Antithyroid drug therapy

Once a euthyroid state is achieved, tlie primary health care provider may add a thyroid hormone to tlie therapeutic regimen to prevent or treat hypothyroidism, which may develop slowly during long-term antithyroid drug therapy or after administration of 131I. 

Agranulocytosis is one of the most serious adverse effects of antithyroid drug therapy. 

Some neonates born to mothers with Graves disease will be hyperthyroid at delivery. Antithyroid drug therapy (propylthiouracil 5-10 mg/kg per day or methimazole 0.5-1 mg/kg per day) may be required for up to 12 weeks. One drop per day of SSKI may be used in the first few days to rapidly reduce thyroid hormone synthesis and release. 

Antithyroid drug therapy should continue for 12 to 24 months to induce a long-term remission. 

The three primary methods for controlling hyperthyroidism are antithyroid drug therapy, surgical thyroidectomy, and destruction of the gland with radioactive iodine. 

Solomon BL, Evaul JE, Burman KD, Wartofsky L. Remission rates with antithyroid drug therapy continuing influence of iodine intake Ann Intern Med 1987 107(4) 510-2. 

Stege R. Antithyroid drug therapy in hyperthyroidism. Recurrence, hypothyroidism and thyroid antibodies. Acta Chir Scand Suppl 1980 501 1-130. 

Low LC, Ratcliffe WA, Alexander WD. Intrauterine hypothyroidism due to antithyroid-drug therapy for thyrotoxicosis during pregnancy. Lancet 1978 2(8085) 370-1. 

Feldt-Rasmussen, U. etai (1993) Reassessment of antithyroid drug therapy of Graves disease. Anna. Rev. Med.. 44.323-334. 

If the objective of therapy is to induce a long-term remission, the patient shonld remain on continnons antithyroid drug therapy for 12 to 24 months. Antithyroid drug therapy induces permanent remission rates of 10% to 98%, with an overall average of about 40% to 50%. This is much higher than the remission rate seen with propranolol alone, which is reported to range from 22% to 36%. Patient... 

Items 1-3 A 24-year-old woman is found to have thyrotoxicosis. She appears to be in good health otherwise. It is decided to place her on antithyroid drug therapy. 

Methimazole can cause liver damage that is typically characterized by cholestasis, but no cases of liver damage resulting in transplantation or death have been described [17 ]. A 60-year-old man with hyperthyroidism developed cholestasis and acute cholecystitis after taking methimazole for 4 days the cholestasis improved rapidly after withdrawal of antithyroid drug therapy [19 ]. 

B. Solomon, J. Evaul, K. Burman and L. Wortofsky, Remission Rates with Antithyroid Drug Therapy Continuing Influence of Iodine Intake, Ann. Int Med. 107 510-512 (1987). 

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