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Block & replace regime versus titration regime of antithyroid drugs for the treatment of Graves’ disease: a retrospective observational study
Author(s) -
Vaidya Bijay,
Wright Ailsa,
Shuttleworth Joanna,
Donohoe Mollie,
Warren Roderick,
Brooke Antonia,
Gericke Christian A.,
Ukoumunne Obioha C
Publication year - 2014
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12478
Subject(s) - levothyroxine , medicine , graves' disease , context (archaeology) , thyroid function , retrospective cohort study , thyroid function tests , thyroidectomy , endocrinology , thyroid , group b , paleontology , biology
Summary 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 ATD s for GD at a secondary care hospital. Exclusion criteria included treatment with ATD s 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 ( TFT s) 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.