What is the first line of treatment for angioedema in patients with thyroid disease?

From the Guidelines

The first line of treatment for angioedema in patients with thyroid disease is discontinuation of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II type 1 receptor blockers (ARBs), if the patient is taking these medications, as they are a common cause of angioedema. This approach is based on the most recent and highest quality study available, which emphasizes the importance of discontinuing ACE-I or ARB in the management of ACE-I–associated angioedema 1.

Key Considerations

• Discontinuation of the offending medication is the cornerstone of therapy, although there might be a significant time lag between discontinuation of the drug and the propensity for angioedema.
• During acute attacks, patients need to be observed in a controlled environment in case they require intubation.
• Treatment with antihistamines, corticosteroids, or epinephrine has not been shown to be efficacious for ACE-I–associated angioedema, as noted in the study published in the Journal of Allergy and Clinical Immunology 1.
• For patients with thyroid disease, it is essential to address the underlying thyroid condition, as thyroid dysfunction can contribute to angioedema episodes.
• In cases of autoimmune thyroid disease, the angioedema may have an autoimmune component, so immunomodulatory approaches might be considered in refractory cases, as suggested by the diagnostic algorithm for chronic spontaneous urticaria and angioedema 1.

Additional Treatment Options

• Icatibant and fresh frozen plasma have been described as potential treatments for ACE-I–associated angioedema, although no controlled studies have been reported 1.
• Tranexamic acid or attenuated androgens may be considered as long-term prophylaxis for hereditary angioedema, especially in situations where first-line treatments are not available 1.
• Regular monitoring for side effects and engagement with international Global Access Programs to enable local access to highly effective HAE medications are crucial for optimal management 1.

From the Research

Angioedema and Thyroid Disease

• Angioedema in patients with thyroid disease can be a complex condition to manage, with limited research available on the first line of treatment.
• A case study published in 2020 2 reported a patient with hypothyroidism who presented with acute onset of angioedema, requiring complex airway management and medical treatment.
• Another study published in 2022 3 reported a patient with autoimmune thyroid disease who presented with chronic idiopathic urticaria and facial angioedema, which resolved after thyroidectomy.

Treatment Options

• The treatment options for angioedema in patients with thyroid disease are not well established, but may include:
  • Antihistamines and levothyroxine, as reported in a study published in 2022 3
  • Thyroidectomy, as reported in a study published in 2022 3
  • Medical treatment, such as corticosteroids and immunosuppressants, as reported in a study published in 2020 2

Thyroid Disease Management

• The management of thyroid disease, including hypothyroidism and hyperthyroidism, is crucial in patients with angioedema.
• Levothyroxine is the treatment of choice for hypothyroidism, as reported in a study published in 2016 4.
• Treatment options for hyperthyroidism include antithyroid drugs, radioactive iodine, and surgery, as reported in a study published in 2021 5 and 2023 6.