New therapeutic approaches in thyroidal autoimmune diseases

Antithyroid drugs (AD) still represent the most widely chosen therapy for hyperthyroidism of Graves' disease. Since their interaction with iodine is still poorly understood, this was addressed in multicenter clinical trials. The interaction of iodine and methimazole was studied in 260 patients from iodine deficient countries. Whereas patients with very low iodine supply needed low doses of methimazole, patients with even slightly increased iodine supply needed high doses of methimazole to remain euthyroid. In another study of 1256 patients side effects of AD were shown to be dose-dependent. Immunological markers of thyroid autoimmunity disappear in most patients during treatment with AD although with many exceptions. Remissions after treatment with AD may represent disease heterogeneity within a spontaneous disease course and the spectrum of relapsing hyperthyroidism over euthyroidism to hypothyroidism. Lastly therapeutic strategies in thyroid eye disease have not provided evidence which therapy is superior.