Thionamides are considered the main drugs for treatment of diffuse toxic goitre (DTG). Thiamazole, carbimazole and propylthiouracil are the most frequently used thyreostatic drugs.
According to R. Wilson et al. (1988), propylthiouracil and carbimazole, while producing the same effect on reduction of the thyroid gland (TG) hormone secretion, had a different effect on the immune system. Thus, a more significant reduction of TSH receptor antibodies in blood serum and increase of T-suppressor cells was observed in patients on carbimazole compared to patients who received a propylthiouracil therapy (Abraham P., Acharya S., 2010).
Replacement of thiamazole drugs with carbimazole is associated with fewer side effects and disappearing allergic reactions and this allows patients to continue with DTG treatment and achieve a clinical and immunological remission.
Achievement of the clinical remission is combined with the need for long-term use of thyreostatics for at least 1-2 years (1.5 years on average). As the duration of carbimazole effect is directly related to active substance concentration in the thyroid gland rather than to its plasma half-life, this results in its higher antithyroid activity. This, in its turn, ensures a practically 24-hour effect of a single dose which makes it possible to use the drug once daily. The optimal term of antithyroid therapy with dose titration is 12 to 18 months.
Prepared by Pankiv V.I.
Published in "International Endocrinologic Journal" №3(51)'2013
