Autoimmune hyperthyroidism: initiation and duration of thionamide therapy
Graves disease is a common autoimmune disorder with autoimmunity against the TSH-receptor being a central pathogenetic element. The disease may present with a number of clinical manifestations, among which hyperthyroidism caused by TSH-receptor stimulating antibodies is the most prevalent. The disease is common in all adult ages and affects women 45 times more often than men.
In many countries the preferred initial therapy of the hyperthyroidism is thionomide drugs (TD) that will in most patients lead to euthyroidism and be followed by a gradual remission of the underlying autoimmune abnormality with disapperance of TSH-receptor autoantibodies from blood
The three major problems with TD therapy are:
1. Side-effects to the drugs.
2. A frequent relapse of hyperthyroidism after drug withdrawal
3. Insufficient response to TD in a minority of patients
The choice of drug in specific situations, the initial dosing, and evidence for and against prolonged TD therapy will be discussed.
Interim data from the RISG study (Remission Induction and Sustenance in Graves hyperthyroidism) investigating prolonged use of TD in a prospective randomized design will be discussed, as will data related to the use of Propylthiouracil for initial therapy of patients with impending thyrotoxic crisis and patients not responding to conventional TD therapy.
Declaration of interest: The author declares that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.