The commonest cause of Thyrotoxicosis is Graves disease , which is an autoimmune disease caused by thyroid stimulating immunoglobulins (TSI). Treatment for Graves disease include Anti-thyroid drugs, Thyroidectomy and Radio-iodine . There is lack of general agreement as to which therapy is the best , as none is ideal. The goal of treatment in Graves disease is early and durable achievement of euthyroid status with out side effects. The Radio-iodine therapy has been commonly used for the treatment of Graves disease and has been considered as effective and safe. It can be given to all patients more than 5 years age. Pregnancy and significant Orbitopathy are the only contraindications. The main side effect of Radio-iodine is the high incidence of Hypothyroidism in the treated patients. It is difficult to accept the concept ,that for treating one disease, you are justified to induce another disease . This led many Physicians to try other modes of treatment like, prolonged anti-Thyroid drugs.
In the Indian subcontinent may Physicians and Endocrinologists are having experience with long term anti-Thyroid drugs. Many of the cases are at the request of the patients who are reluctant to undertake, Radio-iodine therapy or undergo surgery. One of the earlier studies of long term continuous methimazole treatment in comparison with radio-iodine, published in European Journal of Endocrinology in2005, showed the long term continuous treatment of hyperthyroidism with Methimazole is safe, and effacacious. Recently in a study done in South India by Kannan et al, regarding the long term use of antithyroid drugs for Graves disease concluded that long term ATD use is safe for long periods, 4 to 17 years. With doses of carbimazole 5-10 mg per day, more than 80% of patients remain in euthyroid stage.
In my personal series of 124 patients on long term antithyoid drugs for more than 10 years , 90% are in euthyroid state with a dose of 5-10mg (mean 8 mg) daily. Their quality of life is very good and they and their biochemical parameters are with in normal range. In will be presented in detail during the presentation.
It may be concluded that Long term anti-Thyroid drug is an acceptable alternative to radio-iodine therapy for Graves disease.