Antithyroid drug regimen for treating Graves' hyperthyroidism

Pediatric Graves’ disease: management in the post-propylthiouracil Era

“…Thyroid function tests should thus be obtained monthly after therapy onset. After T4 levels become normal, the MMI doses can be cut by half to maintain euthyroidism [21]. Because TSH levels may take months to normalize, they should not be used to guide changes in medication in early phases of treatment.…”

“…Rather than titrating the MMI dose lower when circulating thyroid hormone levels fall, some physicians prefer the block-and-replace approach and add levo-thyroxine while not changing the MMI dose, however, there is a greater risk of adverse events using block and replace vs. dose reduction [21,22]. Recognizing that there is a potential dose–response relationship for some MMI-related complications [23,24], it is preferable to use the lowest MMI dose that achieves control, rather than using the block and replace approach.…”

Interventions for preventing and treating hyperthyroidism in pregnancy

“…Graves' disease is more common in women than in men, and is most common in women aged between 20 and 40 years (Abraham 2005), which corresponds with women's peak reproductive years. About half the women who experience hyperemesis gravidarum (severe nausea and vomiting) have elevated T 4 concentrations, but there does not appear to be a direct link between hyperemesis gravidarum and thyroid function (LeBeau 2006).…”

“…Maternal adverse effects of antithyroid drug treatment: Up to 15% of women prescribed antithyroid drug therapy experience adverse effects such as itching, rash, hives, joint pain and swelling, fever, altered taste sensation, nausea and vomiting (Abraham 2005). Serious adverse effects such as agranulocytosis (a fall in white cell blood count), sepsis, abnormal liver function and vasculitis (inflammation of blood vessels) are rare (Abraham 2005;Casey 2007;Cooper 2005).…”

“…Serious adverse effects such as agranulocytosis (a fall in white cell blood count), sepsis, abnormal liver function and vasculitis (inflammation of blood vessels) are rare (Abraham 2005;Casey 2007;Cooper 2005). Fever and sore throat are the most common presenting symptoms of agranulocytosis and women with these symptoms should cease their drug therapy and seek medical advice (Cooper 2005).…”