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1 April 1996 | Volume 124 Issue 7 | Page 694
More than 4 years ago, Hashizume and colleagues [1] reported a new medical treatment for Graves disease that was associated with an astonishingly low relapse rate. In this study, 60 hyperthyroid patients were rendered euthyroid with methimazole and then treated for 1 year with both methimazole, 10 mg/d, and thyroxine, 100 µg/d, followed by thyroxine alone for 3 more years. Only 1 of these 60 patients (1.7%) became hyperthyroid during the 4-year study period, compared with 17 of 49 patients (34.7%) in a control group receiving placebo instead of thyroxine. To explain this dramatic result, the researchers suggested that thyroxine may suppress thyroid autoimmunity by several different mechanisms.
Since 1991, we have used Hashizume and colleagues' protocol to treat six patients with Graves disease in the endocrine clinic of a large public hospital. The patients were selected for long-term medical therapy because they had refused radioiodine treatment. Their hyperthyroidism ranged from mild to severe. The characteristics of these patients and the results of treatment are given in Table 1. Although our sample is small, we have had more failures in the treatment of six hyperthyroid patients using thyroxine than Hashizume and coworkers had in more than 100 patients in two separate studies [1, 2]. Two of our patients had relapse while receiving the fixed-dose initial regimen of methimazole and thyroxine, and three patients subsequently had relapse while receiving thyroxine alone. Our poor results probably cannot be explained by noncompliance, given that all patients had become euthyroid while receiving antithyroid drugs before beginning the protocol. Genetic, geographic, or dietary differences may account for the disparate results. Our discouraging observations and those of others [3-5] question the effectiveness of thyroxine for treating Graves disease. LETTER
Failure of Thyroxine Therapy for Graves Disease
TO THE EDITOR:
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1. Hashizume K, Ichikawa K, Sakurai A, Suzuki S, Takeda T, Kobayashi M, et al. Administration of thyroxine in treated Graves' disease—effects on the level of antibodies to thyroid-stimulating hormone receptors and on the risk of recurrence of hyperthyroidism. N Engl J Med. 1991; 324:947-53.
2. Hashizume K, Ichikawa K, Nishii Y, Kobayashi M, Sakurai A, Miyamoto T, et al. Effect of administration of thyroxine on the risk of postpartum recurrence of hyperthyroid Graves' disease. J Clin Endocrinol Metab. 1992; 55:108-12.
3. Tamai H, Hayaki I, Kawai K, Komaki G, Matsubayashi S, Kuma K, et al. Lack of effect of thyroxine administration on elevated thyroid-stimulating hormone receptor antibody levels in treated Graves' disease patients. J Clin Endocrinol Metab. 1995; 80:1481-4.
4. Hershman JM. Does thyroxine therapy prevent recurrence of Graves' hyperthyroidism? [Editorial] J Clin Endocrinol Metab. 1995; 80:1479-80.
5. Zwicker H, Abbott C, Douglas R, Givner M, Lehman L, Reddy S, et al. Effect of methimazole plus thyroxine on serum levels of TSH-receptor antibodies in Graves' disease [Abstract]. 77th Annual Endocrine Society Meeting. 1995; OR11-1:60.
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This article has been cited by other articles:
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  A. Lucas, I. Salinas, F. Rius, E. Pizarro, M.L. Granada, M. Foz, and A. SanmartI Medical Therapy of Graves' Disease: Does Thyroxine Prevent Recurrence of Hyperthyroidism? J. Clin. Endocrinol. Metab., August 1, 1997; 82(8): 2410 - 2413. [Abstract] [Full Text] [PDF]
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