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Controversies about antithyroid drug use

Controversies about antithyroid drug use
Controversy Best available answer
For how long should patients be treated? 12 to 18 months
Does the dose influence the chances of remission? Probably not
Do higher doses bring the disease under more rapid control? Yes
Does the coadministration or subsequent use of T4 or T3 improve remission rates? No
Are there baseline predictors of the likelihood of remission? Severe disease, large goiter, high anti-TRAb titers may be predictive of failure, but only in extreme cases
Does pretreatment with antithyroid drugs decrease the chances of thyroid storm or other adverse outcomes after radioiodine therapy? Possibly, but only because thyroid hormone levels are lower after therapy in those few patients who exhibit an exacerbation
Will antithyroid drug therapy after radioiodine lead to more rapid disease control? Propylthiouracil, no (at six weeks); methimazole, yes
T3: liothyronine; T4: levothyroxine; TRAb: thyrotropin receptor antibody.
Adapted with permission from: Cooper DC. Antithyroid drugs in the management of patients with Graves' disease: An evidence-based approach to therapeutic controversies. J Clin Endocrinol Metab 2003; 88:3474. http://jcem.endojournals.org/. Copyright © 2003 The Endocrine Society.
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