Efficacy of Single Daily Dosage of Methimazole vs. Propylthiouracil in the Induction of Euthyroidism
Mayuree Homsanit, สุทิน ศรีอัษฎาพร, สาธิต วรรณแสง, ธวัชชัย พีระพัฒน์ดิษฐ์, วรรณี นิธิยานันท์, อภิชาต วิชญาณรัตน์
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Prannok Road, Bangkok Noi, Bangkok 10700, Thailand. Fax: +662 419 7792; E-mail: sisdp@mahidol.ac.th
Previous studies of the treatment of hyperthyroidism with a single daily dose of antithyroid drugs have demonstrated a favourable result with methimazole (MMI). However, the efficacy of a single daily dose of propylthiouracil (PTU) was inconsistent. The present prospective randomized study was conducted to compare the efficacy of a single daily dose of MMI and PTU in the induction of euthyroidism in patients with Graves' disease.Seventy-one patients with newly diagnosed Graves' disease were studied.Patients were randomized to two groups to receive once daily dose of either 15 mg MMI or 150 mg PTU for 12 weeks. The therapeutic efficacy was determined biochemically by serum total T3, total T4 and TSH levels at baseline and at 4, 8 and 12 weeks during the study period.There was no significant difference in baseline characteristics. Serum total T3 levels of the MMI group were significantly lower than those of the PTU group after four weeks of the treatment (3.54 ± 0.72 vs. 5.49 ± 2.74 nmol/l, P < 0.05) through the end of the study (2.22 ± 1.42 vs. 4.30 ± 1.78 nmol/l, P < 0.05). The changes in serum total T4 levels occurred in the same direction as serum total T3 levels but a significant difference was observed only after eight weeks of the treatment (MMI vs. PTU; 101.67 ± 54.05 vs. 176.32 ± 66.92 nmol/l, P < 0·05). At the end of the study, more patients in the MMI group had both serum total T3 and T4 levels less than the upper limit of the normal range compared to the PTU group (77.1% vs. 19.4%). Hypothyroidism was observed in 31·4% of the patients in the MMI group but not in the PTU group.During 12-weeks' treatment of Graves' hyperthyroidism, a single daily dose of 15 mg of MMI was much more effective in the induction of euthyroidism than a single daily dose of 150 mg of PTU. Once daily regimen of MMI not only decreased serum T3 and T4 levels more rapidly but also induced euthyroidism four times more effectively than did the once daily regimen of PTU. In the doses used in this study, MMI is preferable to PTU when a once-daily regimen of antithyroid drug is considered for the treatment of hyperthyroidism.
ปี 2544, March ปีที่: 54 ฉบับที่ 3 หน้า 385-390