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Antithyroid drugs in Graves' hyperthyroidism: differences between "block and replace" and "titration" regimes in frequency of euthyroidism and Graves' orbitopathy during treatment.
- Source :
-
Journal of endocrinological investigation [J Endocrinol Invest] 2021 Feb; Vol. 44 (2), pp. 371-378. Date of Electronic Publication: 2020 Jun 10. - Publication Year :
- 2021
-
Abstract
- Purpose: Whereas antithyroid drugs (ATD) are the preferred treatment modality for Graves' hyperthyroidism (GH), there is still controversy about the optimal regimen for delivering ATD. To evaluate whether 'Block and Replace' (B + R) and 'Titration' (T) regimes are equivalent in terms of frequency of euthyroidism and Graves' Orbitopathy (GO) during ATD therapy.<br />Methods: A prospective multicentre observational cohort study of 344 patients with GH but no GO at baseline. Patients were treated with ATD for 18 months according to B + R or T regimen in line with their institution's policy.<br />Results: Baseline characteristics were similar in both groups. In the treatment period between 6 and 18 months thyrotropin (TSH) slightly increased in both groups, but TSH was on average 0.59 mU/L (95% CI 0.27-0.85) lower in the B + R group at all time points (p = 0.026). Serum free thyroxine (FT4) remained stable during the same interval, with a tendency to higher values in the B + R group. The point-prevalence of euthyroidism (TSH and FT4 within their reference ranges) increased with longer duration of ATD in both groups; it was always higher in the T group than in the B + R group: 48 and 24%, respectively, at 6 months, 81 and 58% at 12 months, and 87 and 63% at 18 months (p < 0.002). There were no significant differences between the B + R and T regimens with respect to the fall in thyrotropin binding inhibiting immunoglobulins (TBII) or thyroid peroxidase antibodies (TPO-Ab). GO developed in 15.9% of all patients: 9.1 and 17.8% in B + R group and T group, respectively, (p = 0.096). GO was mild in 13% and moderate-to-severe in 2%.<br />Conclusion: The prevalence of biochemical euthyroidism during treatment with antithyroid drugs is higher during T compared to B + R regimen. De novo development of GO did not differ significantly between the two regimens, although it tended to be higher in the T group. Whether one regimen is clinically more advantageous than the other remains unclear.
- Subjects :
- Adult
Antithyroid Agents adverse effects
Europe epidemiology
Female
Follow-Up Studies
Graves Ophthalmopathy chemically induced
Graves Ophthalmopathy epidemiology
Graves Ophthalmopathy metabolism
Humans
Male
Prognosis
Prospective Studies
Thyroid Function Tests
Time Factors
Antithyroid Agents administration & dosage
Graves Disease drug therapy
Graves Ophthalmopathy pathology
Hyperthyroidism drug therapy
Thyroid Hormones metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1720-8386
- Volume :
- 44
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of endocrinological investigation
- Publication Type :
- Academic Journal
- Accession number :
- 32524368
- Full Text :
- https://doi.org/10.1007/s40618-020-01320-7