Block &amp; replace regime versus titration regime of antithyroid drugs for the treatment of Graves’ disease: a retrospective observational study

Vaidya, Bijay; Wright, Ailsa; Shuttleworth, Joanna; Donohoe, Mollie; Warren, R. E.; Brooke, Antonia; Gericke, Christian A.; Ukoumunne, Obioha C

doi:10.1111/cen.12478

Cited by 30 publications

(29 citation statements)

References 16 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…UK guidelines currently recommend that TRAb testing is not required to determine the cause of hyperthyroidism, particularly if the clinical features are suggestive of Graves’ disease [22]. TPO antibody was positive in 73.1% of those tested which is in keeping with a similar previous studies [23, 24]. …”

Section: Discussionsupporting

confidence: 82%

Epidemiology, management and outcomes of Graves’ disease—real life data

et al. 2017

View full text Add to dashboard Cite

PurposeTreatment options in Graves’ disease are clearly defined, but management practices and the perceptions of success are varied. The outcomes of treatment in large consecutive cohorts of Graves’ disease have not been well characterised. The study describes the epidemiology, management strategies and medium term outcomes following anti-thyroid drug treatment, radio-iodine ablation and surgery in Graves’ disease.MethodsAll patients (n = 659) who received treatment for a new diagnosis of Graves’ disease in secondary care over a 5 year period were included with a median (interquartile range) follow-up of 42.9 (29–57.5) months.ResultsThe age adjusted incidence of adult onset Graves’ disease in Sheffield, UK was 24.8 per 100,000 per year. Excluding 35 patients lost to follow-up, 93.1% (n = 581) were controlled on anti-thyroid drug treatment. Of these, 73.6% went into remission following withdrawal of anti-thyroid drugs; 5.2% were still undergoing initial therapy; 13.3% lost control whilst on anti-thyroid drugs; and 7.9% went on to have either surgery or radio-iodine ablation whilst controlled on anti-thyroid drugs. Of the 428 patients who achieved remission, 36.7% relapsed.Of 144 patients who had radio-iodine ablation treatment, 5.6% relapsed and needed further treatment. Of 119 patients having surgery, 5.2% had long-term hypoparathyroidism and none had documented long-term recurrent laryngeal nerve palsy.ConclusionsIn the follow-up, 39.9% of patients underwent surgery or radio-iodine ablation with little morbidity. Up to two-thirds of patients who achieved remission did not relapse. Data on effectiveness and risks of treatments for Graves’ disease presented in this study will help clinicians and patients in decision making.

show abstract

Section: Discussionsupporting

confidence: 82%

Epidemiology, management and outcomes of Graves’ disease—real life data

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Medical treatment of GD is not as effective to restore euthyroid status, and the “block and replace” method using a higher dose of ATDs combined with levothyroxine to avoid development of hypothyroidism has been extremely controversial [15,16,17]. However, the “block and replace” protocol remains widely used by French endocrinologists.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, the percentage of patients who are euthyroid at 3 months was significantly higher with the “block and replace” protocol than with ATDs alone ( p < 0.0001). Classically, “block and replace” carries an increased risk of side effects (agranulocytosis) and is reported not to increase the long-term recovery rate although the main argument of the supporters of the “block and replace” protocol is that euthyroidism is obtained more rapidly and that it reduces the number of laboratory assessments needed during follow-up [15,16,17]. …”

Section: Discussionmentioning

confidence: 99%

Survey of Clinical Practice Patterns in the Management of 992 Hyperthyroid Patients in France

Goichot¹,

Bouée²,

Castello-Bridoux³

et al. 2017

Eur Thyroid J

View full text Add to dashboard Cite

Background: Considerable variations in diagnosis and therapeutic practices are reported for hyperthyroidism (HT) between countries. Methods: A clinical study was conducted among a representative sample of 263 endocrinologists in France. All consecutive patients seen for HT during the study period were included. Diagnosis and treatment modalities were recorded from hyperthyroid patients with Graves disease (GD, n = 802), multinodular goiter (MNG, n = 121), and toxic adenoma (TA, n = 69). Results: Antithyroid antibodies were measured in half of the population (anti-TPO in 48.5% and anti-TSH receptor in 57.8%). Patients had thyroid ultrasonography and scintigraphy in 93.8 and 40.3%, respectively. Therapeutic management depended on the etiology: for the first episode of GD, antithyroid drugs (ATDs) were the first-line treatment in 91% of the patients, combined with surgery in 6.1% and with radioiodine in 2.9%. Surgery was preferred to radioiodine in MNG (52.6 vs. 22.4%) and TA (59.1 vs. 24.2%). Euthyroid status was achieved after 3 months in 64.4% of GD. A “block and replace” protocol was used in 41.2% of patients. After 3 months, 73% of patients were euthyroid in the “block and replace” group compared to 56.2% in the group with ATDs alone (p = 0.009). For MNG and TA, more than 75% of patients were euthyroid at the 3-month follow-up. Conclusions: Large discrepancies remain between clinical practice and international guidelines. These results should boost efforts to improve adherence to these guidelines.

show abstract

“…Some physicians start with the titration regimen and subsequently shift to the block-and-replace one. While recurrence rates of Graves' hyperthyroidism are reported to be similar in the two regimens, none seems to have specific advantages except for the lower prevalence of antithyroid drug side effects in the titration regimen [1]. However, the studies available are retrospective and it is surprising that no prospective clinical randomized trial has been reported.…”

Section: Doi: 101159/000491585mentioning

confidence: 99%