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Initial response of young people with thyrotoxicosis to block and replace or dose titration thionamide

OBJECTIVE: Patients with thyrotoxicosis are treated with anti-thyroid drug (ATD) using block and replace (BR) or a smaller, titrated dose of ATD (dose titration, DT). DESIGN: A multi-centre, phase III, open-label trial of newly diagnosed paediatric thyrotoxicosis patients randomised to BR/DT. We com...

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Autores principales: Wood, Claire L, Morrison, Niamh, Cole, Michael, Donaldson, Malcolm, Dunger, David B, Wood, Ruth, Pearce, Simon H S, Cheetham, Timothy D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142802/
https://www.ncbi.nlm.nih.gov/pubmed/34981745
http://dx.doi.org/10.1530/ETJ-21-0043
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author Wood, Claire L
Morrison, Niamh
Cole, Michael
Donaldson, Malcolm
Dunger, David B
Wood, Ruth
Pearce, Simon H S
Cheetham, Timothy D
author_facet Wood, Claire L
Morrison, Niamh
Cole, Michael
Donaldson, Malcolm
Dunger, David B
Wood, Ruth
Pearce, Simon H S
Cheetham, Timothy D
author_sort Wood, Claire L
collection PubMed
description OBJECTIVE: Patients with thyrotoxicosis are treated with anti-thyroid drug (ATD) using block and replace (BR) or a smaller, titrated dose of ATD (dose titration, DT). DESIGN: A multi-centre, phase III, open-label trial of newly diagnosed paediatric thyrotoxicosis patients randomised to BR/DT. We compared the biochemical response to BR/DT in the first 6 months of therapy. METHODS: Patients commenced 0.75 mg/kg carbimazole (CBZ) daily with randomisation to BR/DT. We examined baseline patient characteristics, CBZ dose, time to serum thyroid-stimulating hormone (TSH)/free thyroxine (FT4) normalisation and BMI Z-score change. RESULTS: There were 80 patients (baseline) and 78 patients (61 female) at 6 months. Mean CBZ dose was 0.9 mg/kg/day (BR) and 0.5 mg/kg/day (DT). There was no difference in time to non-suppressed TSH concentration; 16 of 39 patients (BR) and 11 of 39 (DT) had suppressed TSH at 6 months. Patients with suppressed TSH had higher mean baseline FT4 levels (72.7 vs 51.7 pmol/L; 95% CI for difference 1.73, 31.7; P = 0.029). Time to normalise FT4 levels was reduced in DT (log-rank test, P = 0.049) with 50% attaining normal FT4 at 28 days (95% CI 25, 32) vs 35 days in BR (95% CI 28, 58). Mean BMI Z-score increased from 0.10 to 0.81 at 6 months (95% CI for difference 0.57, 0.86; P < 0.001) and was greatest in patients with higher baseline FT4 concentrations. CONCLUSIONS: DT-treated patients normalised FT4 concentrations more quickly than BR. Overall, 94% of patients have normal FT4 levels after 6 months, but 33% still have TSH suppression. Excessive weight gain occurs with both BR and DT therapy.
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spelling pubmed-91428022022-05-31 Initial response of young people with thyrotoxicosis to block and replace or dose titration thionamide Wood, Claire L Morrison, Niamh Cole, Michael Donaldson, Malcolm Dunger, David B Wood, Ruth Pearce, Simon H S Cheetham, Timothy D Eur Thyroid J Research OBJECTIVE: Patients with thyrotoxicosis are treated with anti-thyroid drug (ATD) using block and replace (BR) or a smaller, titrated dose of ATD (dose titration, DT). DESIGN: A multi-centre, phase III, open-label trial of newly diagnosed paediatric thyrotoxicosis patients randomised to BR/DT. We compared the biochemical response to BR/DT in the first 6 months of therapy. METHODS: Patients commenced 0.75 mg/kg carbimazole (CBZ) daily with randomisation to BR/DT. We examined baseline patient characteristics, CBZ dose, time to serum thyroid-stimulating hormone (TSH)/free thyroxine (FT4) normalisation and BMI Z-score change. RESULTS: There were 80 patients (baseline) and 78 patients (61 female) at 6 months. Mean CBZ dose was 0.9 mg/kg/day (BR) and 0.5 mg/kg/day (DT). There was no difference in time to non-suppressed TSH concentration; 16 of 39 patients (BR) and 11 of 39 (DT) had suppressed TSH at 6 months. Patients with suppressed TSH had higher mean baseline FT4 levels (72.7 vs 51.7 pmol/L; 95% CI for difference 1.73, 31.7; P = 0.029). Time to normalise FT4 levels was reduced in DT (log-rank test, P = 0.049) with 50% attaining normal FT4 at 28 days (95% CI 25, 32) vs 35 days in BR (95% CI 28, 58). Mean BMI Z-score increased from 0.10 to 0.81 at 6 months (95% CI for difference 0.57, 0.86; P < 0.001) and was greatest in patients with higher baseline FT4 concentrations. CONCLUSIONS: DT-treated patients normalised FT4 concentrations more quickly than BR. Overall, 94% of patients have normal FT4 levels after 6 months, but 33% still have TSH suppression. Excessive weight gain occurs with both BR and DT therapy. Bioscientifica Ltd 2021-10-25 /pmc/articles/PMC9142802/ /pubmed/34981745 http://dx.doi.org/10.1530/ETJ-21-0043 Text en © The authors https://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Research
Wood, Claire L
Morrison, Niamh
Cole, Michael
Donaldson, Malcolm
Dunger, David B
Wood, Ruth
Pearce, Simon H S
Cheetham, Timothy D
Initial response of young people with thyrotoxicosis to block and replace or dose titration thionamide
title Initial response of young people with thyrotoxicosis to block and replace or dose titration thionamide
title_full Initial response of young people with thyrotoxicosis to block and replace or dose titration thionamide
title_fullStr Initial response of young people with thyrotoxicosis to block and replace or dose titration thionamide
title_full_unstemmed Initial response of young people with thyrotoxicosis to block and replace or dose titration thionamide
title_short Initial response of young people with thyrotoxicosis to block and replace or dose titration thionamide
title_sort initial response of young people with thyrotoxicosis to block and replace or dose titration thionamide
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142802/
https://www.ncbi.nlm.nih.gov/pubmed/34981745
http://dx.doi.org/10.1530/ETJ-21-0043
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