MEDICAL THERAPY OF GRAVES-DISEASE - DOES THYROXINE PREVENT RECURRENCEOF HYPERTHYROIDISM

Sixty patients with Graves' disease (GD) hyperthyroidism were distribu ted in two randomized groups. Patients in group A (n = 30) received ca rbimazole by a titration regimen, and patients in group B (n = 30) wer e treated with higher doses of carbimazole plus T-4. Clinical and anal ytical evaluations were done at baseline, during treatment (18.4 +/- 2 .6 months), and after, until the relapse of hyperthyroidism, or for 4. 98 +/- 1.6 yr in patients who did not relapse. There were no differenc es in clinical parameters, thyroid hormones, or TSH binding inhibitory immunoglobulins (TBII) levels between the two groups, either al basel ine or at the end of treatment. Serum TSH persisted undetectable in 16 out of 60 patients (group A: 9: group B: 7) after treatment. Relapse occurred in 38 patients (63.3%), (group A: 18 (60%) vs. group B: 20 (6 6.7%)). Patients who relapsed had bigger goiters at baseline (P = 0.02 ) and at the end of treatment (P = 0.03). Eighty-seven percent (14/16) of patients with undetectable TSH after therapy relapsed, vs. 54.5% ( 24/44) of those with normal TSH (P = 0.01). Undetectable TSH at the en d of treatment was the only independent variable in the logistic analy sis to predict relapse. Treatment modality did not influence the relap se rate. This study has found that, in Spanish patients, the use of hi gh doses of carbimazole with T-4 offers no advantages in the treatment of GD hyperthyroidism.