ESPE2021 ePoster Category 2 Thyroid (46 abstracts)
Initial response to thionamide medication in young people with newly diagnosed thyrotoxicosis
Claire Wood 1,2 , Niamh Morrison 1 , Michael Cole 3 , Malcolm Donaldson 4 , David Dunger 5,6 , Ruth Wood 7 , Simon Pearce 2,8 & Tim Cheetham 1,2
1Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; 2Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; 3Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; 4University of Glasgow School of Medicine, Glasgow, United Kingdom; 5Department of Paediatrics, Cambridge, United Kingdom; 6Wellcome Trust-MRC Institute of Metabolic Sciences, University of Cambridge, Cambridge, United Kingdom; 7Newcastle Clinical Trials Unit, Newcastle University, Newcastle, United Kingdom; 8Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
Methods: Patients commenced 0.75mg/kg carbimazole (CBZ) daily with randomisation to either BR or DT. We examined baseline patient characteristics, CBZ dose, time to serum TSH/FT4 normalisation and BMI Z-score.
Results: There were data available from 80 patients (baseline) and 78 patients (61 female) at 6 months. Mean CBZ dose was 0.9 mg/kg/day (BR) and 0.5 mg/kg/day (DT). There was no difference in the time taken for patients to achieve non-suppressed TSH concentrations; 16 of 39 patients (BR) and 11 of 39 (DT) still had suppressed TSH concentrations at 6 months. Patients with a suppressed TSH had higher mean baseline FT4 levels (72.7 v 51.7 pmol/l; 95% CI for difference 1.73, 31.7, p value for difference=0.029). Time to normalise FT4 levels was shorter in the DT group (log rank test, P=0.049) with 50% attaining a normal FT4 at 28 days in DT (95% CI 25, 32) versus 35 days in BR (95% CI 28, 58). Mean BMI Z-score increased from 0.10 to 0.81 at 6 months (P<0.001), 95% CI for difference 0.57, 0.86 and was greatest in patients with higher baseline FT4 concentrations. 13 patients gained over 10 kg in weight during the first 6 months.
Conclusions: DT-treated patients normalised FT4 concentrations more quickly than BR. This difference may reflect a number of factors including the simplicity of the DT regimen (one medication rather than two) with associated improved compliance. 94% of patients have normal FT4 levels after six months but 33% still have TSH suppression. The risk of excessive weight gain should be discussed in detail with families when ATD is commenced.
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