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Lookup NU author(s): Dr Claire Wood, Mike Cole, Ruth Wood, Professor Simon PearceORCiD, Professor Timothy Cheetham
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
© 2022 The authors Published by Bioscientifica Ltd.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.
Author(s): Wood CL, Morrison N, Cole M, Donaldson M, Dunger DB, Wood R, Pearce SHS, Cheetham TD, Mayo A, Oxley C, Kirk J, Barrett T, Acerini C, Gregory J, Warner J, Stirling H, Greene S, Drake A, Shaikh G, Gault E-J, Staines J, Blair J, Dharmaraj P, Banerjee I, Ehtisham S, Johnstone H, Matthews D, Owen K, Thalange N, Dimitri P, Wright N, Wales J, Albanese A, Bain M
Publication type: Article
Publication status: Published
Journal: European Thyroid Journal
Year: 2022
Volume: 11
Issue: 1
Print publication date: 01/02/2022
Online publication date: 25/10/2021
Acceptance date: 25/10/2021
Date deposited: 09/02/2024
ISSN (print): 2235-0640
ISSN (electronic): 2235-0802
Publisher: BioScientifica Ltd.
URL: https://doi.org/10.1530/ETJ-21-0043
DOI: 10.1530/ETJ-21-0043
PubMed id: 34981745
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