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Journal of Pediatric Endocrinology and Metabolism

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Comparison of methimazole and propylthiouracil in the management of children and adolescents with Graves’ disease: efficacy and adverse reactions during initial treatment and long-term outcome

1 / Masanori Minagawa2 / Nozomu Sasaki3 / Shigetaka Sugihara4 / Itsuro Kazukawa5 / Kanshi Minamitani6 / Kunio Wataki7 / Susumu Konda8 / Hiroaki Inomata9 / Kazunori Sanayama10 / Yoichi Kohno2

1Sunrise Children’s Clinic, Funabashi, Japan

2Department of Pediatrics, Chiba University School of Medicine, Chiba, Japan

3Kawagoe Clinic, Saitama Medical University School of Medicine, Kawagoe, Japan

4Department of Pediatrics, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan

5Division of Endocrinology, Chiba Children’s Hospital, Chiba, Japan

6Department of Pediatrics, Teikyo University Chiba Medical Center, Ichihara, Japan

7Department of Pediatrics, Matsudo Municipal Hospital, Matsudo, Japan

8Konda Children’s Clinic, Chiba, Japan

9 Inomata Children’s Clinic, Funabashi, Japan

10Department of Pediatrics, Narita Red Cross Hospital, Narita, Japan

Corresponding author: Hirokazu Sato, Sunrise Children’s Clinic, Nakayama Medical Square 1F, 4-22-10 Motonakayama, Funabashi, Chiba 273-0035, Japan Phone: +81 47 3338222, Fax: +81 47 3332733

Citation Information: Journal of Pediatric Endocrinology and Metabolism. Volume 24, Issue 5-6, Pages 257–263, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: 10.1515/jpem.2011.194, June 2011


Objective: The aim of this study was to compare the efficacy and adverse reactions during initial treatment and long-term outcome between children and adolescents with Graves’ disease (GD) treated with propylthiouracil (PTU) and those treated with methimazole (MMI).

Design, setting and participants: Retrospective and collaborative study. Children and adolescents with GD were divided into group M (MMI: n=64) and group P (PTU: n=69) and into four subgroups by initial dose: group M1 (<0.75 mg/kg of MMI, n=34), group M2 (≥0.75 mg/kg, n=30), group P1 (<7.5 mg/kg of PTU, n=24) and group P2 (≥7.5 mg/kg, n=45).

Main outcome measures: The duration for normalization of serum T4 on initial treatment, the incidence of adverse effects for one year and outcomes at 10 years after were compared.

Results: Mean durations for normalization of T4 (±SD) were 1.7±1.0 months in group M and 2.3±2.4 in group P [not significant (NS)], while the mean duration in group P1 (3.1±3.3) was significantly longer than those in the other subgroups (M1: 1.9±1.2; M2: 1.4±0.7; P2; 1.7±1.3). No major adverse reaction was observed. Minor adverse effects occurred in 25.0% of cases in group M and 31.9% in group P (NS). The incidence in group P2 (44.4%) was significantly higher than those in group M1 (20.6%) and group P1 (8.3%). Remission rates did not differ between the MMI-treated group (35.0%, n=20) and PTU-treated group (50.0%, n=40).

Conclusions: PTU may not be suitable for initial use in children and adolescents with GD, even with the risk of major adverse reactions such as liver failure excluded.

Keywords: adolescence; anti-thyroid drugs; children; Graves’ disease; methimazole; propylthiouracil

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  • I need this journal for my academic presentation, how can i get this, please? thanks

    posted by: andi wedi on 2012-06-20 06:20 PM (Europe/Berlin)

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