Homsanit M, Sriussadaporn S, Vannasaeng S, Peerapatdit T, Nitiyanant W, Vichayanrat A
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Clin Endocrinol (Oxf). 2001 Mar;54(3):385-90. doi: 10.1046/j.1365-2265.2001.01239.x.
Previous studies of the treatment of hyperthyroidism with a single daily dose of antithyroid drugs have demonstrated a favourable result with methimazole (MMI). However, the efficacy of a single daily dose of propylthiouracil (PTU) was inconsistent. The present prospective randomized study was conducted to compare the efficacy of a single daily dose of MMI and PTU in the induction of euthyroidism in patients with Graves' disease.
Seventy-one patients with newly diagnosed Graves' disease were studied.
Patients were randomized to two groups to receive once daily dose of either 15 mg MMI or 150 mg PTU for 12 weeks. The therapeutic efficacy was determined biochemically by serum total T3, total T4 and TSH levels at baseline and at 4, 8 and 12 weeks during the study period.
There was no significant difference in baseline characteristics. Serum total T3 levels of the MMI group were significantly lower than those of the PTU group after four weeks of the treatment (3.54 +/- 0.72 vs. 5.49 +/- 2.74 nmol/l, P < 0.05) through the end of the study (2.22 +/- 1.42 vs. 4.30 +/- 1.78 nmol/l, P < 0.05). The changes in serum total T4 levels occurred in the same direction as serum total T3 levels but a significant difference was observed only after eight weeks of the treatment (MMI vs. PTU; 101.67 +/- 54.05 vs. 176.32 +/- 66.92 nmol/l, P < 0.05). At the end of the study, more patients in the MMI group had both serum total T3 and T4 levels less than the upper limit of the normal range compared to the PTU group (77.1% vs. 19.4%). Hypothyroidism was observed in 31.4% of the patients in the MMI group but not in the PTU group.
During 12-weeks' treatment of Graves' hyperthyroidism, a single daily dose of 15 mg of MMI was much more effective in the induction of euthyroidism than a single daily dose of 150 mg of PTU. Once daily regimen of MMI not only decreased serum T3 and T4 levels more rapidly but also induced euthyroidism four times more effectively than did the once daily regimen of PTU. In the doses used in this study, MMI is preferable to PTU when a once-daily regimen of antithyroid drug is considered for the treatment of hyperthyroidism.
既往关于每日单次剂量抗甲状腺药物治疗甲状腺功能亢进症的研究表明，甲巯咪唑（MMI）疗效良好。然而，每日单次剂量丙硫氧嘧啶（PTU）的疗效并不一致。本前瞻性随机研究旨在比较每日单次剂量的MMI和PTU诱导格雷夫斯病患者甲状腺功能正常的疗效。
对71例新诊断的格雷夫斯病患者进行了研究。
将患者随机分为两组，分别接受每日一次剂量的15mg MMI或150mg PTU，疗程为12周。通过研究期间基线及第4、8和12周时血清总T3、总T4和促甲状腺激素（TSH）水平进行生化测定来确定治疗效果。
两组患者的基线特征无显著差异。治疗4周后直至研究结束，MMI组的血清总T3水平显著低于PTU组（3.54±0.72 vs. 5.49±2.74nmol/L，P<0.05）（研究结束时为2.22±1.42 vs. 4.30±1.78nmol/L，P<0.05）。血清总T4水平的变化与血清总T3水平变化趋势相同，但仅在治疗8周后观察到显著差异（MMI组 vs. PTU组；101.67±54.05 vs. 176.32±66.92nmol/L，P<0.05）。研究结束时，与PTU组相比，MMI组更多患者的血清总T3和总T4水平均低于正常范围上限（77.1% vs. 19.4%）。MMI组31.4%的患者出现甲状腺功能减退，而PTU组未出现。
在格雷夫斯病甲状腺功能亢进症12周的治疗期间，每日单次剂量15mg的MMI在诱导甲状腺功能正常方面比每日单次剂量150mg的PTU有效得多。MMI每日一次给药方案不仅能更快降低血清T3和T4水平，而且诱导甲状腺功能正常的效果比PTU每日一次给药方案高4倍。在本研究使用的剂量下，当考虑采用每日一次抗甲状腺药物给药方案治疗甲状腺功能亢进症时，MMI比PTU更可取。
