Mantenimiento a largo plazo con dosis bajas de fármacos antitiroideos de síntesis frente a retirada, en pacientes con hipertiroidismo de la enfermedad de Graves

García, Francisco Morales; Cayuela, Aurelio; Hernández, Natividad García; Viñau, Fernando Losada; Cruz, Miguel Ángel Mangas; Brocca, María Asunción Martínez; González, Elena Navarro; Lopez, Ariel Pablo; Astolfi, Federico Relimpio; Moreno, Alfonso Soto; Fernández, Fernando Villamil

doi:10.1016/s1575-0922(08)70648-x

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…The results from a recent meta-analysis showed that the 12-month titration regimen has a lower recurrence rate than the 6-month regimen, but extending treatment beyond 18 months failed to provide more benefits [16]. In addition, considering the high recurrence rate after drug withdrawal, some studies even advocated a continuous treatment with low-dose ATD for GD patients [19, 20]. They proposed that long-term maintenance of low-dose ATD had a persistent effect on preventing recurrence [19, 20].…”

Section: Treatment Strategies Of Atd and The Recurrence Riskmentioning

confidence: 99%

“…In addition, considering the high recurrence rate after drug withdrawal, some studies even advocated a continuous treatment with low-dose ATD for GD patients [19, 20]. They proposed that long-term maintenance of low-dose ATD had a persistent effect on preventing recurrence [19, 20]. However, because of the intermittent blood check and higher medical costs during long-term ATD maintenance, the titration regimen for 12–18 months is still considered as the optimal strategy of ATD.…”

Section: Treatment Strategies Of Atd and The Recurrence Riskmentioning

confidence: 99%

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Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

Liu

et al. 2017

International Journal of Endocrinology

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Graves' disease (GD) is the most common cause of hyperthyroidism worldwide. Current therapeutic options for GD include antithyroid drugs (ATD), radioactive iodine, and thyroidectomy. ATD treatment is generally well accepted by patients and clinicians due to some advantages including normalizing thyroid function in a short time, hardly causing hypothyroidism, and ameliorating immune disorder while avoiding radiation exposure and invasive procedures. However, the relatively high recurrence rate is a major concern for ATD treatment, which is associated with multiple influencing factors like clinical characteristics, treatment strategies, and genetic and environmental factors. Of these influencing factors, some are modifiable but some are nonmodifiable. The recurrence risk can be reduced by adjusting the modifiable factors as much as possible. The titration regimen for 12–18 months is the optimal strategy of ATD. Levothyroxine administration after successful ATD treatment was not recommended. The addition of immunosuppressive drugs might be helpful to decrease the recurrence rate of GD patients after ATD withdrawal, whereas further studies are needed to address the safety and efficacy. This paper reviewed the current knowledge of ATD treatment and mainly focused on influencing factors for recurrence in GD patients with ATD treatment.

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Section: Treatment Strategies Of Atd and The Recurrence Riskmentioning

confidence: 99%

Section: Treatment Strategies Of Atd and The Recurrence Riskmentioning

confidence: 99%

Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

Liu

et al. 2017

International Journal of Endocrinology

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Which Patients Are a Risk of Relapse After Long-Term Methimazole Therapy in Patients with Graves' Hyperthyroidism?

Wu,

Gild,

Tsang

2024

Clinical Thyroidology®

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Benefits of Long-Term Continuation of Low-Dose Methimazole Therapy in the Prevention of Recurrent Hyperthyroidism in Graves’ Hyperthyroid Patients: A Randomized Prospective Controlled Study

Lertwattanarak

Kunavisarut

Sriussadaporn

2022

International Journal of Endocrinology

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Background. The long-term continuation of the low-dose antithyroid drug (ATD) beyond the standard duration of ATD therapy of 12–18 months to prevent recurrent hyperthyroidism (RH) is recommended with low quality of evidence. Objectives. To examine whether long-term continuation of low-dose ATD beyond the recommended duration of treatment would provide a benefit in the prevention of RH in patients with Graves’ hyperthyroidism (GH) who achieved euthyroid status with a standard course of ATD therapy. Methods. A 36-month prospective randomized controlled study was conducted in 184 patients who had first diagnosed GH and were treated with a standard regimen of ATD therapy using methimazole (MMI) until achieving euthyroidism that was stably maintained for at least 6 months with a low-dose of (2.5–5 mg/day) MMI. All patients had neither a history of adverse effects from MMI, recurrent GH, severe and active ophthalmopathy nor conditions known to affect thyroid function before randomization. The patients were randomized into 2 groups: one group (92 cases) was assigned to discontinue (DISCONT-MMI) and the other (92 cases) was assigned to continue low-dose MMI (CONT-MMI) that was taken at the time of enrollment. The patients in both groups were followed up at 3, 6, 12, 18, 24, 30, and 36 months. The rate of RH was compared between both groups, and the adverse effects and risk factors of RH were also studied. Results. At the end of the 36-month study, 83 cases in CONT-MMI and 90 cases in DISCONT-MMI were eligible for analysis. The cumulative rates of RH in CONT-MMI were significantly lower than those in DISCONT-MMI at every follow-up time point (1.2% vs. 11.2%, 6.8% vs. 18.4%, 11.0% vs. 27.2%, 11.0% vs. 35.0%, and 11.0% vs. 41.2% at 6, 12, 18, 24, and 36 months, respectively; p < 0.01 ). Cox proportional hazard multivariate analysis showed that there were 2 factors independently associated with the risk of RH, including continuation of low-dose MMI therapy, which decreased the risk of RH by 3.8 times (HR = 0.26, p = 0.007 , 95% CI = 0.10–0.70) and age onset of hyperthyroidism before 40 years, which increased the risk of RH by 2.9 times (HR = 2.9, p = 0.015 , 95% CI = 1.23–6.88). Neither minor nor major adverse effects of low-dose MMI therapy were observed during the study period. Conclusions. In Graves’ hyperthyroid patients with no or nonsevere ophthalmopathy who have completed a standard course of methimazole therapy without an adverse effect and have achieved an euthyroid status that is stably maintained with low-dose methimazole, a long-term continuation of the low-dose methimazole of 2.5–5 mg daily is effective and safe in the prevention of recurrent hyperthyroidism or maintenance of euthyroid status as long as the low-dose methimazole is continued. (TCTR20170705002).

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Mantenimiento a largo plazo con dosis bajas de fármacos antitiroideos de síntesis frente a retirada, en pacientes con hipertiroidismo de la enfermedad de Graves

Cited by 5 publications

References 24 publications

Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

Which Patients Are a Risk of Relapse After Long-Term Methimazole Therapy in Patients with Graves' Hyperthyroidism?

Benefits of Long-Term Continuation of Low-Dose Methimazole Therapy in the Prevention of Recurrent Hyperthyroidism in Graves’ Hyperthyroid Patients: A Randomized Prospective Controlled Study

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