Effect of long-term continuous methimazole treatment of hyperthyroidism: comparison with radioiodine

Azizi, Fereidoun; L, Ataie; Hedayati, Mehdi; Mehrabi, Yadollah; Sheikholeslami, Farhad

doi:10.1530/eje.1.01904

Cited by 120 publications

(90 citation statements)

References 38 publications

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“…In practice, it is not that easy to maintain normal TSH in hypothyroid patients taking levothyroxine. In the present study, of the 46 radioiodineinduced hypothyroid patients on levothyroxine, 7.2% had suppressed TSH and 19.1% had TSH above the normal range, a finding in accordance with many reports in adult patients [28][29][30].…”

Section: Discussionsupporting

confidence: 93%

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Management of thyrotoxicosis in children and adolescents: 35 years’ experience in 304 patients

Azizi

Amouzegar

2018

Journal of Pediatric Endocrinology and Metabolism

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Background: Diffuse toxic goiter accounts for about 15% of all childhood thyroid diseases. There is great controversy over the management of Graves' disease in children and adolescents. This article reports our experience in 304 children and juvenile patients with Graves' disease. Methods: Between 1981 and 2015, 304 patients aged 5-19 years with diffuse toxic goiter were studied, of whom 296 patients were treated with antithyroid drugs (ATD) for 18 months. Patients with persistent or relapsed hyperthyroidism who refused ablative therapy with surgery or radioiodine were managed with continuous methimazole (MMI) treatment. Results: In 304 patients (245 females and 59 males), the mean age was 15.6 ± 2.6 years. After 18 months of ATD therapy, 37 remained in remission and of the 128 who relapsed, two, 29 and 97 patients chose surgery, continuous ATD and radioiodine therapy, respectively. Of the 136 patients who received radioiodine, 66.2% became hypothyroid. Twenty-nine patients received continuous ATD therapy for 5.7 ± 2.4 years. The mean MMI dose was 4.6 ± 12 mg daily, no serious complications occurred and all of them remained euthyroid during the follow-up. Less abnormal thyroid-stimulating hormone (TSH) values were observed in these patients, as compared to patients who were on a maintenance dose of levothyroxine after radioiodine induced hypothyroidism. Conclusions: Original treatment with ATD and subsequent radioiodine therapy remain the mainstay of treatment for juvenile hyperthyroidism. Continuous ATD administration may be considered as another treatment modality for hyperthyroidism.

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Section: Discussionsupporting

confidence: 93%

“…In addition, the rates of suppressed and increased TSH levels were only 1.2% and 1.9%, respectively, which is in accordance with previous studies of adult patients with hyperthyroidism [28,29]. Interest in long-term treatment with ATD is also being considered in pediatric patients.…”

Section: Discussionsupporting

confidence: 89%

Management of thyrotoxicosis in children and adolescents: 35 years’ experience in 304 patients

Azizi

Amouzegar

2018

Journal of Pediatric Endocrinology and Metabolism

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“…The risk of new hyperthyroidism was considerably higher in patients who were TRAbpositive at the end of medical therapy, but the initial TRAb values and the fall in TRAb during therapy overlapped between patients who became hyperthyroid and those who remained euthyroid. In patients who do not accept the risk of new hyperthyroidism after the stop of medication, prolonged medical therapy may be useful (28)(29)(30)(31). This should be balanced against the risk of drug side effects (32).…”

Section: Discussionmentioning

confidence: 99%

TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study

Laurberg

Wallin²,

Tallstedt³

et al. 2008

European Journal of Endocrinology

357

231

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Introduction: Autoimmunity against the TSH receptor is a key pathogenic element in Graves' disease. The autoimmune aberration may be modified by therapy of the hyperthyroidism. Objective: To compare the effects of the common types of therapy for Graves' hyperthyroidism on TSHreceptor autoimmunity. Methods: Patients with newly diagnosed Graves' hyperthyroidism aged 20-55 years were randomized to medical therapy, thyroid surgery, or radioiodine therapy (radioiodine was only given to patients R35 years of age). L-thyroxine (L-T 4 ) was added to therapy as appropriate to keep patients euthyroid. Anti-thyroid drugs were withdrawn after 18 months of therapy. TSH-receptor antibodies (TRAb) in serum were measured before and for 5 years after the initiation of therapy. Results: Medical therapy (nZ48) and surgery (nZ47) were followed by a gradual decrease in TRAb in serum, with the disappearance of TRAb in 70-80% of the patients after 18 months. Radioiodine therapy (nZ36) led to a 1-year long worsening of autoimmunity against the TSH receptor, and the number of patients entering remission of TSH-receptor autoimmunity with the disappearance of TRAb from serum during the following years was considerably lower than with the other types of therapy. Conclusion: The majority of patients with Graves' disease gradually enter remission of TSH-receptor autoimmunity during medical or after surgical therapy, with no difference between the types of therapy. Remission of TSH-receptor autoimmunity after radioiodine therapy is less common.

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“…It is possible that patients may also choose this modality of treatment, creating a stable situation earlier in the course of therapy and saving several years of regular outpatient clinic visits and possible upsets caused by relapses of hyperthyroidism. The possibility of long-term low-dose continuous anti-thyroid use has also been suggested in a recent trial with over 10 years of follow-up for 26 patients on lowdose methimazole (32).…”

Section: Discussionmentioning

confidence: 99%

A systematic review of drug therapy for Graves’ hyperthyroidism

Abraham

Avenell

Park³

et al. 2005

eur j endocrinol

177

113

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We assessed the effects of dose, regimen and duration of anti-thyroid drug therapy for Graves' thyrotoxicosis on recurrence of hyperthyroidism, course of ophthalmopathy, adverse effects, health-related quality of life and economic outcomes. We undertook a systematic review and meta-analyses of randomised controlled trials (RCTs). We identified RCTs regardless of language or publication status by searching six databases, and trial registries. Dual, blinded data abstraction and quality assessment were undertaken. Trials included provided therapy for at least 6 months with follow-up at least 1 year after drug cessation. Fixed or random effects meta-analyses were used to combine study data. Twelve trials compared a Block-Replace regimen (requiring a higher dose of anti-thyroid drug treatment) with a Titration regimen. Overall, there was no significant difference between the regimens for relapse of hyperthyroidism (relative risk (RR) ¼ 0.93, 95% confidence interval (CI) 0.84 to 1.03). Participants were more likely to withdraw due to adverse events with a Block-Replace regimen (RR ¼ 1.89, 95% CI 1.25 to 2.85). Prescribing replacement thyroxine, either with the anti-thyroid drug treatment, or after this was completed, had no significant effect on relapse. Limited evidence suggested 12-18 months of anti-thyroid drug treatment should be used. The titration regimen appeared as effective as the Block-Replace regimen, and was associated with fewer adverse effects. However, relapse rates over 50% and high participant drop-out rates in trials mean that the results should be interpreted with caution, and may suggest that other strategies for the management of Graves' disease, such as radioiodine, should be considered more frequently as first-line therapy. There were no data on the course of ophthalmopathy, health-related quality of life and economic outcomes.European Journal of Endocrinology 153 489-498

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Effect of long-term continuous methimazole treatment of hyperthyroidism: comparison with radioiodine

Cited by 120 publications

References 38 publications

Management of thyrotoxicosis in children and adolescents: 35 years’ experience in 304 patients

Management of thyrotoxicosis in children and adolescents: 35 years’ experience in 304 patients

TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study

A systematic review of drug therapy for Graves’ hyperthyroidism

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