Short-Term Antithyroid Drug Therapy for the Thyrotoxicosis of Graves's Disease

Abstract

We investigated whether thyrotoxic patients treated with short-term antithyroid therapy would achieve prolonged remissions. Thirty-one previously untreated and nine previously treated patients with thyrotoxic Graves's disease received a single daily dose of methimazole or propylthiouracil. The drug was stopped at, or shortly after, the time they became euthyroid. Twelve of the 31 previously untreated patients remained in remission for 29 +/- 3.5 months (mean +/- S.E.) after treatment for 4.5 +/- 0.3 months. Four of the nine previously treated have remained in remission of 13.0 +/- 2.1 months after treatment for 3.0 +/- 0.3 months. Of various possibilities analyzed, only a small goiter at the onset of therapy and tri-iodothyronine toxicosis were significantly favorable prognostic indicators that a remission would be maintained. The lasting remission rate is as good when antithyroid drugs are stopped as soon as the patient is euthyroid as when they are continued for one year or more.

Antithyroid Drug Therapy for Graves' Hyperthyroidism: Is Long-Term Administration of a Small Maintenance Dose Necessary?

“…THAT GRAVES' thyrotoxic patients can be treated with antithyroid drugs (ATDs) is well known, but the duration of ATD treatment is one of the important factors which influence the outcome of ATD treatment [4,6,10]. It is generally said that ATD therapy for more than two years results in a higher remission rate than short-term therapy [4,10].…”

“…Greer et al [6] reported that the remission rate was as good in patients who discontinued ATDs soon after becoming euthyroid as it was in patients who discontinued ATDs only after a longer period of one year or more. Provided that remission with short-term ATD comes with the same frequency and long lasting result as conventional treatment, this would represent a considerable saving in patient's and clinician's time.…”

“…Therefore, although the duration of ATD was short-term (3-4 months), the remission rate was low (30-40%) [6,9]. In this study conducted at the Noguchi Thyroid Clinic, ATDs were gradually reduced in the same way as in conventional therapy; and when the patients became euthyroid with normal serum TSH levels on a daily dose of 5mg MMI or 50mg PTU for 2 months, and ATDs were immediately discontinued without the administration of a small maintenance dose.…”

Changes in Serum Autoantibodies to Thyroid Peroxidase During Antithyroid Drug Therapy for Graves' Disease.

“…Then, the antigenicity of TPO may be reduced, resulting in a decrease in the serum TPOab concentration. The antithyroid drug therapy in this study was short-term, as was that in a study conducted by Greer et al (1977), who reported that 39% of their patients experienced remission. A similar percentage of our patients entered remission after treatment.…”

Long term antithyroid drug therapy for intractable cases of graves' disease.

“…According to several reports on a large number of patients, about 35 to 55% of them remain in permanent remission after stopping antithyroid drugs. (Hershman et al, 1966 ;Shizume et al, 1970;Ito et al, 1974 ;Thalassions et al, 1974) Greer et al, (1977 recently reported that the lasting remission rate after 3 or 4 months of treatment with antithyroid drugs was as good as that after the treatment for one year or more. McLarty et al (1973) reported that 4 of 28 patients became eu- perience and in view of the high incidence of hypothyroidism after radioiodine therapy (Dunn and Chapman, 1964), the long-term administration of antithyroid drugs should be considered as an alternative choice for the treatment of intractable Graves' disease.…”