Antithyroid drug regimen for treating Graves' hyperthyroidism

Abraham, P; Avenell, A; Watson, W.A.; Park, CM; Bevan, J. S.

doi:10.1002/14651858.cd003420

Cited by 17 publications

(28 citation statements)

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“…Management options are antithyroid drugs, radioiodine ablation (RIA) and surgery. Antithyroid drugs are usually first-line treatment but up to 60% relapse 2 3. In patients who relapse, options include a further course of antithyroid drugs, RIA or surgery.…”

Section: Purpose Of the Studymentioning

confidence: 99%

Patients’ perceptions and views of surgery and radioiodine ablation in the definitive management of Graves’ disease

Hookham

Truran

Allahabadia

et al. 2016

Postgraduate Medical Journal

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Background Patients’ perceptions and preferences influence the choice of radioiodine ablation (RIA) or surgery in the definitive management of Graves’ disease. This study aimed to evaluate their concerns, experiences and satisfaction following definitive treatment. Methods A postal survey of patients who had treatment with surgery or RIA between January 2011 and June 2013 for Graves’ disease was conducted. Results Of 214 patients, 136 (64%) responded. The majority of patients felt actively involved in decision making (83.8%) and were satisfied (84.9%) with their treatment. Compared with RIA, patients who underwent surgery were more satisfied with their treatment (p=0.008). Discussion with the doctor was the most useful aid to decision making. Feeling involved in decision-making process was associated with improved satisfaction (p<0.001). Common reasons for not choosing surgery were need for general anaesthesia, scarring and voice change. Avoiding close contact, risk of persistent hyperthyroidism and worsening eye disease were common reasons for not choosing RIA. Ongoing concerns were hypothyroidism, scarring and eye problems after surgery and hypothyroidism and eye problems after RIA. Conclusions This study provides insight into patients’ experiences of surgery and RIA for Graves’ disease and reinforces the importance of patient involvement in the decision-making process.

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Section: Purpose Of the Studymentioning

confidence: 99%

Patients’ perceptions and views of surgery and radioiodine ablation in the definitive management of Graves’ disease

Hookham

Truran

Allahabadia

et al. 2016

Postgraduate Medical Journal

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“…On the basis of the results of four randomised clinical trials variously comparing treatment durations of 6, 12, 18, 24, and 42 months, it has been determined that treatment with a thionamide for 12-18 months is optimal, resulting in long term remission in 40-60% of patients with Graves' disease 8. Aggregate data from several small clinical trials show no clear benefit from using a block-replace regimen (a large dose of a thionamide in combination with thyroid hormone) 8. Because toxic nodular goitre rarely, if ever, goes into remission, thionamides may be used for the short term treatment of patients with toxic nodular goitre, to induce euthyroidism before definitive treatment, but are not appropriate for long term therapy.…”

Section: Antithyroid Drugsmentioning

confidence: 99%

Diagnosis and management of thyrotoxicosis

Pearce

2006

BMJ

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“…Antithyroid drugs are generally well tolerated but 5-10% of patients develop a treatment-related rash 38. Agranulocytosis is a rare effect (reported rate 13-38 events per million prescriptions) 39.…”

Section: Radioiodine Vs Other Therapiesmentioning

confidence: 99%

“…Drug treatment is often the first-line treatment for Graves' disease, although radioiodine is increasingly being used as first-line therapy for this type of hyperthyroidism 38. This is particularly so in older people, in whom the risks from hyperthyroidism are greater (e.g.…”

Section: Radioiodine Vs Other Therapiesmentioning

confidence: 99%

“…if they have cardiac arrythmias, angina, osteoporosis). Drug treatment is typically continued for 12-18 months but hyperthyroidism recurs in around half of patients within 1-2 years of stopping treatment 38. Patients who relapse after stopping drug treatment or who cannot tolerate the unwanted effects of such therapy are usually offered definitive treatment with either radioiodine or surgery.…”

Section: Radioiodine Vs Other Therapiesmentioning

confidence: 99%

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Radioiodine therapy for hyperthyroidism

2006

DTB

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Abstract:In the New England Journal of Medicine last year, Ross provided an excellent summary of current evidence on use of radioactive iodine (RAI) in the treatment of hyperthyroidism 1 . However, clinical practice with regard to RAI treatment varies widely, with some key differences existing between the North American perspective provided by Ross and what is more widely practiced in Europe. Treatment of hyperthyroidism first requires an accurate diagnosis of the underlying aetiology. Hyperthyroidism refers to any condition in which there is an excessive production of thyroid hormone, which may arise from diffuse autoimmune stimulation in the case of Graves disease (GD) or autonomously functioning nodules including toxic multinodular goitre (TMNG) and solitary toxic adenoma (TA). GD is the commonest cause of hyperthyroidism, but in areas of iodine deficiency the prevalence of TMNG and TA increase with age and therefore are more common than GD in older persons. Spontaneous remission occurs in approximately 30% of patients with GD, but is unlikely to occur in toxic nodules.The rationale for RAI treatment is that iodine is a substrate for thyroid hormone synthesis and is actively transported into thyroid follicular cells, where thyroxine (T4) and triiodothyronine (T3) are formed and then stored within the colloid space. Radioiodine (131I) is similarly processed, and destruction of follicular cells is the result of ?-particle radiation, effectively ablating functional thyroid tissue within a 1-2mm radius 1 . A number of studies have provided reassurance with regard to the safety of RAI. The largest study included over 35,000 patients, followed for a mean of 21 years, and found that radioiodine was not linked to cancer mortality or any specific cancer 2 .The main aim of RAI therapy is to eliminate the hyperthyroid state. However, for patients with GD there are philosophical differences in the approach used to achieve this goal. In the US the goal of RAI in GD is to render the patient hypothyroid. In contrast, the local practice in many Irish centres is to administer a dose of RAI calculated on the basis of an uptake scan with the intent of inducing a euthyroid state. The downside of this approach is that the incidence of persistent hyperthyroidism is higher and some patients may need a second treatment 6 months later.Most hyperthyroid patients will develop normal thyroid function within 4-8 weeks of treatment. Hypothyroidism can occur from 4 weeks, but more commonly arises between 2 and 6 months. For this reason, thyroid function is usually checked at 2, 4, and 6 months post-treatment, and less frequently thereafter. Thyroid stimulating hormone (TSH) levels may remain suppressed for several months following resolution of hyperthyroidism and should therefore be interpreted cautiously and only in association with free T4 and T3 levels. If thyroxine replacement is initiated, the dose should initially be guided by the free T4 level. In contrast to GD, the approach to patients with TMNG or TA is generally the same world ...

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Antithyroid drug regimen for treating Graves' hyperthyroidism

Cited by 17 publications

References 0 publications

Patients’ perceptions and views of surgery and radioiodine ablation in the definitive management of Graves’ disease

Patients’ perceptions and views of surgery and radioiodine ablation in the definitive management of Graves’ disease

Diagnosis and management of thyrotoxicosis

Radioiodine therapy for hyperthyroidism

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