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I believe the current standard for Graves is no longer PTU because of the hepatotoxicity. I have been using the mnemonic Potentially Toxic Ugh.
Thanks bdig.
While it’s still used, it seems to have fallen out of favor as a first-line agent. Methimazole seems to have stepped up to the plate. Love the mnemonic… I’m assuming it’s yours and I’m going to use it! Here’s the updated version:
GRAVES DISEASE = HYPERthyroidism
Graves disease (aka Grave’s Disease) causes hyperthyroidism due to the presence of “thyroid-stimulating immunoglobulin.” Signs/symptoms may include an infiltrative ophthalmopathy, emotional lability, weight loss, heat intolerance and possible LID LAG. TSH should be VERY low/absent! Radioactive Iodine Uptake is HIGH in Grave’s since it needs lots of iodine to make all of the THYROXINE being released. Treatments options include methimazole, iodine ablation, a beta blocker (propranolol for symptomatic relief) and thyroidectomy. Methimazole and PTU inhibit T4 production (not secretion). GOITERS in patients with hyperthyroidism are cells that are FULL of thyroid hormone so it can take months to become euthyroid.
PEARL: Some of the symptoms of hyperthyroidism may be disguised as “hyperactivity, disorganized thinking and trouble sleeping.”
PEARL: If a patient has a goiter, more information is needed to differentiate between hypothyroidism and hyperthyroidism
MNEMONIC: PTU can be quite toxic so it is NOT a first-line agent. P-T-U = Potentially Toxic, UGH!
Is methimazole preferred over I131 since I131 is a more successful therapy for Grave’s and methimazole does not offer a better long term remission rate plus a lot of adverse reactions comparatively?
If given a question about Graves Disease, I would choose methimazole over i131.
PTU…To Use in Pregnacy
I’d stick to the “Potentially Toxic, Ugh” mnemonic. PTU is Preg. category D – Pregnancy Toxic Use or Potentially Toxic Use.
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