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Antithyroid drug regimen for treating Graves' hyperthyroidism.

P Abraham¹, A Avenell, W A Watson

¹Endocrinology, University of Aberdeen, Ward 27/28, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK, AB25 2ZN.

The Cochrane Database of Systematic Reviews

|April 24, 2004

Summary

For Graves' hyperthyroidism, 12-18 months of antithyroid drug therapy using the titration regimen is optimal. The titration regimen also showed fewer side effects than the block-replace regimen.

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Area of Science:

Endocrinology
Pharmacology
Internal Medicine

Background:

Antithyroid drugs are standard treatment for hyperthyroidism.
Significant variability exists in prescribed antithyroid drug dosage, regimen, and treatment duration.

Purpose of the Study:

To evaluate the impact of antithyroid drug therapy's dose, regimen, and duration on Graves' hyperthyroidism outcomes.
To compare the efficacy and safety of different antithyroid drug treatment strategies.

Main Methods:

Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
Searched multiple databases (Central, MEDLINE, EMBASE, etc.) and contacted investigators.
Data extraction and quality assessment performed independently by two reviewers.

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Main Results:

Nineteen trials (2233 participants) were included; overall trial quality was poor.
Longer duration (18 months) titration therapy reduced relapse rates compared to 6 months (OR=0.42).
Titration regimen showed fewer adverse effects (rashes, withdrawals) than the block-replace regimen.

Conclusions:

Optimal duration for titration antithyroid drug therapy appears to be 12-18 months.
The block-replace regimen showed no significant benefit over the titration regimen in terms of relapse rates.
Titration regimen is associated with fewer adverse effects and comparable efficacy to the block-replace regimen.