Is there a methimazole dose effect on remission rate in Graves' disease? Results from a long‐term prospective study

Benker, G.; Reinwein, D.; Kahaly, G.; Tegler, Lennart; Alexander, W. D.; Fassbinder, J.; Hirche, H.

doi:10.1046/j.1365-2265.1998.00554.x

Cited by 96 publications

(48 citation statements)

References 28 publications

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“…However, there were large losses to follow-up, with 234 and 223 in the Block-Replace and Titration groups respectively. Excluding one study (17,18) with a loss to follow-up of 44% had no major effect on the overall results (RR ¼ 0.91, 95% CI 0.81 to 1.03). When analysis was carried out making the extreme assumption of relapsed hyperthyroidism in participants lost to follow-up there was a significant difference between the two groups, with relapse rates of 63% (549 of 870) in the Block-Replace group and 68% (566 of 837) in the Titration group (RR ¼ 0.93, 95% CI 0.87 to 0.99).…”

Section: Is Unknown)mentioning

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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Section: Is Unknown)mentioning

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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“…However, there are reports with the opposite findings concerning the effects of age (9,11,17) and the levels of FT3, FT4 (9,14,29,34) and FT3/FT4 ratio (14,26) at diagnosis on the prognosis of GD treated with ATDs. In this study, high baseline TRAb and TSAb levels were associated with a GD relapse.…”

Section: Discussionmentioning

confidence: 77%

“…Many previous studies have shown that patients with more severe hyperthyroidism, a large goiter and/or a high triiodothyronine/thyroxine (T3/ T4) ratio are less likely to enter remission after a course of drug treatment than those with a milder disease and a smaller goiter (7)(8)(9). In addition, patients with higher baseline levels of thyroid-stimulating hormone (TSH) receptor Aichi Prefectural University School of Nursing and Health, Japan and Department of Endocrinology and Diabetes, Ichinomiya Municipal Hospital, Japanantibodies (TRAbs) probably have a lower likelihood of remission (8,10).…”

Section: Introductionmentioning

confidence: 99%

Thyroglobulin Autoantibodies Are Associated with Refractoriness to Antithyroid Drug Treatment for Graves' Disease

Katahira

Ogata

2016

Intern. Med.

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Objective The recurrence rate associated with antithyroid drug (ATD) treatment for Graves' disease (GD) is high compared with that for radioiodine therapy or surgery. It is important to identify patients in whom remission is unlikely, so that they are not given treatment that is destined to fail. The objective of this study was thus to evaluate factors influencing the prognosis of GD patients treated with ATDs. Patients One hundred and sixty-one patients were divided into two groups: 100 patients who could not discontinue ATDs for eight years or more (refractory group) and 61 patients who achieved remission within eight years after starting ATD treatment (nonrefractory group). The groups were compared in terms of age, thyroid function and thyroid-related autoantibodies at diagnosis, and the durations to the recovery of thyroid function and thyroid-related autoantibodies. Results The baseline levels of free triiodothyronine (T3), free thyroxine (T4), thyroid-stimulating antibodies (TSAbs) and thyroid-stimulating hormone (TSH) receptor antibodies (TRAbs) were high, and the age at diagnosis and the baseline level of thyroglobulin autoantibodies (TgAbs) were low in the refractory group compared with those in the nonrefractory group. The durations to the recovery of TSH, free T4, TRAb and TSAb levels were longer in the refractory group than in the nonrefractory group. No significant difference was observed with regard to thyroid peroxidase autoantibodies. Conclusion We compared the clinical features of these two groups in order to identify factors influencing the prognosis of GD patients treated with ATDs. A low baseline level of TgAbs is associated with the refractoriness of GD to ATD treatment.

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“…It is clear that there is little to choose between titrated and block-replace antithyroid drug regimens in terms of long-term outcome of Graves' disease. Twenty-four months after stopping treatment, both methods leave approximately 50% of subjects in medium-to long-term remission (2,3,(6)(7)(8). Thus, the evidence cited by Abrahams and colleagues to favour titrated antithyroid drug regimens over block-replace regimens comes exclusively from the higher rate of adverse events found in the block-replace arms of the trials examined by the meta-analysis.…”

Section: Discussionmentioning

confidence: 88%

What is the evidence behind the evidence-base? The premature death of block-replace antithyroid drug regimens for Graves’ disease

Razvi¹,

Vaidya²,

Perros³

et al. 2006

eur j endocrinol

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Block-replace and titration antithyroid drug regimens both give similar rates of medium-to long-term remission of hyperthyroid Graves' disease. Recent meta-analysis, however, has suggested that titration regimens may be preferable owing to a higher rate of adverse events seen in the block-replace arms of published comparative studies. This article critically re-evaluates the evidence upon which these metaanalyses were based. We suggest that there is little objective evidence that is pertinent to current clinical practice to separate block-replace from titration antithyroid drug regimens and that both remain satisfactory approaches to the medical management of hyperthyroid Graves' disease. European Journal of Endocrinology 154 783-786

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Is there a methimazole dose effect on remission rate in Graves' disease? Results from a long‐term prospective study

Abstract: The dose of methimazole in Graves' disease therapy can safely be kept to the minimal required dose. This will provide the same chance of remission as higher doses, and provide the best balance of risk and benefit.

Cited by 96 publications

References 28 publications

A systematic review of drug therapy for Graves’ hyperthyroidism

A systematic review of drug therapy for Graves’ hyperthyroidism

Thyroglobulin Autoantibodies Are Associated with Refractoriness to Antithyroid Drug Treatment for Graves' Disease

What is the evidence behind the evidence-base? The premature death of block-replace antithyroid drug regimens for Graves’ disease

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