TSH SUPPRESSION COMBINED WITH CARBIMAZOLE FOR GRAVES-DISEASE - EFFECTON REMISSION AND RELAPSE RATES

OBJECTIVE We studied the influence of TSH suppressive therapy combined with carbimazole (CBZ) on treatment outcome in Graves' disease, DESIG N Open non-randomized prospective study, SETTING University Hospital o f Montpellier, France, SUBJECTS Sixty-six consecutive patients without prior treatment were included, All the patients were treated initiall y with 30mg of CBZ, After 1 month of treatment, one group continued CB Z alone (n=23), another group received a combination of CBZ plus T3 (n =19) and a third group received CBZ and 3,5,3'-triiodothyroacetic acid (Triac, n=24), Therapy was stopped when remission was obtained based on clinical euthyroidism, normalization of FT4 and of early radioiodin e uptake. Nine patients with medical treatment failure or major side e ffects requiring to stop antithyroid drugs underwent surgery or radioi odine therapy, Nine patients were lost to follow-up, The remaining 48 patients were available for analysis of both remission and relapse, RE SULTS The median duration of therapy was 18 months (range, 4-41 months ), Based on clinical examination, goitre size at 4 months decreased mo re in the CBZ+T3 and CBZ+ Triac groups than in the CBZ group (P=0.02). The overall remission rate tended to be higher in the groups treated with CBZ+T3 and CBZ+ Triac than in the group treated with CBZ alone, b ut the difference did not reach statistical significance (P=0.17). No difference in the relapse rate was observed between the three groups. CONCLUSION TSH suppression combined with CBZ has little or no effect o n remission and relapse rates in Graves' disease patients.