Abstract
Graves' disease is an autoimmune disease characterized by hyperthyroidism due to circulating autoantibodies. Radioactive iodine (RAI) and antithyroid drugs (ATD) are the preferred initial treatment options in Graves' disease in many parts of the world. Long term treatment with methimazole in Grave's disease patients beyond the recommended period is shown to be safe and effective and emerging evidence suggests that continuous methimazole therapy may even be superior to RAI therapy in some aspects. Recent randomized trials comparing long-term methimazole to RAI in patients who relapse, have confirmed these findings Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2013; 3 : 41-44 DOI: http://dx.doi.org/10.4038/sjdem.v3i1.5503
Highlights
Graves' disease is an autoimmune disease characterized by hyperthyroidism due to circulating autoantibodies
The current recommendation by The American Thyroid Association (ATA) and American Association of Clinical Endocrinologists (AACE) is, if methimazole is chosen as the primary therapy for Graves’ disease, the medication should be continued for approximately 12-18 months and tapered or discontinued if the TSH is normal at that time [1]
The two drugs in common use are methimazole and propylthiouracil. They both belong to thionamide group and exert their antithyroid effect by inhibition of thyroid peroxidase catalysed synthesis of thyroid hormones
Summary
I131 therapy (radioactive iodine) and antithyroid drugs are the preferred initial treatment options in Graves’ disease in many parts of the world and thyroidectomy is no longer recommended as a first-line therapy. The two drugs in common use are methimazole (or its pro-drug carbimazole) and propylthiouracil They both belong to thionamide group and exert their antithyroid effect by inhibition of thyroid peroxidase catalysed synthesis of thyroid hormones. The frequency of prolonged remission among patients treated with a thionamides for one to two years varies from 20 to 70 percent with lower rate of remission occurring in children and adolescents[2]. This is the most commonly used treatment modality for Graves’ disease as primary therapy in some countries and as the standard therapy by most when relapse occurs after a course of ATD. Since there is a probable association between low dose RAI and late occurrence of thyroid cancer in children, relatively high doses of RAI should be administered to minimize residual thyroid tissue [3]
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