Long-Term Antithyroid Drug Treatment: A Systematic Review and Meta-Analysis

[helvella]

We have read of too many Graves sufferers being pushed towards either radioactive iodine treatment or surgery. We have also seen quite a few who have stuck with anti-thyroid medicines for many years. Clearly opposing viewpoints. Good to see a paper specifically looking at long term use of anti-thyroid medicines.

Thyroid. 2017 Oct;27(10):1223-1231. doi: 10.1089/thy.2016.0652. Epub 2017 Sep 15.

Long-Term Antithyroid Drug Treatment: A Systematic Review and Meta-Analysis.

Azizi F1, Malboosbaf R1.

Author information

1 Endocrine Research Center of Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, I.R. Iran .

Abstract

BACKGROUND:

Several studies have reported inconsistent findings on the advantages and disadvantages of long-term treatment with antithyroid drugs (ATD). A systematic review and meta-analysis was undertaken to clarify the numerous aspects of long-term treatment with ATD.

METHODS:

Medline and the Cochrane Library for trials published between 1950 and May 2016 were systematically searched. Studies containing data for long-term (>24 months) ATD treatment were included. Summary estimates of pooled prevalence, odds ratio, and weighted mean difference were calculated with a random effects model.

RESULTS:

Of 587 related articles found, six fulfilled the inclusion criteria. Long-term ATD treatment induced a remission rate of 57% [confidence interval (CI) 45-68%], a rate that was higher in adults than in non-adults (61% vs. 53%). The rate of complications was 19.1% [CI 9.6-30.9%], of which only 1.5% were major complications. The annual remission rate for each year of treatment was 16% [CI 10-27%], which was higher in adults than non-adults (19% vs. 14%). However, it should be noted that this is not a true linear correlation, but a positive relationship can be suggested between time and remission rate. Meta-regression revealed that smoking had a significant lowering effect on remission rate.

CONCLUSIONS:

Long-term ATD treatment is effective and safe, especially in adults, indicating that it should be considered as an alternative treatment for Graves' disease.

KEYWORDS:

Graves' disease; antithyroid drugs; continuous therapy; long-term therapy; meta-analysis; methimazole; propylthiouracil

PMID: 28699478

DOI: 10.1089/thy.2016.0652

ncbi.nlm.nih.gov/pubmed/286...

[thyras]

I noticed that the ratio 15:1 was used. Does anyone happen to know how much T4/T3 is released in healthy people?

The dose of NDT was like 30 mg in average which is pretty small.

For some reason they didn't compare the results of the questions done at baseline to the end of the study.

[helvella Administrator in reply to thyras]

I think you might have replied on the wrong thread!

[Pushka]

Do you know if the same applies to people who are hyper but not Graves?

I’m hyper due to toxic modules and am being pushed towards radio iodine treatment , been on carbimazole for two years with no side effects

[helvella Administrator in reply to Pushka]

The simple answer is that I do not know. However, there is nothing I can see which is specific to Graves. On the other hand, perhaps there is a less obvious reason?

[APAscot in reply to Pushka]

I am also hyper without Graves and have been taking carbimazole for just over two years without side affects. Everyone here said avoid radioactive iodine which I have told endocrinologist who was very understanding. Having read about all the possible after affects it worried the life out of me. Also I read there's a 50 to 80% chance of becoming hypo. Told I would need to be on carbimazole for the duration - I'll take my chances. I also have benign toxic nodules. So thanks to everyone on here.

[Pushka in reply to APAscot]

Thank you for your reply, I really feel pressured by my Endo to have the radioactive treatment, I’ve done the same research as you and it terrifies me. you’re the only person I’ve come across who has the same condition as me so if I pester you a bit I’m sorry 😐

How much carbimazole do you take and how’s your heart rate?

What have they said to you re long term effects of carb?

[APAscot in reply to Pushka]

I'm on a low dose of carbimazole only 5mg alternate days the other days it's 10 mg. my endocrinologist said that long term affects of the drug were not known but he didn't think there would be a problem. The conclusion in Helvella's post says it's effective and safe and should be considered as an alternative treatment for Graves' disease, which, fortunately, we don't have.

I don't have any heart problems. Did have a problem with breathing for a little while but once I decided not to go ahead with the radio iodine it all calmed down - it was stressing me out unbelievably

Good luck with your endo. My argument was that I don't feel ill (fortunately) so why would I want to make myself ill (by becoming hypo).

[Chippy10 in reply to APAscot]

Hi , I am in the same situation with toxic nodules and been resisting Radio iodine for four years. I am now feeling so exhausted feel I have to do something. I am going to ask consultant for Carbimazole. Haven't been offered this at all ,was wondering if it was because of my age which is 71. How have you been getting on and may I ask your age. Thanks

[APAscot in reply to Chippy10]

Hi Chippy10 I'm still feeling well, thankfully, and now only on 5mg carbimazole a day. Have now been taking it for almost 4 years so would have been 71 at the time. Maybe your test results don't match the requirements to qualify for the drug but I'm no expert, unlike most people on this forum. I guess when you say consultant you mean endocrinologist, if not push your GP for a referral, listing any other symptoms but read everything you can on here. I was lucky in that my symptoms (tremors and difficulty sleeping) were what triggered blood tests. Unfortunately a few months later I had multiple, unrelated, health problems which overtook my mild thyroid ones. Hope you can get yours resolved soon. I'm so pleased I listened to people on here and didn't have the RAI as I don't think I could have coped with the, possible, after effects on top of what occurred. Don't forget a lot of people don't suffer from and are pleased they had the RAI. If you're feeling awful keep pushing for some action. Good luck.

Ann

[Chippy10 in reply to APAscot]

Thankyou for your quick response and glad you are feeling well. I am going to see my Endo soon and will ask for the tablets. I have been trying for ages to sort this out ( toxic nodules) and having been refused RFA (laser ablation) as it wasn't possible for me personally I think it's time to try the Carbimazole. BTW I am classed as subclinical hyperthyroidism TSH totally suppressed and T3 top of range T4 about 1/3 of range. Thanks again and keep well.

[Chippy10 in reply to Chippy10]

If you don't mind me asking where you ever on HRT ?

[APAscot in reply to Chippy10]

No, never. Hope you get the help you need soon.

[Chippy10 in reply to APAscot]

Thankyou , I for one bitterly regret not taking HRT as this is the cause of everthing.