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Thionamides in the treatment of Graves' disease

Douglas S Ross, MD
Section Editor
David S Cooper, MD
Deputy Editor
Jean E Mulder, MD


The thionamides, methimazole, carbimazole, and propylthiouracil (PTU), are effective treatment of patients with Graves' hyperthyroidism. They are actively transported into the thyroid gland where they inhibit both the organification of iodine to tyrosine residues in thyroglobulin and the coupling of iodotyrosines (figure 1) [1]. (See "Pharmacology and toxicity of thionamides".)

The clinical use and efficacy of the thionamides in the treatment of Graves' hyperthyroidism will be reviewed here; the pharmacology and toxicity of these drugs, as well as other treatment options for Graves' hyperthyroidism, are reviewed separately. (See "Pharmacology and toxicity of thionamides" and "Graves' hyperthyroidism in nonpregnant adults: Overview of treatment".)


Thionamides are often started in patients with Graves' hyperthyroidism to attain a euthyroid state rapidly in preparation for radioiodine therapy or thyroidectomy. However, patients who want to avoid or defer ablative therapy with radioiodine or surgery can continue the thionamide for prolonged periods. (See "Graves' hyperthyroidism in nonpregnant adults: Overview of treatment", section on 'Choice of therapy'.)

Although hyperthyroidism can almost always be controlled as long as the drug is taken, overall, only approximately 20 to 30 percent of patients achieve a permanent remission. This estimate includes patients with severe disease in whom remissions are unlikely, as well as patients with mild disease in whom remission rates may be as high as 75 percent. (See 'Rate of prolonged remission' below.)

Patients treated with thionamides take three to eight weeks to become euthyroid because they block new hormone synthesis, and any already formed thyroxine (T4) and triiodothyronine (T3) stored in the colloid must be secreted and metabolized for clinical improvement to occur.

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Literature review current through: Nov 2017. | This topic last updated: Nov 30, 2016.
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