A systematic review of drug therapy for Graves’ hyperthyroidism

Abraham, Prakash; Avenell, Alison; Park, Christine M; Watson, Wendy; Bevan, John S.

doi:10.1530/eje.1.01993

Cited by 178 publications

(123 citation statements)

References 26 publications

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“…Dotted horizontal lines indicate upper reference range for the assay. meta-analyses of randomized controlled trials, Abraham et al (14) concluded that neither the dose of thionamide drug nor the use of additional levothyroxine had any importance for the remission of Graves' disease during drug therapy or for the risk of relapse after stop of drugs.…”

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Remission of Graves’ disease during anti-thyroid drug therapy. Time to reconsider the mechanism?

Laurberg

2006

eur j endocrinol

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Therapy of Graves' hyperthyroidism with thionamide anti-thyroid drugs is accompanied by a gradual remission of the autoimmune aberration in the majority of patients. The most likely mechanism behind this remission has been considered to be a direct immunosuppressive effect of thionamide drugs. However, a number of findings in clinical studies of patients with Graves' disease indicate that remission is probably not caused by a special effect of thionamide drugs. Many studies have shown that remission is linked to restoration of the euthyroid state, and that it is independent of drug dose and type. Moreover, similar remission is observed when patients become euthyroid after thyroid surgery. In an explanatory model described, it is assumed that the autoimmune aberration of Graves' disease is often basically quit mild and self-limiting. Patients may become ill by the running of a vicious cycle of hyperthyroidism worsening the autoimmunity, and autoimmunity worsening the hyperthyroidism. Once patients are made euthyroid by one or the other drug or by thyroid surgery, the majority of patients will gradually enter remission of the disease. The conclusion that remission is associated with restoration of the euthyroid state, and that it is not a special drug effect, highlights the importance of making and keeping patients with Graves' disease euthyroid. European Journal of Endocrinology 155 783-786

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“…As discussed, this idea has turned out to be a dead end. It only leads to more side effects of the drugs (8,14).…”

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Remission of Graves’ disease during anti-thyroid drug therapy. Time to reconsider the mechanism?

Laurberg

2006

eur j endocrinol

123

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“…The first is based on the use of anti-thyroid drugs (ATDs) while the second is based on the use of either iodine-131 or total thyroidectomy. In Europe, the medical option is often preferred as a first-line approach with a risk of relapse between 51 and 68% after a complete initial course of therapy (at least 12 months) (3,4). Radical options are mainly indicated for recurrences, resistance to (ATDs) or after drug-related adverse events (i.e.…”

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Quality of life, clinical outcomes and safety of early prophylactic levothyroxine administration in patients with Graves' hyperthyroidism undergoing radioiodine therapy: a randomized controlled study

Taïeb¹,

Bournaud

Eberlé

et al. 2016

European Journal of Endocrinology

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Objective: While radioiodine therapy is commonly used for treating Graves' disease, a prolonged and clinical hypothyroidism may result in disabling symptoms leading to deterioration of quality of life (QoL) of patients. Introducing levothyroxine (LT 4 ) treatment in the early post-therapeutic period may be an interesting approach to limit this phenomenon. Methods: A multicenter, prospective, open-label randomized controlled trial enrolled 94 patients with Graves' hyperthyroidism randomly assigned to the experimental group (nZ46) (group A: early prophylactic LT 4 treatment) or the control group (nZ48) (group B: standard follow-up). The primary endpoint was the 6-month QoL. The secondary endpoints were other QoL scores such as Graves' ophthalmopathy (GO) outcomes, thyroid function tests and safety. Results: The primary endpoint at 6 months was achieved: the mental composite score (MCS) of Short Form 36 (SF-36) was significantly higher in group A compared to group B (PZ0.009). Four other dimension scores of the SF-36 and four dimension scores of the thyroid-specific patient-reported outcome (ThyPRO) significantly differed between the two groups, indicating better QoL in group A. After adjustment for variables, the early LT 4 administration strategy was found as an independent factor for only two scores of SF-36: the MCS and the general health (GH) score. There were no differences in GO, final thyroid status and changes in the anti-TSH receptor antibodies (TRAbs) levels between the two groups. No adverse cardiovascular event was reported. Conclusion: Early LT 4 administration post-radioactive iodine (RAI) could represent a safe potential benefit for patients with regard to QoL. The optimal strategy taking into account administered RAI activities and LT 4 treatment dosage and timing remains to be determined.

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“…Nenhuma delas é considerada ideal, visto que não atuam diretamente na etiopatogênese da disfunção. A escolha do tratamento é influenciada por diferentes fatores, como a idade do paciente, o volume glandular, a intensidade do hipertireoidismo, a preferência do paciente e a do médico, os recursos disponíveis e a prática médica local (6)(7)(8)(9)(10). Há uma variação regional quanto ao tratamento de primeira linha, diferindo entre os diferentes países.…”

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Avaliação da radioiodoterapia com doses fixas de 10 e 15 mCi em pacientes com doença de graves

Canadas

Vilar²,

Moura³

et al. 2007

Arq Bras Endocrinol Metab

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RESUMOAs opções terapêuticas para a hipertireoidismo da doença de Graves são as drogas antitireoidianas, a cirurgia e o radioiodo, porém nenhuma delas é considerada ideal pois não atuam diretamente na etiopatogênese da doença. O radioiodo vem sendo cada vez mais utilizado como primeira escolha, sendo um tratamento definitivo, seguro e de fácil administração. Há autores que preferem doses mais altas para induzir deliberadamente o hipotireoidismo, enquanto outros recomendam doses mais baixas que, a curto prazo, implicam menor incidência de hipotireoidismo e maior de eutireoidismo. Não há consenso sobre o melhor esquema de doses fixas a ser utilizado, sendo esse o principal enfoque deste estudo, no qual comparamos doses de 10 e 15 mCi. Dos 164 pacientes analisados, 61 (37,2%) foram submetidos a 10 mCi e 103 (62,8%), a 15 mCi de 131 I. Na análise longitudinal, observou-se que a remissão do hipertireoidismo foi estatisticamente diferente no sexto mês (p < 0,001), sendo maior no grupo em que foi empregada a dose de 15 mCi. Contudo, foi semelhante nos dois grupos após 12 e 24 meses. É possível concluir que doses fixas de 10 e 15 mCi promovem semelhante remissão do hipertireoidismo após 12 meses de tratamento. A remissão do hipertireoidismo não teve associação com idade, sexo ou uso prévio de drogas antitireoidianas. The treatment options for the hyperthyroidism of Graves' disease are antithyroid drugs, surgery and radioiodine, none of which is considered ideal, as they do not act directly on the etiopathogenesis of the disease. Radioiodine has been increasingly used as the treatment of choice because it is a safe and definitive therapy whose administration is very easy. Some authors prefer to administer higher doses in order to deliberately induce hypothyroidism, while others recommend lower doses that result in a lower incidence of hypothyroidism and a greater incidence of euthyroidism. There is no consensus for the optimal regimen of fixed doses to be used and this is the main focus of the present study, where doses of 10 and 15 mCi of 131 I were compared. Among the 164 patients analyzed, 61 (37.2%) were submitted to 10 mCi and 103 (62.8%) to 15 mCi. In the longitudinal analysis it was observed that remission of the hyperthyroidism was statistically different in the sixth month (p < 0.001), being higher in the group that used the dose of 15 mCi, but similar in both groups at 12 and 24 months. It may be concluded that the administration of fixed doses of 10 and 15 mCi of 131 I brought about a similar remission of the hyperthyroidism after 12 months of treatment. Moreover, the remission rate of the hyperthyroidism had no association with age, sex or previous therapy with antithyroid drugs.

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A systematic review of drug therapy for Graves’ hyperthyroidism

Cited by 178 publications

References 26 publications

Remission of Graves’ disease during anti-thyroid drug therapy. Time to reconsider the mechanism?

Remission of Graves’ disease during anti-thyroid drug therapy. Time to reconsider the mechanism?

Quality of life, clinical outcomes and safety of early prophylactic levothyroxine administration in patients with Graves' hyperthyroidism undergoing radioiodine therapy: a randomized controlled study

Avaliação da radioiodoterapia com doses fixas de 10 e 15 mCi em pacientes com doença de graves

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