Toward Ultimate Care for Graves' Hyperthyroidism

Efficacy of low-dose methimazole in control of multiple relapses of Graves' hyperthyroidism: a case report

INTRODUCTION

Methimazole (MMI) is the treatment of choice for patients with Graves' disease. The major drawback of this treatment is the relapse of hyperthyroidism in half of the patients after discontinuation of the recommended conventional 12-18 months of MMI treatment. TSH receptor antibody (TRAb) concentration is recognized as the strongest predictor of hyperthyroidism relapse. In this case report, efficacy of low-dose MMI to control hyperthyroidism even after multiple recurrences in the setting of normal TRAb concentrations is shown.

CASE PRESENTATION

An 80-year-old Iranian woman with Graves' disease was treated with MMI for 31 years. While receiving treatment, she always had a normal serum TRAb concentration; however, three times during the 31 years she decided to stop MMI therapy, and each time the disease recurred 16-21 months after MMI withdrawal. It is noteworthy that she maintained euthyroidism with the low-dose 1.25-2.5 mg MMI daily without any adverse events during three decades of treatment.

CONCLUSIONS

Normal serum TRAb is not a sufficiently strong marker to predict relapse of Graves' hyperthyroidism. Long-term therapy with low-dose MMI is an effective and safe treatment to sustain euthyroidism.

Effect of Aqueous Extract of F. capensis Leaves and Its Combination with C. aconitifolius Leaves on Essential Biochemical Parameters of Phenylhydrazine-Induced Anemic Rats

BACKGROUND

Ficus capensis Moraceae and Cnidoscolus aconitifolius Euphorbiaceae leaves have been used separately in traditional medical practice to treat different ailments, of which anemia is one. This study aims to evaluate the effect of F. capensis and C. aconitifolius on hepatic, renal parameters and oxidative stress of phenylhydrazine-induced anemic rats.

METHODS

Thirty-five rats were randomized into seven groups (A-G) of five rats each. Groups A and B served as the normal control and anemic control, respectively, while Groups C, D, E, F, and G were treated with a standard drug (vitamin B12), 200mg/kg bw. aqueous extract of F. capensis, 400mg/kg b.w. aqueous extract of F. capensis, 200mg/kg bw. of a combination of aqueous extract of F. capensis and C. aconitifolius and 400mg/kg bw. of a combination of aqueous extract of F. capensis and C. aconitifolius, respectively. The biochemical analysis (liver and kidney function analysis, oxidative stress) was carried out using standard diagnostic techniques.

RESULTS

The results showed that there was significant decrease (p<0.05) in the values obtained for Aspartate Transaminase (AST), alanine Transaminase (ALT), Alkaline Phosphatase (ALP), total bilirubin, urea, creatinine, potassium ion, Total Cholesterol (TCHOL), Low-density Lipoprotein (LDL-C), Triglycerides (TRIG), Very Low-density Lipoprotein (VLDL-C) and Malondialdehyde (MDA) and a significant increase (p<0.05) in obtained values for High-density Lipoprotein (HDL) in all the extract-treated groups compared with the anemic-untreated. The values obtained for most of these biochemical parameters in the extract-treated groups were in the range of the normal control showing that the extract did not, in any way, alter the biochemical parameters. There was a significant increase (p<0.05) in the glutathione peroxidase (Glut. Perox.) enzyme activity of the groups treated with the aqueous extract of F. capensis and its combination with C. aconitifolius compared with the anemic-untreated.

CONCLUSION

These results suggest that the aqueous extracts of F. capensis and C. aconitifolius leaves may promote liver function parameters, maintain normal serum electrolyte level and kidney function indices, stimulate reduction of "bad cholesterols" and increase "good cholesterol" and reduce oxidative stress.