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Noh, Ito
Comparison of Methimazole and Propylthiouracil in Patients with Hyperthyroidism Caused by Graves' disease.Nakamura H, Noh JY, Itoh K, Fukata S, Miyauchi A, Hamada N. J Clin Endocrinol Metab. 2007 Mar 27; [Epub ahead of print]
"Context: Although methimazole (MMI) and propylthiouracil (PTU) have long been used to treat hyperthyroidism caused by Graves' disease, there is still no clear conclusion about the choice of drug or appropriate initial doses.
Objective: To compare the MMI 30mg/day-treatment with the PTU 300mg/day- and MMI 15mg/day-treatment in terms of efficacy and adverse reactions.
Design, Setting and Participants: Patients newly diagnosed with Graves' disease were randomly assigned to one of the three treatment regimes in a prospective study at four Japanese hospitals.
Main outcome measurements: Percentages of patients with normal serum free T4 (FT4) or free T3 (FT3) and frequency of adverse effects were measured at 4, 8 and 12 weeks.
Results: MMI 30mg/day normalized FT4 in more patients than PTU 300mg/day and MMI 15mg/day for the whole group (240 patients) at 12 weeks (96.5% vs. 78.3%, P=0.001, and 86.2%, P=0.023, respectively). When patients were divided into two groups by initial FT4, in the group of the patients with severe hyperthyroidism (FT4: 7ng/dl or more, 64 patients) MMI 30mg/day normalized FT4 more effectively than PTU 300mg/day at 8 and 12 weeks and MMI 15mg/day at 8 week, respectively (P<0.05). No remarkable difference between the treatments was observed in patients with initial FT4 less than 7ng/dl. Adverse effects, especially mild hepatotoxicity, were higher with PTU and significantly lower with MMI 15mg/day compared with MMI 30mg/day.
Conclusion: MMI 15mg/day is suitable for mild and moderate Graves' disease, while MMI 30mg/day is advisable for severe cases. PTU is not recommended for initial use."
[Treatment with inorganic iodine for Graves' hyperthyroidism]Noh JY, Chino T, Ito K. Nippon Rinsho. 2006 Dec;64(12):2269-73. Review. Japanese. [abstract only]
"Nowadays, patients with Graves' hyperthyroidism are initially treated with methimazole or propylthiouracil. Several serious adverse reactions like agranulocytosis are caused by these drugs. Inorganic iodine decreases serum thyroid hormone concentrations in patients with Graves' hyperthyroidism without adverse reaction, but this effect usually continues only a limited time. However, a virtually complete remission or longstanding euthyroid state may be obtained with inorganic iodine therapy alone in patients with mild Graves' disease, who show small thyroid volume and low TRAb titers. Inorganic iodine therapy may become one of the treatment methods in the patients with mild Graves' hyperthyroidism."
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