Practical Treatment with Minimum Maintenance Dose of Anti-Thyroid Drugs for Prediction of Remission in Graves' Disease.

Abstract

Although many researchers have reported clinical and laboratory parameters for prediction of remission in Graves' disease during or after anti-thyroid drug therapy, there is no reliable one to assure the complete remission. We prospectively examined a practical therapy with minimum maintenance dose of anti-thyroid drugs for prediction of remission in Graves' disease. Fifty-seven patients with Graves' disease were treated with anti-thyroid drugs at the initial dose of 30 mg/day of methimazole (MMI) or 300 mg/day of propylthiouracil (PTU). Then, doses were gradually decreased, and finally discontinued when the patients were able to maintain euthyroid (normal FT4 and TSH) for at least 6 months with the minimum maintenance dose (MMI 5 mg every other day or PTU 50 mg every other day). After discontinuation of drugs, FT4, FT3, TSH and TSH-binding inhibitory immunoglobulin (TBII) were measured every one to two months for the first 6 months and every 3-4 months for the next 18 months to confirm continuous remission. After 2 years of drug cessation, 46 (81%) of 57 patients were in remission and the other 11 patients had relapsed into thyrotoxicosis. At the time of drug discontinuation, the serum concentration of FT4, FT3 and TSH, titers of anti-thyroglobulin antibodies and anti-thyroid microsomal antibodies, goiter size were not different between the remission and relapse groups. At the time of drug cessation, the activities of TBII and thyroid-stimulating antibodies (TSAb) overlapped between the two groups, although they were significantly lower in the remission group than in the relapse group (p<0.01). Forty percent (4/10) of TBII positive patients and 71% (23/32) of TSAb positive patients continued to be in remission. On the other hand, thyrotoxicosis relapsed in 5 (11%) of 47 TBII negative and 2 (8%) of 25 TSAb negative patients. These data indicate that minimum maintenance therapy to keep euthyroid (normal FT4 and TSH) for 6 months is a practical measure for 81% prediction of remission in Graves' disease. The measurement of TBII or TSAb gave little additional information for predicting remission.

Integrative study of hypothalamus–pituitary–thyroid–immune system interaction: thyroid hormone-mediated modulation of lymphocyte activity through the protein kinase C signaling pathway

“…It is worth noting that this dose of PTU is in the range of the minimum maintenance dose recently proposed for maintaining euthyroid status in Graves' disease (Kashiwai et al 2003). In these conditions, lower proliferative responses to T-and B-selective mitogens were found compared with euthyroid control mice.…”

Does thyroid surgery for Graves’ disease improve health-related quality of life?

“…One patient (2 %) in our study had transient unilateral vocal cord palsy detected by the fiberoptic laryngoscope, but without evident impairment of the voice. With regard to the control group, in addition to the wellknown side effects and recurrences following medical therapy [22,23], the most frequent problems that persisted despite anti-thyroid drug treatment concerned clinical manifestations (gastrointestinal, cardiovascular and muscular alterations), and also alterations in physical appearance, neurovegetative and psychological systems (anxiety, insomnia, depression and stress) and social disorders. Some improvement was observed in body weight and hormonal values at the beginning of therapy; although worsened ocular pressures, exophthalmos and migraine were also observed (final results summarized in Table 5).…”

Evaluation of a 1 step TRAb Assay for the Detection of High-affinity Components to hTSHR: Evidences Indicating Superiority of the Assay in the Lower TRAb Range

“…That is, these assays could detect TRAb even in some Graves' patients during clinical remission after antithyroid drug (ATD) treatment, so that physicians are encountering difficulties when judging the timing of drug cessation based upon the TRAb results. Many investigators reported difficulty in the prediction of clinical remission or relapse using TRAb results [5,[10][11][12][13][14], and some have already tried to set up elevated cut-off points based on retrospective analyses of their Graves' patients [15][16][17].…”