This Article Full Text Full Text (PDF) All Versions of this Article: 92/6/2157    most recent Author Manuscript (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nakamura, H. Search for Related Content PubMed PubMed Citation Articles by Nakamura, H. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB LEVOTHYROXINE LIOTHYRONINE METHIMAZOLE PROPYL THIOURACIL Related Collections Autoimmunity Thyroid

Comparison of Methimazole and Propylthiouracil in Patients with Hyperthyroidism Caused by Graves’ Disease

Department of Internal Medicine II (H.N.), Hamamatsu University School of Medicine, Handayama 1-20-1, Hamamatsu, Shizuoka 4313129, Japan; Ito Hospital (J.Y.N., K.I.), Jingumae 4-3-6, Shibuya-ku, Tokyo 1508308, Japan; Kuma Hospital (S.F., A.M.), Shimoyamatedori 8-2-35, Chuo-ku, Kobe 6500011, Japan; and Sumire Hospital (N.H.), Furuichi 1-20-85, Joto-ku, Osaka 536-0001, Japan

Address all correspondence and requests for reprints to: Hirotoshi Nakamura, Department of Internal Medicine II, Hamamatsu University School of Medicine, Handayama 1-20-1, Hamamatsu, Shizuoka, Japan. E-mail: hirotosh{at}hama-med.ac.jp.

Context: Although methimazole (MMI) and propylthiouracil (PTU) have long been used to treat hyperthyroidism caused by Graves’ disease (GD), there is still no clear conclusion about the choice of drug or appropriate initial doses.

Objective: The aim of the study was to compare the MMI 30 mg/d treatment with the PTU 300 mg/d and MMI 15 mg/d treatment in terms of efficacy and adverse reactions.

Design, Setting, and Participants: Patients newly diagnosed with GD were randomly assigned to one of the three treatment regimens in a prospective study at four Japanese hospitals.

Main Outcome Measures: Percentages of patients with normal serum free T₄ (FT4) or free T₃ (FT3) and frequency of adverse effects were measured at 4, 8, and 12 wk.

Results: MMI 30 mg/d normalized FT4 in more patients than PTU 300 mg/d and MMI 15 mg/d for the whole group (240 patients) at 12 wk (96.5 vs. 78.3%; P = 0.001; and 86.2%, P = 0.023, respectively). When patients were divided into two groups by initial FT4, in the group of the patients with severe hyperthyroidism (FT4, 7 ng/dl or more, 64 patients) MMI 30 mg/d normalized FT4 more effectively than PTU 300 mg/d at 8 and 12 wk and MMI 15 mg/d at 8 wk, respectively (P < 0.05). No remarkable difference between the treatments was observed in patients with initial FT4 less than 7 ng/dl. Adverse effects, especially mild hepatotoxicity, were higher with PTU and significantly lower with MMI 15 mg/d compared with MMI 30 mg/d.

Conclusions: MMI 15 mg/d is suitable for mild and moderate GD, whereas MMI 30 mg/d is advisable for severe cases. PTU is not recommended for initial use.

This article has been cited by other articles:

				G. A. Brent Graves' Disease N. Engl. J. Med., June 12, 2008; 358(24): 2594 - 2605. [Full Text] [PDF]

				Methimazole vs. Propylthiouracil for Hyperthyroidism Journal Watch (General), June 19, 2007; 2007(619): 1 - 1. [Full Text]