Meds for hyperthyroidism
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Medications for Hyperthyroidism: An Overview
Antithyroid Drugs for Hyperthyroidism Treatment
Methimazole and Propylthiouracil: Primary Antithyroid Drugs
Methimazole (MMI) and propylthiouracil (PTU) are the primary antithyroid drugs used to treat hyperthyroidism. These drugs inhibit the synthesis of thyroid hormones and are often used as the first line of treatment or as a preparatory step before radioiodine therapy or thyroidectomy. MMI is generally preferred due to its longer half-life and fewer severe side effects compared to PTU.
Titration vs. Block-Replace Regimens
The Titration regimen involves adjusting the dose of antithyroid drugs to maintain normal thyroid hormone levels, while the Block-Replace regimen uses high doses of antithyroid drugs combined with thyroid hormone replacement. Studies have shown that the Titration regimen, when administered for 12 to 18 months, is effective and has fewer adverse effects compared to the Block-Replace regimen . The Block-Replace regimen, although equally effective in controlling hyperthyroidism, is associated with higher rates of side effects such as rashes and withdrawal due to adverse reactions .
Duration of Therapy
The optimal duration for antithyroid drug therapy using the Titration regimen is between 12 to 18 months. Extending the treatment beyond 18 months does not significantly improve relapse rates . For the Block-Replace regimen, a six-month duration is as effective as a 12-month treatment, but extending beyond this period does not offer additional benefits .
High vs. Low Dosage Regimens
A study comparing high and low dosage regimens of antithyroid drugs found that high doses of PTU or MMI resulted in higher remission rates compared to lower doses. This suggests that higher doses may have greater immunosuppressive effects, potentially leading to lasting remission of Graves' disease.
Nonthionamide Antithyroid Drugs (NTADs)
For patients who cannot tolerate thionamide drugs due to severe side effects like agranulocytosis, hepatotoxicity, and vasculitis, nonthionamide antithyroid drugs (NTADs) are an alternative. NTADs include iodine-containing compounds, lithium carbonate, perchlorate, glucocorticoids, and cholestyramine. These drugs are particularly useful in situations requiring rapid reduction of thyroid hormone levels, such as thyroid storm or preoperative preparation.
Chinese Herbal Medicines
In some countries, Chinese herbal medicines are used either alone or in combination with conventional antithyroid drugs. Studies suggest that these herbal medicines may help lower relapse rates, reduce adverse effects, and improve thyroid function when combined with antithyroid drugs. However, due to methodological limitations, there is insufficient strong evidence to recommend any specific herbal preparation for clinical use.
Conclusion
The treatment of hyperthyroidism primarily involves the use of antithyroid drugs like methimazole and propylthiouracil, with the Titration regimen being preferred due to its effectiveness and lower incidence of side effects. High dosage regimens may offer better remission rates, and nonthionamide drugs provide alternatives for patients intolerant to thionamides. While Chinese herbal medicines show potential, more robust clinical trials are needed to validate their efficacy.
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