Increased Remission Rates After Long-Term Methimazole Therapy in Patients with Graves' Disease: Results of a Randomized Clinical Trial

Azizi, Fereidoun; Amouzegar, Atieh; Tohidi, Maryam; Khalili, Davood; Cheraghi, Leila; Mehrabi, Yadollah; Takyar, Miralireza

doi:10.1089/thy.2019.0180

Cited by 82 publications

(86 citation statements)

References 23 publications

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“…Recent clinical studies have shown that LT-ATD treatment is safe and provides control of hyperthyroidism without replacing it with hypothyroidism 15 . In addition, LT-ATD treatment of ≥ 5 years is accompanied by cure of disease in 86% of Graves' patients after ATD withdrawal 14 . Therefore, this mode of therapy has become another effective and safe treatment for patients with recurrent hyperthyroidism.…”

Section: Discussionmentioning

confidence: 99%

“…These ndings indicate that failure to attain normal TRAb concentrations after conventional 12-18 months of ATD treatment does not rule out the possibility of remission over a long-term ATD therapy 12 ; therefore, long-term treatment of Graves' hyperthyroidism has become an option in international societies recommendations 4,13 . A recent randomized clinical trial reported that 5-year continuous methimazole (MMI) therapy is accompanied with 84% remission up to 4 years after drug withdrawal 14 . However, the optimal duration of ATD therapy is still debatable.…”

Section: Introductionmentioning

confidence: 99%

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Control of Graves’ hyperthyroidism with very long-term methimazole treatment: A clinical trial

Azizi

Abdi

Amouzegar

2020

Preprint

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Background: Long-term antithyroid drugs therapy has become one of the options for treatment of Graves’ hyperthyroidism. The aim of this study was to compare thyroid status in those who discontinued methimazole (MMI) treatment after 12.8 years with those who continued MMI as long as 24 years.Methods: Fifty nine patients with Graves’ disease on long-term MMI for 14.2±2.9 years were recruited; 32 patients (54%) decided to discontinue MMI and 27 (46%) preferred additional years of MMI treatment. All patients were followed for a mean of 6 additional years.Results: Of 27 patients who continued MMI, 16 and 11 subjects completed median of 20 and 24 years of MMI treatment, respectively. Suppressed serum thyrotropin (TSH) was not observed in any patient after seventh years of treatment. Serum free thyroxine, triiodothyronine, TSH and TSH receptor antibody concentrations remained normal up to the length of the study. Mean daily dose of MMI to maintain TSH in the reference range decreased gradually and reached to 2.8±1.7 mg by 24 years of MMI treatment. No adverse reaction related to MMI occured during additional years of therapy. In 32 patients who discontinued MMI, hyperthyroidism relapsed in 6 patients (19%), one left follow-up and 25 (78%) remained euthyroid during the study.Conclusions: Long-term low dose MMI treatment may be a lifelong effective and safe therapeutic modality in patients with Graves’ hyperthyroidism for prevention of relapse, if studies from other centers confirm findings of this research.Trial registration: IRCT201009224794N, 2010-10-25. Retrospectively registered.www. IRCT.IR/Trial/5143.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Control of Graves’ hyperthyroidism with very long-term methimazole treatment: A clinical trial

Azizi

Abdi

Amouzegar

2020

Preprint

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“…Both retrospective and prospective analyses have suggested that a longer duration of drug therapy is associated with higher remission rates (44,45). A systematic review and meta-analysis of long-term (> 24 months) ATD treatment conducted by Azizi et al (16) suggested a positive relationship between the length of treatment and remission rate, although it was not a true linear correlation.…”

Section: Duration Of Therapymentioning

confidence: 99%

Prediction of Relapse After Antithyroid Drugs Withdrawal: A Narrative Review

Wang

2020

Int J Endocrinol Metab

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Context: Antithyroid drugs (ATD) are the first-line treatment for Graves’ disease (GD); however, relapse following treatment is approximately 30% - 40% in the first year, and 50% - 60% in the long term. Identification of risk factors that predict relapse, after discontinuing ATD, plays an important role in guiding therapeutic options. Evidence Acquisition: PubMed was used to search for studies published in English between 1995 and 2019. The following search terms were used: Graves’ disease, antithyroid drugs, relapse, recurrence, and outcome. The reference lists from review articles were also included in the search in order to find older journals. Results: Factors associated with a high recurrence rate, as reported in most studies, were divided into phenotype and genotype predictors. Phenotype factors included large goiter size, persistence of high TSH receptor antibody (TRAb), severe hyperthyroidism, smoking, younger age, male sex, and prior history of recurrence. Genotype factors included human leukocyte antigen (HLA), CD40, CTLA-4, PTPN22, Tg, and TSHR genes. In a subgroup analysis by age, genetic factors were better predictors in the younger group, while clinical signs were more useful in the older group. The reliability of using individual baseline risk factors to predict subsequent relapse is poor; however, predictive scores calculated by grouping single risk factors might help to predict future outcomes. Conclusions: Longer normalization time of TRAb, the persistence of a palpable goiter, and harboring genetic risk factors in younger patients are associated with high recurrence rate of GD. Multi-marker prediction models have been proposed and validated to improve the predictive value of relapse after ATD withdrawal.

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“…Thioureas are the most commonly used anti-thyroid drugs. [ 8 ] However, these drugs are associated with adverse effects such as liver damage, allergic reactions and leukopenia.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of tripterygium glycosides in the treatment of hyperthyroidism

Xie

Gao

et al. 2020

Medicine

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Background: Hyperthyroidism is a condition in which the thyroid gland is overreactive and produces excess amounts of thyroid hormone. Tripterygium glycosides, traditional Chinese medicine has been widely used in the treatment of rheumatoid arthritis, nephrotic syndrome, hyperthyroidism and other diseases due to its anti-inflammatory and immunosuppressive effects. Evidence-based research is becoming popular especially with the application of Chinese traditional medicine. This paper systematically reviews and evaluates existing clinical data on the efficacy and safety of Tripterygium glycosides in the treatment of hyperthyroidism. Materials and methods: PubMed, Cochrane library and EMBase, Chinese biomedical literature database (CBM), Chinese journal full-text database (CNKI), Wan fang digital periodical full-text database and China Science and Technology Journal Database (VIP) were searched based on the defined inclusion and exclusion criteria. Data extraction, research quality assessment and meta-analysis were conducted with RevMan5.3 software. Trial sequential analysis (TSA) was used to evaluate information size and treatment benefits. Results: Seventeen randomized controlled clinical trials with 1536 participants were included in the systematic review. In the meta-analysis, there were two subgroups: Tripterygium glycosides combined with thiamazole and prednisone group; Tripterygium glycosides combined with thiamazole group. The study results revealed that the degree of exophthalmos, FT3, FT4, BGP, and AKP decreased while TSH, SOD, GSH-PX increased after the addition of Tripterygium glycosides. This study results suggested that Tripterygium glycosides combined with western medicine are an effective therapy for hyperthyroidism. Conclusion: This study indicates that Tripterygium glycosides enhances the effect of thiamazole and prednisone in the treatment of hyperthyroidism and without increasing the risk of adverse events.

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Increased Remission Rates After Long-Term Methimazole Therapy in Patients with Graves' Disease: Results of a Randomized Clinical Trial

Cited by 82 publications

References 23 publications

Control of Graves’ hyperthyroidism with very long-term methimazole treatment: A clinical trial

Control of Graves’ hyperthyroidism with very long-term methimazole treatment: A clinical trial

Prediction of Relapse After Antithyroid Drugs Withdrawal: A Narrative Review

Efficacy and safety of tripterygium glycosides in the treatment of hyperthyroidism

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