Ukrainian Scientific and Practical Center of Endocrine Surgery, Transplantation of endocrine organs and tissues of the Ministry of Health of Ukraine, m. Kyiv
The article is devoted to the study of treatment results of patients with diffuse toxic goitre. A research aim is an estimation of therapeutic efficiency, safety and tolerability of carbimazole (Еspa-Carb) in comparison with thiamazole (Mercazolil-Zdorovie) in patients with hyperthyroidism.
Materials and methods. Under a supervision were 55 patients with diffuse toxic goitre, up-diffused on two groups. The first group (n=30) received carbimazole (Еspa-Carb), second group (n=25) – thiamazole (Mercazolil-Zdorovie). The groups of patients did not differ on age, sex, thyroid volume, reasons and duration of thyrotoxicosis.
Results. The analysis of the obtained data testifies that in the first group of patients more substantial effect registers from treatment comparatively with the patients of the second group. The average thyroid volume for certain diminished only in the first group. In middle a thyroid volume diminished from 37.2±3.1 см3 to 29.3±2.9 см3 (р<0.05). In the second group there was a tendency to reduction, but without statistical authenticity (from 36.4±3.9 см3 to 32.4±2.8 см3 (р>0,05). The patients of the first group with diffuse toxic goitre had a reliable increase of level of ТSH (from 0.027±0.009 mMU/l to 0.37±0.16 mMU/l; р<0.05) and reliable reduction of fТ4 levels (from 29.3±2.3 to 18.4±1.8 nmol/l; р < 0.05) and fТ3 (from 7.8±1.6 nmol/l to 3.2±1.1 nmol/l; р<0.05). Thus the increase of TSH for the patients of the second group did not attain the level of statistical meaningfulness (р>0,05). In the same time for the patients of the second group reliable reduction of fT4 levels (from 31.4±2.1 nmol/l to 21.7±1.8 nmol/l; р<0.05) and fТ3 (from 8.2±1.4 to 3.7±1.2 nmol/l; р < 0,05) was marked. The decline of autoimmune aggression showed up the decline of concentration of antibodies to rТSH, that for the patients of the first group purchased the level of statistical meaningfulness. If middle day's dose of Еspa-Carb and Mercazolil-Zdorovie at the beginning of treatment in the inspected groups of patients did not differ, then in 6 months of treatment the middle dose of carbimazole in the first group presented 15.8±1.7 mg, and in the second group are 19.2±2.1 mg (р>0.05). By-effects at treatment of patients of both groups during six months were not observed. Normalization of content of peripheral hormones (fТ4 and fТ3) in 90 days of supervision is attained in 96.2% patients of the first group and in 74.1% the second group. Number of patients that attained the normal TSH level for certain higher was in the first group (93.3 vs 76%).
Conclusions. Set greater efficiency of carbimazole comparatively with thiamazole, that showed up to more rapid achievements of clinical effect and indemnification of thyrotoxicosis, by reliable reduction of thyroid volume, level of antibodies to the TSH receptor. The use of carbimazole assists reduction of day's dose of antithyroid drugs that diminishes the risk of origin of complications of therapy. At the use of carbimazole during six months in patients with diffuse toxic goitre it was not registered cases of unbearableness or any side effects.
Keywords: thyrotoxicosis, carbimazole, thiamazole.