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What is the evidence behind the evidence-base? The premature death of block-replace antithyroid drug regimens for Graves’ disease

¹ Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK, ² Department of Endocrinology and Diabetes, Royal Devon and Exeter Hospital, Exeter, UK, ³ Department of Endocrinology, Freeman Hospital, Newcastle upon Tyne, UK and ⁴ Institute of Human Genetics & School of Clinical Medical Sciences, University of Newcastle, Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK

(Correspondence should be addressed to S Pearce at the Institute of Human Genetics, University of Newcastle, UK; Email: s.h.s.pearce{at}ncl.ac.uk)

Abstract

Block-replace and titration antithyroid drug regimens both give similar rates of medium- to long-term remission of hyperthyroid Graves’ disease. Recent meta-analysis, however, has suggested that titration regimens may be preferable owing to a higher rate of adverse events seen in the block-replace arms of published comparative studies. This article critically re-evaluates the evidence upon which these meta-analyses were based. We suggest that there is little objective evidence that is pertinent to current clinical practice to separate block-replace from titration antithyroid drug regimens and that both remain satisfactory approaches to the medical management of hyperthyroid Graves’ disease.