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Initial treatment of thyrotoxic Graves' disease with methimazole: a randomized trial comparing different dosages
Abstract:
We evaluated the efficacy of different doses of methimazole (MMI) as the initial therapy for Graves' disease. Fourteen patients were treated with 15 mg/die of the drug (group A) and 14 with 30 mg/die (group B). Blood samples for T3, T4, FT3 and FT4 were obtained before beginning therapy, every 48 h during the first 12 days and on the 45th day of treatment. All these hormonal parameters fell significantly from the 2nd day of therapy in both groups. All the patients, except for one in group B, had normal or subnormal levels of thyroidal hormones on the 45th day of treatment. The comparison between the two groups of regression coefficients over the first 12 days showed no significant differences. The absolute decrease of each examined parameter on day 12 was positively correlated with the relevant pretreatment value. These results demonstrate that doses of MMI (15 mg/die) much lower than those commonly recommended are able to rapidly control thyroidal overproduction as effectively as 30 mg/die.
Insights
Lower doses of methimazole (MMI) effectively treat Graves' disease. A 15 mg/day dose rapidly controlled thyroid hormone levels as well as a 30 mg/day dose.
Area of Science:
- Endocrinology
- Pharmacology
Background:
- Graves' disease is an autoimmune disorder causing hyperthyroidism.
- Methimazole (MMI) is a common initial therapy for Graves' disease.
- Optimal initial MMI dosage for rapid control is debated.
Purpose of the Study:
- To compare the efficacy of two different initial doses of methimazole (MMI) in treating Graves' disease.
- To assess the speed and effectiveness of thyroid hormone normalization with lower-dose MMI therapy.
Main Methods:
- A randomized study involving 28 patients with Graves' disease.
- Group A received 15 mg/day MMI; Group B received 30 mg/day MMI.
- Thyroid hormone levels (T3, T4, FT3, FT4) were monitored frequently for 45 days.
Main Results:
- Both 15 mg/day and 30 mg/day MMI significantly reduced thyroid hormone levels from day 2.
- Nearly all patients achieved normal or subnormal hormone levels by day 45.
- No significant difference in the rate of hormone level decrease between the two MMI doses was observed.
Conclusions:
- Lower initial doses of methimazole (15 mg/day) are as effective as higher doses (30 mg/day) in rapidly controlling hyperthyroidism in Graves' disease.
- This suggests a potential for using lower MMI doses in initial Graves' disease management.