Block & replace regime versus titration regime of antithyroid drugs for the treatment of Graves' disease: a retrospective observational study. (19th May 2014)

• Record Type: Journal Article
• Authors: Vaidya, Bijay; Wright, Ailsa; Shuttleworth, Joanna; Donohoe, Mollie; Warren, Roderick; Brooke, Antonia; Gericke, Christian A.; Ukoumunne, Obioha C
• Is Part Of: Clinical endocrinology. Volume 81:Number 4(2014:Oct.)
• Page Start: 610
• Page End: 613
• Publication Date: 2014-05-19
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.12478
• Languages: English
• ISSNs: 0300-0664

Abstract

<abstract abstract-type="main" id="cen12478-abs-0001"> <title>Summary</title> <sec id="cen12478-sec-0001" sec-type="section"> <title>Context</title> <p>Two widely used antithyroid drug (ATD) regimes for Graves' disease (GD) include the 'block & replace' (B&R) regime (a fixed high‐dose of ATD combined with levothyroxine) and the 'titration' regime (a titrating dose of ATD). Anecdotally, it is believed that B&R is less prone to fluctuating thyroid function.</p> </sec> <sec id="cen12478-sec-0002" sec-type="section"> <title>Objective</title> <p>To study whether, in routine clinical practice, the B&R regime, compared with the titration regime, is associated with more stable thyroid function.</p> </sec> <sec id="cen12478-sec-0003" sec-type="section"> <title>Methods</title> <p>We retrospectively analysed case‐records for 450 patients treated with ATDs for GD at a secondary care hospital. Exclusion criteria included treatment with ATDs for <6 months, thyrotoxicosis due to other causes, treatment with radioiodine or thyroidectomy and pregnancy.</p> </sec> <sec id="cen12478-sec-0004" sec-type="section"> <title>Results</title> <p>Two hundred and twenty three patients were treated with the B&R regime ('B&R group'), 149 with the titration regime ('titration group') and 78 with both regimes. The number of thyroid function tests (TFTs) performed per year (mean(SD): 3·2(1·2) <italic>vs</italic> 3·4(1·5); adjusted mean difference = −0·4; 95% CI: −0·7 to −0·1; and <italic>P</italic> = 0·008) and the number of hospital clinic visits per year (mean (SD): 2·9 (1·0) <italic>vs</italic> 3·2 (1·3); adjusted mean difference = −0·4; 95% CI: −0·7 to −0·2; and <italic>P</italic> = 0·002) were lower in the B&R group than the titration group. The number of abnormal TFT results per year was similar in the two groups (mean(SD): 1·8(1·3) <italic>vs</italic> 1·8(1·4); adjusted mean difference = 0·05; 95%CI: −0·3 to 0·4; and <italic>P</italic> = 0·74).</p> </sec> <sec id="cen12478-sec-0005" sec-type="section"> <title>Conclusions</title> <p>In this retrospective study, there was little evidence that patients under B&R have more stable thyroid function. Further data from prospective studies, however, are needed to confirm this finding.</p> </sec> </abstract>