Block & replace regime versus titration regime of antithyroid drugs for the treatment of Graves' disease: a retrospective observational study

2.50
Hdl Handle:
http://hdl.handle.net/11287/593851
Title:
Block & replace regime versus titration regime of antithyroid drugs for the treatment of Graves' disease: a retrospective observational study
Authors:
Vaidya, Bijay; Wright, Ailsa; Shuttleworth, Joanna; Donohoe, Mollie; Warren, Roderick; Brooke, Antonia; Gericke, Christian A.; Ukoumunne, Obiaha C.
Abstract:
CONTEXT: 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. OBJECTIVE: To study whether, in routine clinical practice, the B&R regime, compared with the titration regime, is associated with more stable thyroid function. METHODS: 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. RESULTS: 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) vs 3.4(1.5); adjusted mean difference = -0.4; 95% CI: -0.7 to -0.1; and P = 0.008) and the number of hospital clinic visits per year (mean (SD): 2.9 (1.0) vs 3.2 (1.3); adjusted mean difference = -0.4; 95% CI: -0.7 to -0.2; and P = 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) vs 1.8(1.4); adjusted mean difference = 0.05; 95%CI: -0.3 to 0.4; and P = 0.74). CONCLUSIONS: 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.
Citation:
Clin Endocrinol (Oxf). 2014 Oct;81(4):610-3.
Publisher:
Wiley
Journal:
Clinical endocrinology
Issue Date:
1-Oct-2014
URI:
http://hdl.handle.net/11287/593851
DOI:
10.1111/cen.12478
PubMed ID:
24801484
Additional Links:
http://dx.doi.org/10.1111/cen.12478
Type:
Journal Article; Research Support, Non-U.S. Gov't
Language:
eng
ISSN:
1365-2265
Appears in Collections:
2014 RD&E publications; Diabetes/Endocrine Services

Full metadata record

DC FieldValue Language
dc.contributor.authorVaidya, Bijayen
dc.contributor.authorWright, Ailsaen
dc.contributor.authorShuttleworth, Joannaen
dc.contributor.authorDonohoe, Mollieen
dc.contributor.authorWarren, Rodericken
dc.contributor.authorBrooke, Antoniaen
dc.contributor.authorGericke, Christian A.en
dc.contributor.authorUkoumunne, Obiaha C.en
dc.date.accessioned2016-01-19T12:35:45Zen
dc.date.available2016-01-19T12:35:45Zen
dc.date.issued2014-10-01en
dc.identifier.citationClin Endocrinol (Oxf). 2014 Oct;81(4):610-3.en
dc.identifier.issn1365-2265en
dc.identifier.pmid24801484en
dc.identifier.doi10.1111/cen.12478en
dc.identifier.urihttp://hdl.handle.net/11287/593851en
dc.description.abstractCONTEXT: 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. OBJECTIVE: To study whether, in routine clinical practice, the B&R regime, compared with the titration regime, is associated with more stable thyroid function. METHODS: 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. RESULTS: 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) vs 3.4(1.5); adjusted mean difference = -0.4; 95% CI: -0.7 to -0.1; and P = 0.008) and the number of hospital clinic visits per year (mean (SD): 2.9 (1.0) vs 3.2 (1.3); adjusted mean difference = -0.4; 95% CI: -0.7 to -0.2; and P = 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) vs 1.8(1.4); adjusted mean difference = 0.05; 95%CI: -0.3 to 0.4; and P = 0.74). CONCLUSIONS: 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.en
dc.language.isoengen
dc.publisherWileyen
dc.relation.urlhttp://dx.doi.org/10.1111/cen.12478en
dc.titleBlock & replace regime versus titration regime of antithyroid drugs for the treatment of Graves' disease: a retrospective observational studyen
dc.typeJournal Articleen
dc.typeResearch Support, Non-U.S. Gov'ten
dc.identifier.journalClinical endocrinologyen

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