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Oxford Textbook of Endocrinology and Diabetes$
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Oxford Textbook of Endocrinology and Diabetes (2 ed.)

Edited by John A.H. Wass, Paul M. Stewart, Stephanie A. Amiel, Melanie C. Davies

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Publisher:
Oxford University Press
Print Publication Date:
Jul 2011
Print ISBN-13:
9780199235292
Published to Oxford Medicine:
Jul 2011
DOI:
10.1093/med/9780199235292.001.1

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Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Antithyroid drug treatment for thyrotoxicosis

Chapter:
Antithyroid drug treatment for thyrotoxicosis
Author(s):

Anthony Toft

DOI:
10.1093/med/9780199235292.003.3189

The most effective and commonly used antithyroid drugs are the thionamides, including carbimazole and its active metabolite methimazole (not available in the UK). These act by inhibiting the synthesis of thyroid hormones, principally by interfering with the iodination of tyrosine by serving as preferential substrates for the iodinating intermediate of thyroid peroxidase. Oxidized iodine is thus diverted from potential iodination sites in thyroglobulin. The iodinated antithyroid drugs are desulfurated and further oxidized to inactive metabolites. There is also some evidence for an immunosuppressive action which is of doubtful clinical significance as most patients relapse after drug withdrawal. Another thionamide, propylthiouracil, is, in addition, a potent inhibitor of type 1 outer ring deiodinase and acutely inhibits thyroxine (T4) to triiodothyronine (T3) conversion, but there is no good evidence to suggest that this effect is of any clinical relevance. Propylthiouracil tends to be reserved for those patients who have developed an adverse reaction to carbimazole or methimazole.

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