Ramírez-Rentería C, Guardado-Mendoza R, Mercado M

Language: Spanish
References: 17
Page: 7-10
PDF size: 105.35 Kb.

ABSTRACT

Background: The treatment algorithm for Graves’ disease is still controversial. Low cure and high recurrence rates are reported when these patients are treated with antithyroid drugs alone, even at high doses. Objective: To determine the proportion of patients that enter remission when treated with methimazole for at least 12 months. Material and methods: Retrospective study in patients with Graves’ disease treated with methimazole in the Hospital de Especialidades, UMAE Siglo XXI from march 2006 to may 2007 that didn’t receive treatment with radioactive iodine. Parametric and non parametric statistic was used as appropriate. Results: Seventy-eight patients were treated with methimazole for over 12 months. The population was considered as low-risk because they were mostly women over 40 years old (54.1%), but high-risk because of their low TSH levels (92.7%, TSH ‹ 0.1 µU/L). The average treatment duration was 29.3 ± 11.8 months. 33.3% remained in remission 12 months after discontinuing treatment. Remission was more likely in women over 40 years old with an OR 11.36, IC 1.84-70.02, p = 0.009. Conclusions: The frequency of remission in our study was similar to the reported rates Mexican and US populations. Some cases may be amenable to pharmacological treatment if hey fulfill a low-risk profile and use the medication for a long period, however, this cases are not common in reference hospitals such as ours.

REFERENCES

1. Mc Grogan A, Seaman HE, Wright JW, de Vries CS. The incidence of autoimmune thyroid disease: A systematic review of the literature. Clinical Endocrinology 2008; 69: 687-696.

2. Watson PF, Saeed N. Thyroid Autoantigens. In: Weetman AP, editor. Autoimmune diseases in endocrinology. New Jersey: Humana Press; 2008: 95-116.

3. Davies TF, Ando T, Lin RY, Tomer Y, Latif R. Thyrotropin receptor-associated diseases: From adenoma to Graves disease. J Clin Invest 2005; 15: 1972-1983.

4. Wartofsky L, Glinoer D, Salomon D, Nagataki S, Lagasse R, Nagayuma Y, Izumi M. Differences and similarities in the diagnosis and treatment Of Graves disease in Europe, Japan and the United States. Thyroid 1991; 1: 129-135.

5. Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN. Hyperthyroidism and other causes of thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21: 593-646.

6. Bolaños F, González-Ortiz M, Durón H, Sánchez C. Remission of Graves hyperthyroidism treated with methimazole. Rev Invest Clin 2002; 54: 307-310.

7. Todd H. Management of thyroid disorders in primary care: challenges and controversies. Postgrad Med J 2009; 85: 655–659.

8. Cooper DS. Antithyroid drugs in the management of patients with Graves’ disease: an evidence-based approach to therapeutic controversies. J Clin Endocrinol Metab 2003; 88: 3474-3481.

9. Emiliano AB, Governale L, Parks M, Cooper DS. Shifts in propylthiouracil and methimazole prescribing practices: antithyroid drug use in the United States from 1991 to 2008. J Clin Endocrinol Metab 2010; 95: 2227–2233.

10. Leech N, Colin D. Controversies in the management of graves disease. Clin Endocrinol 1998; 49: 273-280.

11. Nadrebo BJ, Holm PI, Uhiving S. Predictors of outcome and comparison of different drug regimens for the prevention of relapse in patients with Grave’s Disease. Eur J Endocrinol 2002; 147: 583-589.

12. Abraham P, Avenell A, McGeoch SC, Clark LF, Bevan. Antithyroid regimen for treating Graves hyperthyroidism. Cochrane Database Syst Rev 2010; (1): CD003420.

13. Michelangeli V, Poon C, Taft J, Newnham H, Tapliss D, Colman D. The prognostic value of thyrotropin receptor antibody measurement in the early stages of treatment of Graves’ disease. Thyroid 1998; 8: 119-124.

14. Konishi T, Okamoto Y, Ueda M, Fukuda Y, Harusato I, Tsukamoto Y, Hamada N. Drug discontinuation after treatment with minimum maintenance dose of an antithyroid drug in Graves’ disease: a retrospective study on effects of treatment duration with minimum maintenance dose on lasting remission. Endocrine Journal 2011; 58: 95-100.

15. Mazza E, Carlini M, Flecchia D, Zuccarini O, Gamba S, Beninati S, Messina M. Long-term follow-up of patients with hyperthyroidism due to Graves’ disease treated with methimazole. Comparison of usual treatment schedule with drug discontinuation vs continuous treatment with low methimazole doses: a retrospective study. J Endocrinol Invest 2008; 31: 866-872.

16. Franklin JA. Thyroid gland: Antithyroid therapy-best choice of drug and dose. Nature Reviews Endocrinol 2009; 5: 592-594.

17. In H, Pearce EN, Wong AK, Burgess JF, McAneny DB, Rosen JE. Treatment options for Graves disease: A cost-effectiveness analysis. J Am Coll Surg 2009; 209: 170-179.