Relapse following antithyroid drug therapy for Graves’ hyperthyroidism

Laurberg, Peter; Krejbjerg, Anne; Andersen, Stine Linding

doi:10.1097/med.0000000000000088

Cited by 53 publications

(37 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In contrast to our previous report concerning the risk of relapse after the first course of treatment (36), we observed no independent effect on long-term remission rate of age, ethnicity or serum TRAb levels at diagnosis (40). Other factors, such as sex, iodine intake, smoking and genetic background are thought to modulate individual responsiveness in adults (44,48). This study was subjected to several limitations: a relatively small number of boys were included, possibly preventing the detection of male sex as a determinant of GD relapse, a lack of serum TRAb determinations during the follow-up and a lack of information about genetic background, precluding evaluations of the association of these factors with relapse rate (37).…”

Section: Recent Findings From Studies In Childrencontrasting

confidence: 56%

“…Remission rates vary between geographic areas and seem to be better in Europe and in Japan than those in the USA, where RAI was, until recently, favored as the first-line treatment or used within 1 year of the start of the ATD treatment (12,42,43). Lower remission rates have been reported for men, smokers (especially men) and those with severe biochemical disease with high serum TRAb levels and large goiters (≥80 g) (12,44). However, some patients prefer to prolong treatment with low doses of ATD (2.5-7.5 mg/day, MMI or CMZ) over several years (45) and two recent studies have even suggested that prolonged ATD treatment yielded better results (46,47).…”

Section: Recent Findings From Adult Studiesmentioning

confidence: 99%

See 1 more Smart Citation

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

Léger

Carel

2017

European Journal of Endocrinology

View full text Add to dashboard Cite

Graves' disease is an autoimmune disorder. It is the leading cause of hyperthyroidism, but is rare in children. Patients are initially managed with antithyroid drugs (ATDs), such as methimazole/carbimazole. A major disadvantage of treatment with ATD is the high risk of relapse, exceeding 70% of children treated for duration of 2 years, and the potential major side effects of the drug reported in exceptional cases. The major advantage of ATD treatment is that normal homeostasis of the hypothalamus-pituitary-thyroid axis may be restored, with periods of drug treatment followed by freedom from medical intervention achieved in approximately 40-50% of cases after prolonged treatment with ATD, for several years, in recent studies. Alternative ablative treatments such as radioactive iodine and, less frequently and mostly in cases of very high volume goiters or in children under the age of 5 years, thyroidectomy, performed by pediatric surgeons with extensive experience should be proposed in cases of noncompliance, intolerance to medical treatment or relapse after prolonged medical treatment. Ablative treatments are effective against hyperthyroidism, but they require the subsequent administration of levothyroxine throughout the patient's life. This review considers

show abstract

Section: Recent Findings From Studies In Childrencontrasting

confidence: 56%

Section: Recent Findings From Adult Studiesmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

Léger

Carel

2017

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…4). In a subset of women becoming pregnant while treated with ATD for GD, the risk of hyperthyroidism relapse will be unacceptably high if ATD is withdrawn (75). This will be women who started ATD therapy recently (<6 months), who still have suppressed TSH, who have a relatively high serum T 3 (76), high levels of TRAb, large goitre, active orbitopathy, or other signs of active disease.…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves’ disease

Laurberg

Andersen

2016

European Journal of Endocrinology

Self Cite

View full text Add to dashboard Cite

Thyroid hormones are essential developmental factors, and Graves' disease (GD) may severely complicate a pregnancy. This review describes how pregnancy changes the risk of developing GD, how early pregnancy by several mechanisms leads to considerable changes in the results of the thyroid function tests used to diagnose hyperthyroidism, and how these changes may complicate the diagnosing of GD. Standard therapy of GD in pregnancy is anti-thyroid drugs. However, new studies have shown considerable risk of birth defects if these drugs are used in specific weeks of early pregnancy, and this should be taken into consideration when planning therapy and control of women who may in the future become pregnant. Early pregnancy is a period of major focus in GD, where pregnancy should be diagnosed as soon as possible, and where important and instant change in therapy may be warranted. Such change may be an immediate stop of anti-thyroid drug therapy in patients with a low risk of rapid relapse of hyperthyroidism, or it may be an immediate shift from methimazole/carbimazole (with risk of severe birth defects) to propylthiouracil (with less risk), or maybe to other types of therapy where no risk of birth defects have been observed. In the second half of pregnancy, an important concern is that not only the mother with GD but also her foetus should have normal thyroid function.Thyroid hormones are essential developmental factors as first shown by Gudernatsch when he, in 1912, fed tadpoles thyroid tissue and observed metamorphosis (1). In mammals, thyroid hormones are especially of importance for brain development (2, 3), and even a few months with lack of thyroid hormones in infant life may lead to irreversible brain damage. This is the background for the universal screening for congenital hypothyroidism performed in many countries. However, thyroid hormones are also important for normal pregnancy, and maternal thyroid disease may severely increase the risk of pregnancy complications, including Invited author's profile Peter Laurberg was Clinical Professor of Internal Medicine and Endocrinology, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark. His research mainly focused on thyroid disease prevention, epidemiology, diagnosing and therapy, including studies on iodine and thyroid, and pregnancy and thyroid. He had special research interest on the risk from and optimal management of autoimmune hypo-and hyperthyroidism in pregnancy and post-partum, management of Graves' disease in general, and how the burden of thyroid disease can be minimized by adjusting the population's iodine intake. He has coauthored several international guidelines on thyroid disease management, including management of thyrotoxicosis, and thyroid disease in pregnancy. Peter Laurberg died June 20, 2016.

show abstract

“…RAI should be considered if ATDs are not tolerated, in case of relapse and in patients with cardiac disease [4,114,115,116,117,118] (1/+00).…”

Section: Treatment Of Endo Shyper: Effects Of Treatment With Atds Andmentioning

confidence: 99%

The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism

Biondi¹,

Bartalena²,

Cooper³

et al. 2015

Eur Thyroid J

Self Cite

254

157

View full text Add to dashboard Cite

Endogenous subclinical hyperthyroidism (SHyper) is caused by Graves' disease, autonomously functioning thyroid nodules and multinodular goitre. Its diagnosis is based on a persistently subnormal serum thyroid-stimulating hormone (TSH) level with free thyroid hormone levels within their respective reference intervals. In 2014 the European Thyroid Association Executive Committee, given the controversies regarding the treatment of Endo SHyper, formed a task force to develop clinical practice guidelines based on the principles of evidence-based medicine. The task force recognized that recent meta-analyses, including those based on large prospective cohort studies, indicate that SHyper is associated with increased risk of coronary heart disease mortality, incident atrial fibrillation, heart failure, fractures and excess mortality in patients with serum TSH levels <0.1 mIU/l (grade 2 SHyper). Therefore, despite the absence of randomized prospective trials, there is evidence that treatment is indicated in patients older than 65 years with grade 2 SHyper to potentially avoid these serious cardiovascular events, fractures and the risk of progression to overt hyperthyroidism. Treatment could be considered in patients older than 65 years with TSH levels 0.1-0.39 mIU/l (grade 1 SHyper) because of their increased risk of atrial fibrillation, and might also be reasonable in younger (<65 years) symptomatic patients with grade 2 SHyper because of the risk of progression, especially in the presence of symptoms and/or underlying risk factors or co-morbidity. Finally, the task force concluded that there are no data to support treating SHyper in younger asymptomatic patients with grade 1 SHyper. These patients should be followed without treatment due to the low risk of progression to overt hyperthyroidism and the weaker evidence for adverse health outcomes.

show abstract

Relapse following antithyroid drug therapy for Graves’ hyperthyroidism

Abstract: Prolonged low-dose ATD therapy may be feasible in patients with high risk of relapse, such as children and patients with active Graves' orbitopathy, and in patients with previous relapse who prefer such therapy rather than surgery or radioiodine.

Cited by 53 publications

References 48 publications

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves’ disease

The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism

Contact Info

Product

Resources

About