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Graves' hyperthyroidism: how long should antithyroid drug therapy be continued to achieve remission?

Nature Clinical Practice Endocrinology & Metabolism volume 2, pages 2–3 (2006)Cite this article

When Astwood first reported the use of thionamide antithyroid drugs to inhibit thyroid-hormone synthesis in Graves' disease, it was counterintuitive that this therapy could be withdrawn. Some patients decided otherwise and, tiring of their pills, abandoned treatment. Astwood was surprised that they remained well and, as a result, concluded that 6–9 months' treatment might be adequate.1 More than 60 years and millions of prescriptions later, we are still unclear for how long to give antithyroid drugs.

Many trials have aimed to predict outcome using clinical, biochemical and immunologic markers after fixed-duration therapy, but there are few good trials examining treatment length. Studies that have used different antithyroid drug regimens are hard to compare. This difficulty is compounded by temporal and geographic variations in iodine ingestion, as antithyroid drugs achieve better remission rates in areas with a low iodine intake. Antithyroid drugs are generally administered in one of two ways.2 The most commonly used technique is the titration method, in which the thionamide dose is tapered as the patient becomes euthyroid. Alternatively, in the block–replace method, hypothyroidism is avoided by replacing T4 while blocking thyroid-hormone synthesis with thionamide. Each method has its advocates, determined by local preference rather than by controlled trial.

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References

  1. Hershman JM (1994) Ted Astwood's intellectual legacy: some personal viewpoints. Thyroid 4: 313–317

    Article  CAS  Google Scholar 

  2. Weetman AP (2000) Graves' disease. N Engl J Med 343: 1236–1248

    Article  CAS  Google Scholar 

  3. Leech NJ and Dayan CM (1998) Controversies in the management of Graves' disease. Clin Endocrinol 49: 273–280

    Article  CAS  Google Scholar 

  4. Jorde R et al. (1995) Short-term treatment of Graves' disease with methimazole in high versus low doses. J Intern Med 238: 161–165

    Article  CAS  Google Scholar 

  5. Tamai H et al. (1980) Thionamide therapy in Graves' disease: relation of relapse rate to duration of therapy. Ann Intern Med 92: 488–490

    Article  CAS  Google Scholar 

  6. Hedley AJ et al. (1989) Antithyroid drugs in the treatment of hyperthyroidism of Graves' disease: long-term follow-up of 434 patients. Clin Endocrinol 31: 209–218

    Article  CAS  Google Scholar 

  7. Allannic H et al. (1990) Antithyroid drugs and Graves' disease: a prospective randomized evaluation of the efficacy of treatment duration. J Clin Endocrinol Metab 70: 675–679

    Article  CAS  Google Scholar 

  8. Garcia-Mayor RV et al. (1992) Antithyroid drug and Graves' hyperthyroidism. Significance of treatment duration and TRAb determination on lasting remission. J Endocrinol Invest 11: 815–820

    Article  Google Scholar 

  9. Maugendre D et al. (1999) Antithyroid drugs and Graves' disease—prospective randomized assessment of long-term treatment. Clin Endocrinol 50: 127–132

    Article  CAS  Google Scholar 

  10. Weetman AP et al. (1994) Treatment of Graves' disease with the block–replace regimen of antithyroid drugs: the effect of treatment duration and immunogenetic susceptibility on relapse. Quart J Med 87: 337–341

    CAS  PubMed  Google Scholar 

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  1. Professor of Medicine and the Dean of the Medical School at the University of Sheffield, UK

    Anthony P Weetman

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  1. Anthony P Weetman
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Correspondence to Anthony P Weetman.

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Weetman, A. Graves' hyperthyroidism: how long should antithyroid drug therapy be continued to achieve remission?. Nat Rev Endocrinol 2, 2–3 (2006). https://doi.org/10.1038/ncpendmet0068

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