title: Short-term effects of β-adrenergic antagonists and methimazole in new-onset thyrotoxicosis caused by Graves' disease.
abstract: OBJECTIVE
  β-adrenergic antagonists (β-blockers) are often used to attenuate the hyperadrenergic symptoms of Graves' disease (GD), including palpitation. Although β-blockers reduce the heart rate, cardiac output and oxygen consumption, no firm evidence exists regarding the effects of combined therapy with β-blockers and anti-thyroid drugs. The objective is to elucidate the effects of β-blockers on anti-thyroid drug therapy in GD.
  
  
  METHODS
  Patients newly diagnosed with mild GD were randomly assigned to receive methimazole with or without β-blockers in a prospective multi-center survey. The heart rate and thyroid function were measured and the quality of life was assessed using original and SF-36 questionnaires at 0 and 4 weeks.
  
  
  RESULTS
  A total of 28 patients were enrolled in the study. Fourteen patients (one man, 13 women) were randomly assigned to the group treated with β-blockers and 14 patients (one man, 13 women) were randomly assigned to the group not treated with β-blockers. Although no significant differences in the improvement of thyroid function were observed between the two groups, the heart rates improved more significantly in the group treated with β-blockers. Specific symptoms, such as easy fatigability and shortness of breath, also improved more significantly with the β-blocker treatment. In addition, 'physical functioning' assessed with the SF-36 questionnaires significantly improved only in the group treated with β-blockers.
  
  
  CONCLUSIONS
  Although β-blockers may not reinforce the effects of anti-thyroid drugs on thyroid function, at least during the course of one month, they are effective in reducing heart rates and ameliorating specific symptoms in patients with mild GD.
authors.affiliation: Clinical Research Institute, Division of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan. ttagami@kyotolan.hosp.go.jp
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tagami
authors.forename: Yuko
authors.initials: Y
authors.lastname: Yambe
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tanaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanaka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ogo
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yoshizumi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kaise
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Higashi
authors.forename: Makito
authors.initials: M
authors.lastname: Tanabe
authors.forename: Satoko
authors.initials: S
authors.lastname: Shimazu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Usui
authors.forename: Akira
authors.initials: A
authors.lastname: Shimatsu
authors.forename: Mitsuhide
authors.initials: M
authors.lastname: Naruse
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D013956:Antithyroid Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004417:Dyspnea / Q000517:prevention & control; D005221:Fatigue / Q000517:prevention & control; D005260:Female; D006111:Graves Disease / Q000150:complications*; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D015994:Incidence; D008297:Male; D008713:Methimazole / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013961:Thyroid Gland / Q000187:drug effects / Q000503:physiopathology; D013971:Thyrotoxicosis / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D013956:Antithyroid Agents; D008713:Methimazole