thyroid hormones is increased in thyrotoxic states. Based on this observation, the use of ionic exchange resins to bind thyroid hormones in the intestine has been tried. The present study evaluates the effectiveness of cholestyramine as an adjunctive therapy in the management of hyperthyroid Graves' disease. Thirty patients with newly diagnosed hyperthyroid Graves' disease were randomly assigned to one of the following treatment groups: methimazole, propranolol and cholestyramine for 4 weeks (group I); methimazole and propranolol for 4 weeks (group II); methimazole, propranolol, and cholestyramine for 2 weeks, followed by 2 weeks of methimazole and propranolol (group III). At the end of the study, total and free T4 as well as T3 levels had decreased more in group I compared with group II: 61%, 78%, 68% in group I compared with 43%, 65%, 50% in group II (P = 0.037 for T4, P = 0.038 for free T4, P = 0.012 for T3). Group III behaved like group I while patients were receiving cholestyramine, but once the drug was discontinued, the rate of decline of thyroid hormones slowed down. We conclude that cholestyramine represents an effective and well-tolerated adjunctive therapy in patients with hyperthyroid Graves' disease, and it produces a more rapid and complete decline in thyroid hormone levels in these patients.
Endocrinology Section, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico.

Dr. Wei-An Andy Lee
Clinical Endocrinologist
Assistant Professor of Clinical Medicine
Keck School of Medicine
University of Southern California

"This email message is confidential, intended only for the recipient(s) named above and
may contain information this is privileged, exempt from disclosure under applicable law.
If you are not the intended recipient, do not disclose or disseminate this message to
anyone except the intended recipient. If you have received this message in error, or are
not the named recipient(s), please immediately notify the sender by return email, and
delete all copies of this message."

1 comment:

  1. That's wild. Thinking of trying that with my next in-office severe hyperthyroidism. Now that I think about it , this would be a great initial choice for amiodarone induced hyperthyroidism as it can be difficult to ascertain the underlying cause of the hyperthyroidism. Also a possibility for thyroid storm I suppose, except the state of the GI tract is always a question.


Note: Only a member of this blog may post a comment.