Optimumduration ofantithyroid drugtreatment determined byassay ofthyroid stimulating antibody inpatients withGraves' disease

Objective-To determine theoptimal duration of antithyroid drugtreatment bymonitoring serum thyroid stimulating antibody values inpatients with Graves' disease. Design-Prospective longitudinal trial ofpatients withGraves' disease followed upfor24months after withdrawal oftreatment. Setting-Tertiary referral centre. Patients-A total of64consecutive patients with untreated Graves' disease, eight ofwhom were subsequently excluded. Fifty sixpatients completed thestudy. Interventions-All patients weretreated initially withcarbimazole 40mg,thenwithdecreasing doses thatmaintained aeuthyroid state. Treatment was scheduled tocontinue for18monthsbutwaswithdrawnearlier ifserumthyroid stimulating antibody becameundetectable. Endpoint-Serum values ofthyroid stimulating antibody (assayed bystimulation ofhumanthyroid cells invitro) andthyroid hormones andthyroid state every three monthsduring treatment andafterwards every sixmonths for24months. Measurements andmainresults-In 44patients serumthyroid stimulating antibody becameundetectable during treatment andtreatment was withdrawn (median duration oftreatment nine months, range3-18months). In12patients the antibody couldbedetected during 18monthsof treatment. Amongthefirst groupof44patients initial values oftheantibody before treatment weresignificantly lowerthaninthesecondgroupof12 patients (median 225%(range 138-1236%) v 570% (250-1480%), p<0001); theincidence ofrelapse was also lower (41%v92%,p<0001); andamongthose who didrelapse thedisease freeinterval after treatment waslonger (median 12monthsv1month, p

Keywords:

• Hormone
• Antibody
• Disease
• Gastroenterology
• Thyroid stimulating antibody
• Internal medicine
• Medicine
• Surgery
• referral centre
• after treatment

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