Antithyroid drug regimen for treating Graves' hyperthyroidism

Abraham, Prakash; Avenell, Alison; McGeoch, Susan; Clark, Louise F.; Bevan, John S.

doi:10.1002/14651858.cd003420.pub4

Cited by 164 publications

(141 citation statements)

References 50 publications

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“…The 1-year relapse rate of 30% compares favourably with w50% in the systematic review from the Cochrane Collaboration (3,5). Swedish studies from the 1970s and 1980s report somewhat higher relapse rates than our study (7,20) even though definite ablative methods were used more frequently, and that would supposedly lead to fewer and more easily ATD-treated patients at that time.…”

Section: Discussioncontrasting

confidence: 40%

“…FT 4 and fT 3 were not significant prognostic factors, using a cut-off at the median (Table 2). Palpable goitre was associated with worse prognosis compared with no goitre (51.2 vs 68.9% in remission after 5 years; PZ0.014; Fig.…”

Section: Prognostic Factorsmentioning

confidence: 98%

“…The levels of TSH, fT 4 and fT 3 were measured by electrochemiluminescence immunoassays (Roche Diagnostics). The upper reference intervals varied between 20.0 and 22.0 pmol/l for fT 4 and between 6.5 and 7.8 pmol/l for fT 3 .…”

Section: Laboratory Analysismentioning

confidence: 99%

“…The upper reference intervals varied between 20.0 and 22.0 pmol/l for fT 4 and between 6.5 and 7.8 pmol/l for fT 3 . For simplicity and due to the small variations, values are compared on common scales.…”

Section: Laboratory Analysismentioning

confidence: 99%

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Long-term prognosis after medical treatment of Graves' disease in a northern Swedish population 2000–2010

Mohlin

Nyström

Eliasson

2014

European Journal of Endocrinology

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Objective: To investigate the long-term prognosis of patients with Graves' disease (GD) after antithyroid drug (ATD) treatment and follow-up outside of highly specialised care. Design and methods: Medical records of all patients diagnosed with first-time GD in 2000-2010 with at least 6 months ATD treatment at a central hospital and follow-up in primary health care in the county of Norrbotten in northern Sweden were retrospectively reviewed. Patients were followed for relapse until 31st December 2012. We included 219 patients (mean age 46 years, 82.5% women) with follow-up of maximum 10 years and 829 observed patient years. Data were analysed using Kaplan-Meier estimates and log-rank test. Results: During the observation period, 43.5% of the patients had relapsed into active GD. The cumulative relapse rates were 22.6, 30.2, 36.9 and 41.5% after 6 months, 1, 3 and 5 years respectively. The presence of goitre (PZ0.014) predicted relapse. Previous smoking was protective against relapse (PZ0.003). The levels of free thyroxine or free tri-iodothyronine, age, gender, current smoking and ophthalmopathy did not predict relapse. Agranulocytosis was found in 1.7% (95% CI 0.7-4.0%). Conclusion: A long-term remission of 56.5%, in an iodine-sufficient area where ATD is offered to most patients in the real world of central and district hospitals, is higher than in most studies. Relapse was most common during the first year, and prognosis was excellent after 4 years without relapse. The protective effect of previous smoking merits further research.

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Section: Discussioncontrasting

confidence: 40%

Section: Prognostic Factorsmentioning

confidence: 98%

Section: Laboratory Analysismentioning

confidence: 99%

Section: Laboratory Analysismentioning

confidence: 99%

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Long-term prognosis after medical treatment of Graves' disease in a northern Swedish population 2000–2010

Mohlin

Nyström

Eliasson

2014

European Journal of Endocrinology

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“…These ATDs have fewer severe side effects than propylthiouracil [32], which was not used at all in this study. However, the block-replace regimen has been found to be associated with a higher frequency of adverse events than the titration regimen [33]. From 2016, when revised national guidelines were published in Sweden, the titration regimen is recommended as the first-line treatment for CT in Sweden.…”

Section: Discussionmentioning

confidence: 99%

The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden

et al. 2019

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Background: We found an increase in the incidence rate (IR) of childhood thyrotoxicosis (CT) during the 1990s in central Sweden. The optimal treatment method for CT is a subject that is still debated upon. Objectives: To investigate whether the increase in IR of CT in Sweden persists and to study the treatment outcome. Method: Children <16 years of age diagnosed with CT during 2000–2009 and living in 1 of 5 counties in central Sweden were identified retrospectively using hospital registers. Data on clinical and biochemical characteristics and outcomes of treatment were collected from medical records. The corresponding data from 1990 to 1999 were pooled with the new data. Results: In total, 113 children were diagnosed with CT during 1990–2009 in the study area. The overall IR was 2.2/100,000 person-years (95% CI 1.2–2.5/100,000 person-years). The IR was significantly higher during 2000–2009 than during 1990–1999 (2.8/100,000 [2.2–3.6] vs. 1.6/100,000 person-years [1.2–2.2], p = 0.006). The increase was significant for both sexes. Seventy percent of the patients who completed the planned initial treatment with antithyroid drugs (ATDs) and were not lost to follow-up relapsed within 3 years. Boys tended to relapse earlier than girls (6.0 months after drug withdrawal [95% CI 1.9–10.0] vs. 12.0 months [95% CI 6.8–17.3], p = 0.074). Conclusions: The IR of CT is increasing in both girls and boys. Relapse rate after withdrawal of ATD treatment is 70%. Boys tend to relapse earlier than girls, and this needs to be further investigated.

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Interventions for preventing and treating hyperthyroidism in pregnancy

Earl

Crowther

Middleton

2010

Cochrane Database of Systematic Reviews

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Background Women with hyperthyroidism in pregnancy have increased risks of miscarriage, stillbirth, preterm birth, and intrauterine growth restriction; and they can develop severe pre-eclampsia or placental abruption. Objectives To assess the effects of interventions for preventing or treating hyperthyroidism in pregnant women. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (28 July 2010). Selection criteria We intended to include randomised controlled trials comparing antithyroid treatments in pregnant women with hyperthyroidism. Data collection and analysis Two review authors would have assessed trial eligibility and risk of bias, and extracted data. Main results No trials were located. Authors’ conclusions As we did not identify any eligible trials, we are unable to comment on implications for practice, although early identification of hyperthyroidism before pregnancy may allow a woman to choose radioactive iodine therapy or surgery before planning to have a child. Designing and conducting a trial of antithyroid drugs for pregnant women with hyperthyroidism presents formidable challenges. Not only is hyperthyroidism a relatively rare condition, both of the two main drugs used have potential for harm, one for the mother and the other for the child. More observational research is required about the potential harms of methimazole in early pregnancy and about the potential liver damage from propylthiouracil.

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Antithyroid drug regimen for treating Graves' hyperthyroidism

Abstract: Analysis 2.1. Comparison 2 Short versus longer duration of antithyroid drug therapy (assuming relapse in all drop-outs), Outcome

Cited by 164 publications

References 50 publications

Long-term prognosis after medical treatment of Graves' disease in a northern Swedish population 2000–2010

Long-term prognosis after medical treatment of Graves' disease in a northern Swedish population 2000–2010

The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden

Interventions for preventing and treating hyperthyroidism in pregnancy

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