Horm Metab Res 2024; 56(10): 712-717
DOI: 10.1055/a-2281-0911
Original Article: Endocrine Care

Lipid Profile Evolution in Graves’ Disease Treated with Titration Regimen of Anti-Thyroid Drugs Versus Block and Replace Regimen

1   Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2   Endocrinology IV, “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
,
Oana Pop
1   Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,
Mariana Purice
3   Research Department, “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
,
Corin Badiu
1   Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2   Endocrinology IV, “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
› Institutsangaben
Funding Information European Social Fund Plus — http://dx.doi.org/10.13039/501100004895; POCU/993/6/13/154722

Abstract

The aim was to compare the lipid profile of patients with GD treated with anti-thyroid drugs (ATDs) using a titration regimen versus a block and replace regimen. This is an 18-month prospective observational study. In this study were included 149 medically treated GD patients, aged+>+18 years. Pregnant women and patients treated with radioactive iodine therapy or partial/total thyroidectomy were excluded. Patients were divided into 2 subgroups: titration (A) and block and replace (B) therapy, according to the ATD regimen used. Thyroid and metabolic profile was measured at baseline and at least one visit during medical treatment. The whole group included 122 (81.87%) females (F) and 27 (18.12%) males (M), ratio F:M=4.5:1. As expected, at the time of diagnosis, thyrotoxic patients were with normal lipid profile. During medical treatment, in patients who achieved euthyroidism, the cholesterol levels increased as follows: in subgroup A: by 52.9 mg/dl (95% CI: 26.4–79.3), p<0.001 for total cholesterol (T-C), by 33.3 mg/dl (95% CI: 10.3–56.3), p=0.007 for low-density lipoprotein cholesterol (LDL-C) and by 11.44 mg/dl (95% CI: 3.08–19.79), p=0.009 for high-density lipoprotein cholesterol (HDL-C); in subgroup B T-C increased by 45.1 mg/dl (95% CI: 22.2–68), p<0.001 and for LDL-C by 33.57 mg/dl (95% CI: 12.72–54.42), p=0.003. No statistically significant increase in triglyceride levels was determined. Medical treatment of hyperthyroidism due to Graves’ disease increased cholesterol levels regardless of the ATD regimen used.



Publikationsverlauf

Eingereicht: 04. Dezember 2023

Angenommen nach Revision: 27. Februar 2024

Artikel online veröffentlicht:
02. April 2024

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  • References

  • 1 Ross DS, Burch HB, Cooper DS. et al. 2016 American thyroid association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016; 26: 1343-1421
  • 2 Bartalena L. Diagnosis and management of Graves disease: a global overview. Nat Rev Endocrinol 2013; 9: 724-734
  • 3 Sharma M, Modi A, Goyal M. et al. Anti-thyroid antibodies and the gonadotrophins profile (LH/FSH) in euthyroid polycystic ovarian syndrome women. Acta Endocrinol (Buchar) 2022; 18: 79-85
  • 4 Genc GC, Celik SK, Arpaci D. et al. Granulysin peptide and gene polymorphism in the pathogenesis of Hashimoto thyroiditis. Acta Endocrinol (Buchar) 2022; 18: 288-293
  • 5 Chen Y, Wu X, Wu R. et al. Changes in profile of lipids and adipokines in patients with newly diagnosed hypothyroidism and hyperthyroidism. Sci Rep 2016; 6: 1-7
  • 6 Abrams JJ, Grundy SM. Cholesterol metabolism in hypothyroidism and hyperthyroidism in man. J Lipid Res 1981; 22: 323-338
  • 7 Senese R, Cioffi F, Petito G. et al. Thyroid hormone metabolites and analogues. Endocrine 2019; 66: 105-114
  • 8 Senese R, Lasala P, Leanza C. et al. New avenues for regulation of lipid metabolism by thyroid hormones and analogs. Front Physiol 2014; 5: 1-7
  • 9 Bartalena L. Hyperthyroidism due to Graves’ disease – is there an optimal pharmacological treatment regimen?. Eur Endocrinol 2008; 4: 63-65
  • 10 Hashizume K, Ichikawa K, Sakurai A. et al. Administration of thyroxine in treated Graves’ disease – effects on the level of 464 antibodies to thyroid stimulating hormone receptors and on the risk of recurrence of hyperthyroidism. N Engl J Med 1991; 324: 947-953
  • 11 Masiello E, Veronesi G, Gallo D. et al. Antithyroid drug treatment for Graves’ disease: baseline predictive models of relapse after treatment for a patient-tailored management. J Endocrinol Invest 2018; 41: 1425-1432
  • 12 Abraham P, Avenell A, Park CM. et al. A systematic review of drug therapy for Graves’ hyperthyroidism. Eur J Endocrinol 2005; 153: 489-498
  • 13 Vaidya B, Wright A, Shuttleworth J. et al. Block & replace regime versus titration regime of antithyroid drugs for the treatment of Graves’ disease: A retrospective observational study. Clin Endocrinol (Oxf) 2014; 81: 610-613
  • 14 Duntas LH. Block-and-replace vs. titration antithyroid drug regimen for Graves’ hyperthyroidism: two is not always better than one. J Endocrinol Invest 2021; 44: 1337-1339
  • 15 Duntas LH, Brenta G. The effect of thyroid disorders on lipid levels and metabolism. Med Clin North Am 2012; 96: 269-281
  • 16 Kotwal A, Cortes T, Genere N. et al. Treatment of thyroid dysfunction and serum lipids: a systematic review and meta-analysis. J Clin Endocrinol Metab 2020; 105: 3683-3694
  • 17 Sauter G, Weiss M, Hoermann R. Cholesterol 7 alpha-hydroxylase activity in hypothyroidism and 481 hyperthyroidism in humans. Horm Metab Res 1997; 29: 176-179
  • 18 O’Brien T, Katz K, Hodge D. et al. The effect of the treatment of hypothyroidism and hyperthyroidism on plasma lipids and apolipoproteins AI, AII and E. Clin Endocrinol (Oxf) 1997; 46: 17-20
  • 19 Vrca VB, Mayer L, Škreb F. et al. Antioxidant supplementation and serum lipids in patients with Graves’ disease: Effect on LDL-cholesterol. Acta Pharm 2012; 62: 115-122
  • 20 Razvi S, Vaidya B, Perros P. et al. What is the evidence behind the evidence-base? The premature death of block-replace antithyroid drug regimens for Graves’ disease. Eur J Endocrinol 2006; 154: 783-786
  • 21 Boelaert K, Edward Visser W, Taylor PN. et al. Endocrinology in the time of COVID-19: management of hyperthyroidism and hypothyroidism. Eur J Endocrinol 2020; 183: G33-G39
  • 22 Francis N, Francis T, Lazarus JH. et al. Current controversies in the management of Graves’ hyperthyroidism. Expert Rev Endocrinol Metab 2020; 15: 159-169
  • 23 Struja T, Fehlberg H, Kutz A. et al. Can we predict relapse in Graves’ disease? Results from a systematic review and meta-analysis. Eur J Endocrinol 2017; 176: 87-97
  • 24 Subekti I, Pramono LA. Current diagnosis and management of Graves’ disease. Acta Med Indones 2018; 50: 177-182
  • 25 Struja T, Kaeslin M, Boesiger F. et al. External validation of the GREAT score to predict relapse risk in Graves’ disease: results from a multicenter, retrospective study with 741 patients. Eur J Endocrinol 2017; 176: 413-419
  • 26 Effraimidis G. Predictive scores in autoimmune thyroid disease: are they useful?. Eur J Endocrinol 2019; 181: R119-R131
  • 27 Jiang X, Hu H, Fu Z. et al. Association between the ctla-4 exon 1+49a/G polymorphism and the relapse of Grave’s disease after Atd withdrawal: a meta-analysis. Acta Endocrinol 2022; 18: 324-332
  • 28 Bartalena L, Burch HB, Burman KD. et al. A 2013 European survey of clinical practice patterns in the management of Graves’ disease. Clin Endocrinol (Oxf) 2016; 84: 115-120
  • 29 Sabini E, Mazzi B, Profilo MA. et al. High serum cholesterol is a novel risk factor for Graves’ orbitopathy: results of a cross-sectional study. Thyroid 2018; 28: 386-394
  • 30 Lanzolla G, Sabini E, Profilo MA. et al. Relationship between serum cholesterol and Graves’ orbitopathy (GO): a confirmatory study. J Endocrinol Invest 2018; 41: 1417-1423
  • 31 Lanzolla G, Vannucchi G, Ionni I. et al. Cholesterol serum levels and use of statins in Graves’ orbitopathy: a new starting point for the therapy. Front Endocrinol (Lausanne) 2020; 10: 1-8