EFFICACY OF DIFFERENT DOSAGE REGIMENS OF CARBIMAZOLE IN THE TREATMENT OF PRIMARY HYPERTHYROIDISM
Abstract
Background: Carbimazole is a prodrug that is converted to methimazole as soon as it is taken orally (15–30 minutes required). The plasma half-life of carbimazole is 5.3–5.4 hours, while that of its active counterpart, methimazole, is 64 hours. However, in the thyroid gland its half-life is up to 20 hours prompting to the sufficiency of a single dose of its pro drug carbimazole in hyperthyroid patients. Objectives were to compare the efficacy of Single dose with Divided dose regimen of Carbimazole for the induction of Euthyroidism in hyperthyroid patients. Methods: All consecutive hyperthyroidism patients from December 2018 to December 2019 fulfilling the inclusion criteria were included. They were allocated randomly into 2 groups: Group A - single dose of Carbimazole (OD-CMZ) and Group B - divided dose of Carbimazole (DD-CMZ). The therapeutic efficacy was measured at regular intervals (every 4 weeks) for 6 months. Their demographics and therapeutic management were analysed. Results: Of a total of 69 (n=34 in Group A, n=35 in Group B) patients, there was no significant difference in baseline concentrations of TSH and T4 as well as their cumulative rate of reductions (p value, 0.023). Furthermore, no difference in achieving euthyroidism was noted at follow-up visits between Group A and B respectively ([0:0%; p value 1.00, month 1], [70.6:74.3%; p value 0.22, month 2], [85.3:85.7%; p value 0.39, month 3], 97.1:82.9%; p value 0.23, month 4], [100:91.4%; p value 0.29, month 5], [100:100%%; p value 1.00, month 6] at monthly intervals. Cases of Hypothyroidism were reported more in the DD-CMZ (14.3%) and the difference was statistically significant (p value 0.003). Conclusion: Due to no significant difference in the efficacy and more chances of getting hypothyroid in divided dose regimen, we conclude that single dose regimen is more effective method for treating hyperthyroidism.References
Liu J, Fu J, Xu Y, Wang G. Antithyroid Drug Therapy for Graves' Disease and Implications for Recurrence. Int J Endocrinol 2017;2017:3813540.
Sjölin G, Holmberg M, Törring O, Byström K, Khamisi S, de Laval D, et al. The Long-Term Outcome of Treatment for Graves' Hyperthyroidism. Thyroid 2019;29(11):1545–57.
Iqbal MA, Naseem Z, Qureshy A, Shahid A, Roohi N. Prevalence and manifestations of thyroidal dysfunction in central Punjab Pakistan (A Case Study). Sci Int 2016;28(4):3959–63.
Attaullah S, Haq BS, Muska M. Thyroid dysfunction in Khyber Pakhtunkhwa, Pakistan. Pak J Med Sci 2016;32(1):111–5.
Messina M, Milani P, Gentile L, Monaco A, Brossa C, Porta M, et al. Initial treatment of thyrotoxic Graves' disease with methimazole: A randomized trial comparing different dosages. J Endocrinol Invest 1987;10(3):291–5.
Nakamura H, Noh JY, Itoh K, Fukata S, Miyauchi A, Hamada N. Comparison of methimazole and propylthiouracil in patients with hyperthyroidism caused by Graves’ disease. J Clin Endocrinol Metab 2007;92(6):2157–62.
Kahaly GJ, Bartalena L, Hegedüs L, Leenhardt L, Poppe K, Pearce SH. 2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism. Eur Thyroid J 2018;7(4):167–86.
Benker G, Reinwein D, Creutzig H, Hirche H, Alexander WD, McCruden D, et al. Effects of high and low doses of methimazole in patients with Graves' thyrotoxicosis. Acta Endocrinol Suppl (Copenh) 1987;281:312–7.
Mashio Y, Beniko M, Ikota A, Mizumoto H, Kunita H. Treatment of hyperthyroidism with a small single daily dose of methimazole. Acta Endocrinol (Copenh) 1988;119(1):139–44.
MacFarlane IA, Davies D, Longson D, Shalet SM, Beardwell CG. Single daily dose short term carbimazole therapy for hyperthyroid Graves’ disease. Clin Endocrinol (Oxf) 1983;18(6):557–61.
Sriussadaporn S, Pumchumpol W, Lertwattanarak R, Kunavisarut T. Efficacy of Once Daily versus Divided Daily Administration of Low Daily Dosage (15 mg/Day) of Methimazole in the Induction of Euthyroidism in Graves’ Hyperthyroidism: A Randomized Controlled Study. Int J Endocrinol 2017;2017:2619695.
Mafauzy M, Wan Mohamad WB, Zahary MK, Mustafa BE. Comparison of the efficacy of single and multiple regimens of carbimazole in the treatment of thyrotoxicosis. Med J Malaysia 1993;48(1):71–5.
Gupta SK, Mithal A, Godbole MM. Single daily dose of carbimazole in the treatment of hyperthyroidism. Natl Med J India 1992;5(5):214–6.
Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag 2008;4(1):269–86.
Ehret MJ, Wang M. How to increase medication adherence: What works? Ment Health Clin 2014;2(8):230–2.
Siddiqui MF, Hasnain S, Batool Z, Qazi MH, Imtiaz M, Fatima I, et al. Clinical effectiveness of Carbimazole and Propylthiouracil for Hyperthyroidism in Patients of Punjab, Pakistan. Adv Life Sci 2014;2(1):10–5
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
