M Žarković1,2, W Wiersinga3, P Perros4, L Bartalena5, S Donati5, O Okosieme6, D Morris7, N Fichter8, J Lareida8, C Daumerie9, M-C Burlacu9, G J Kahaly10, S Pitz11, B Beleslin12,13, J Ćirić12,13, G Ayvaz14, O Konuk15, F B Törüner14, M Salvi16, D Covelli16, N Curro17, L Hegedüs18, T Brix18. 1. School of Medicine, University of Belgrade, Belgrade, Serbia. milos.zarkovic@med.bg.ac.rs. 2. Clinic of Endocrinology Clinical Centre of Serbia, Belgrade, Serbia. milos.zarkovic@med.bg.ac.rs. 3. Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. 4. Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK. 5. School of Medicine, University of Insubria, Varese, Italy. 6. Department of Endocrinology, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, UK. 7. Cardiff Eye Unit, University Hospital of Wales, Cardiff, UK. 8. Interdisciplinary Centre for Graves' Orbitopathy, Olten and University Eye Hospital, Basel, Switzerland. 9. Department of Endocrinology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. 10. Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany. 11. Orbital Center, Ophthalmic Clinic, Buergerhospital, Frankfurt, Germany. 12. School of Medicine, University of Belgrade, Belgrade, Serbia. 13. Clinic of Endocrinology Clinical Centre of Serbia, Belgrade, Serbia. 14. Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey. 15. Department of Ophthalmology, Faculty of Medicine, Gazi University, Ankara, Turkey. 16. Graves' Orbitopathy Unit, Department of Clinical Science and Community Health, Fondazione Ca'Granda IRCCS, University of Milan, Milan, Italy. 17. Department of Ophthalmology, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy. 18. Department of Endocrinology and Metabolism, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Abstract
PURPOSE: Whereas antithyroid drugs (ATD) are the preferred treatment modality for Graves' hyperthyroidism (GH), there is still controversy about the optimal regimen for delivering ATD. To evaluate whether 'Block and Replace' (B + R) and 'Titration' (T) regimes are equivalent in terms of frequency of euthyroidism and Graves' Orbitopathy (GO) during ATD therapy. METHODS: A prospective multicentre observational cohort study of 344 patients with GH but no GO at baseline. Patients were treated with ATD for 18 months according to B + R or T regimen in line with their institution's policy. RESULTS: Baseline characteristics were similar in both groups. In the treatment period between 6 and 18 months thyrotropin (TSH) slightly increased in both groups, but TSH was on average 0.59 mU/L (95% CI 0.27-0.85) lower in the B + R group at all time points (p = 0.026). Serum free thyroxine (FT4) remained stable during the same interval, with a tendency to higher values in the B + R group. The point-prevalence of euthyroidism (TSH and FT4 within their reference ranges) increased with longer duration of ATD in both groups; it was always higher in the T group than in the B + R group: 48 and 24%, respectively, at 6 months, 81 and 58% at 12 months, and 87 and 63% at 18 months (p < 0.002). There were no significant differences between the B + R and T regimens with respect to the fall in thyrotropin binding inhibiting immunoglobulins (TBII) or thyroid peroxidase antibodies (TPO-Ab). GO developed in 15.9% of all patients: 9.1 and 17.8% in B + R group and T group, respectively, (p = 0.096). GO was mild in 13% and moderate-to-severe in 2%. CONCLUSION: The prevalence of biochemical euthyroidism during treatment with antithyroid drugs is higher during T compared to B + R regimen. De novo development of GO did not differ significantly between the two regimens, although it tended to be higher in the T group. Whether one regimen is clinically more advantageous than the other remains unclear.
PURPOSE: Whereas antithyroid drugs (ATD) are the preferred treatment modality for Graves' hyperthyroidism (GH), there is still controversy about the optimal regimen for delivering ATD. To evaluate whether 'Block and Replace' (B + R) and 'Titration' (T) regimes are equivalent in terms of frequency of euthyroidism and Graves' Orbitopathy (GO) during ATD therapy. METHODS: A prospective multicentre observational cohort study of 344 patients with GH but no GO at baseline. Patients were treated with ATD for 18 months according to B + R or T regimen in line with their institution's policy. RESULTS: Baseline characteristics were similar in both groups. In the treatment period between 6 and 18 months thyrotropin (TSH) slightly increased in both groups, but TSH was on average 0.59 mU/L (95% CI 0.27-0.85) lower in the B + R group at all time points (p = 0.026). Serum free thyroxine (FT4) remained stable during the same interval, with a tendency to higher values in the B + R group. The point-prevalence of euthyroidism (TSH and FT4 within their reference ranges) increased with longer duration of ATD in both groups; it was always higher in the T group than in the B + R group: 48 and 24%, respectively, at 6 months, 81 and 58% at 12 months, and 87 and 63% at 18 months (p < 0.002). There were no significant differences between the B + R and T regimens with respect to the fall in thyrotropin binding inhibiting immunoglobulins (TBII) or thyroid peroxidase antibodies (TPO-Ab). GO developed in 15.9% of all patients: 9.1 and 17.8% in B + R group and T group, respectively, (p = 0.096). GO was mild in 13% and moderate-to-severe in 2%. CONCLUSION: The prevalence of biochemical euthyroidism during treatment with antithyroid drugs is higher during T compared to B + R regimen. De novo development of GO did not differ significantly between the two regimens, although it tended to be higher in the T group. Whether one regimen is clinically more advantageous than the other remains unclear.
Authors: Thomas H Brix; Lars C Lund; Daniel P Henriksen; Lars Folkestad; Steen J Bonnema; Jesper Hallas; Laszlo Hegedüs Journal: Lancet Diabetes Endocrinol Date: 2020-02-05 Impact factor: 32.069
Authors: Douglas S Ross; Henry B Burch; David S Cooper; M Carol Greenlee; Peter Laurberg; Ana Luiza Maia; Scott A Rivkees; Mary Samuels; Julie Ann Sosa; Marius N Stan; Martin A Walter Journal: Thyroid Date: 2016-10 Impact factor: 6.568
Authors: Claire L Wood; Niamh Morrison; Michael Cole; Malcolm Donaldson; David B Dunger; Ruth Wood; Simon H S Pearce; Timothy D Cheetham Journal: Eur Thyroid J Date: 2022-01-01