Suppression of serum thyrotropin with thyroxine in patients with Graves' disease: effects on recurrence of hyperthyroidism and thyroid volume

Abstract

Based on findings that thyroxine may have a beneficial effect on the recurrence of Graves' hyperthyroidism, we prospectively studied the effects of a TSH suppressive treatment with thyroxine on the course of Graves' disease in fifty patients with recent onset of hyperthyroidism. After the normalization of serum tri-iodothyronine (T3) and thyroxine (T4) concentrations, one group of patients was randomly assigned to a combined treatment with carbimazole and a TSH suppressive dose of T4 for 12 months, followed by another 12 months of TSH suppressive therapy alone. The other group of patients also received carbimazole for one year, but T4 was only added as indicated to normalize elevated TSH serum concentrations, and patients received no therapy during the second year. By the end of the second year, a relapse of hyperthyroidism had occurred in 43% of the patients with and in 45% of the patients without suppressive T4 treatment. In those patients without a relapse of hyperthyroidism, initial thyroid size significantly (P = 0.01) decreased with time in both treatment groups. However, patients on suppressive T4 treatment tended to have a greater reduction in thyroid volume than patients with normal TSH serum concentrations (P = 0.05). In conclusion, we were unable to detect a preventive effect of exogenous TSH suppression on the recurrence of hyperthyroidism. However, our data suggest that TSH suppressive treatment may have a beneficial effect on thyroid enlargement in Graves' disease.

A systematic review of drug therapy for Graves’ hyperthyroidism

“…5) Combining the data from three studies (22)(23)(24) adding in T4 led to fewer relapses (RR ¼ 0.65, 95% CI 0.14 to 3.00, random effects model). There was marked heterogeneity (I 2 ¼ 88%) with the result being largely influenced by one study (22) where the relapses in the T4 group were less than 2% compared with 35% in the placebo group.…”

Relapse of Graves' Disease After Successful Outcome of Antithyroid Drug Therapy: Results of a Prospective Randomized Study on the Use of Levothyroxine

“…The concept of letting the thyroid rest to recover from autoimmune disease that emerged from these studies was highly debated for years (4,5). However, others failed to reproduce the favorable results of the initial studies (6)(7)(8)(9)(10)(11)(12).…”

“…The issue of the administration of levothyroxine for prevention of relapse after successful treatment and that of the levothyroxine addition to antithyroid drug therapy, which was examined by a number of previous studies (6)(7)(8)(9)(10)(11)(12), must be considered separately. Therefore, we changed the design of the present study compared to that of the previous trials.…”

Medikamentöse Behandlung der Immunhyperthyreose (Typ Morbus Basedow)

“…Levothyroxin wird beim M. Basedow unter 2 Gesichtspunkten eingesetzt: In den darauffolgenden Jahren wurden zahlreiche Folgestudien aus Ländern mit vergleichsweise geringer Jodversorgung angeschlossen, die die Ergebnisse der Hashizume-Studie nicht bestätigen konnten [8,12,13,17,20,21,23,25,27]. Eine hochrangig publizierte Studie von Mc Iver et al entbehrte allerdings einer ausreichenden statistischen Power,um die Wirksamkeit von Levothyroxin statistisch tatsächlich widerlegen zu können [17].In diese Studie wurden initial 111 unbehandelte Patienten eingeschlossen, die mit einer täglichen Dosis von 40 mg Carbimazol behandelt wurden.…”

“…"Follow-upGruppe" weiterhin beobachtet und neigten-wie sich im Verlauf zeigte-viel häu-figer zu Rezidiven als die Gruppen mit normalem TSH (⊡ Abb. 2) [7,8,10,13,15,20,22,26,27,28]). …”