Hormone-replacement therapy discontinuation

In appropriate women, hormone-replacement therapy should be recommended at the lowest dose for the shortest duration and should be tapered before discontinuation in order to prevent the recurrence of hot flashes. 

In a reanalysis of 51 studies, less than 5 years of therapy with combined estrogen and progestogen was associated with a 15% increase in risk for breast cancer, and the risk increased with greater duration of treatment. Five years after discontinuation of hormone replacement therapy, the risk of breast cancer was no longer increased. 

Grady D. A 60-year-old woman trying to discontinue hormone replacement therapy. JAMA 2002 287 2130-2137. 

Iodine-induced hypothyroidism usually improves within a few weeks after iodine withdrawal, but some patients require temporary hormone replacement therapy (Wemeau, 2002). Unless there is underlying Graves disease, patients with iodine-induced hyperthyroidism do not have exophthalmos (Fradkin and Wolff, 1983 Roti and degU Uberti, 2001). Unlike hypothyroidism, iodine-induced hyperthyroidism is often not self-limited, and medication is required in addition to discontinuation of iodine-containing pharmaceuticals (Rajatanavin et al, 1984). 

Those on hormone-replacement therapy or the birth-control pill should not consume chasteberry, because combination effects are unknown. But women who have difficulty achieving pr nancy due to irregular ovulation may benefit from chasteberry. Their difficulties may be due to too much prolactin and too little progesterone, both of which can be regulated with chasteberry. They must, however, discontinue the therapy as soon as diey conceive, since the effects of chasteberry compounds on the developing fetus are unknown. 

Allergic reaction due to streptokinase overdose should be treated with corticosteroids and histamines. Severe hemorrhage requires discontinuation of streptokinase. Packed red blood cells are preferable for blood-replacement therapy, and volume expansion is advisable. Streptokinase may be used with caution with heparin, allopurinol, sex hormones, sulfonamides, tetracyclines, and dextran. 

Lithium is associated with hypothyroidism in up to 34% of patients, and hypothyroidism may occur after years of therapy. Lithium appears to inhibit thyroid hormone synthesis and secretion. Patients with underlying autoimmune thyroiditis are more likely to develop lithium-induced hypothyroidism. Patients may require LT4 replacement even if lithium is discontinued. 

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