Current trends in antithyroid drug treatment of Graves' disease.
BACKGROUND
Graves' hyperthyroidism is associated with significant morbidity and mortality risk. The thionamides, methimazole, its pro-drug derivative carbimazole, and propylthiouracil, remain a cornerstone of management. Yet despite decades of use, optimal strategies for maximising treatment response and curtailing adverse effect risk remains uncertain.


METHODS
We reviewed the current literature on the evidence based medical management of Graves' disease. Specifically, we evaluated current approaches to the use of thionamides, adjunctive therapies, and potential novel agents for controlling Graves' hyperthyroidism.


CONCLUSIONS
Primary medical therapy is successful in less than 50% of cases and so careful selection of patients for medical treatment based on a combination of pathological and pragmatic considerations is essential. Carbimazole or methimazole is the treatment of choice in the non-pregnant population driven by its more favourable pharmacokinetic and adverse effect profile over propylthiouracil. In pregnancy the choice of treatment is less straightforward and an approach that minimises undue fetal exposure to all thionamides should be adopted. Additional data is needed on the value of adjunctive therapies including potassium perchlorate, iodides, glucocorticoids, lithium, and cholestyramine. Novel agents directed against pathogenetic targets including TSH receptor blocking monoclonal antibodies and small molecule antagonists may hold promise for the future.
a Thyroid Research Group, Institute of Molecular and Experimental Medicine , School of Medicine, Cardiff University , Cardiff , UK.|b Endocrine and Diabetes Department , Prince Charles Hospital, Cwm Taf University Health Board , Merthyr Tydfil , UK.
Onyebuchi E
OE
Okosieme
a Thyroid Research Group, Institute of Molecular and Experimental Medicine , School of Medicine, Cardiff University , Cardiff , UK.
John H
JH
Lazarus
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D013956:Antithyroid Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D006111:Graves Disease / Q000188:drug therapy*; D006801:Humans; D008713:Methimazole / Q000627:therapeutic use; D011355:Prodrugs; D011441:Propylthiouracil / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D013956:Antithyroid Agents; D011355:Prodrugs; D008713:Methimazole; D011441:Propylthiouracil
Graves’ disease; Hyperthyroidism; antithyroid drugs; carbimazole; methimazole; propylthiouracil