Endocrinol Metab.  2021 Jun;36(3):491-499. 10.3803/EnM.2021.1070.

Antithyroid Drug Treatment in Graves’ Disease

• Chung JH

• KMID: 2517638
• DOI: http://doi.org/10.3803/EnM.2021.1070

Abstract

Graves’ disease is associated with thyrotropin (TSH) receptor stimulating antibody, for which there is no therapeutic agent. This disease is currently treated through inhibition of thyroid hormone synthesis or destruction of the thyroid gland. Recurrence after antithyroid drug (ATD) treatment is common. Recent studies have shown that the longer is the duration of use of ATD, the higher is the remission rate. Considering the relationship between clinical outcomes and iodine intake, recurrence of Graves’ disease is more common in iodine-deficient areas than in iodine-sufficient areas. Iodine restriction in an iodine-excessive area does not improve the effectiveness of ATD or increase remission rates. Recently, Danish and Korean nationwide studies noted significantly higher prevalence of birth defects in newborns exposed to ATD during the first trimester compared to that of those who did not have such exposure. The prevalence of birth defects was lowest when propylthiouracil (PTU) was used and decreased by only 0.15% when methimazole was changed to PTU in the first trimester. Therefore, it is best not to use ATD in the first trimester or to change to PTU before pregnancy.

Keyword

Graves disease; Antithyroid agents; Recurrence; Iodine; Congenital abnormalities; Pregnancy

Figure

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  Fig. 1 The prevalence of birth defects in pregnancies exposed to antithyroid drugs during the first trimester by drug type, duration, and cumulative dose. Birth defects occurred from the onset of propylthiouracil (PTU) use during the first trimester, and the risk for birth defects did not differ with the duration and cumulative dose of PTU. However, a high cumulative dose of methimazole (>495 mg) during the first trimester was associated with an increased risk for birth defects compared with a low dose (1 to 126 mg) (adjusted odds ratio, 1.87; 95% confidence interval, 1.06 to 3.30). Adapted from Seo et al. [67], with permission from The American College of Physicians.

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