1. In this multi-centre cohort study, there were no significant differences in mortality or adverse effects between methimazole and propylthiouracil in the management of thyroid storm.
Evidence Rating Level: 2 (Good)
Thyroid storm is a medical emergency characterized by severe thyrotoxicosis that results in potentially fatal acute end-organ damage and is therefore associated with a high mortality rate of 8-25%. Management of thyroid storm includes thioamides (propylthiouracil, methimazole, or carbimazole), but there is global variation in the recommendations for first-line thioamide therapy. The Premier Healthcare Database was used to identify and evaluate a cohort of 1383 patients admitted to US intensive or intermediate care units with a diagnosis of thyroid storm between January 2016 to December 2020, to compare the efficacy of propylthiouracil and methimazole as treatments. The primary composite outcome of in-hospital death or hospice discharge occurred in 8.5% (95% CI, 6.4%-10.7%) of patients in the propylthiouracil group and 7.4% (95% CI, 4.6%-8.1%) of patients in the methimazole group. This difference was not statistically significant according to the adjusted risk difference of 0.6% (95% CI, −1.8% to 3.0%, P = .64). Similarly, no differences were found in the outcomes of in-hospital mortality alone, hospice discharge alone, duration of organ support, or total hospitalization costs. There was a small decrease in thioamide-specific costs when using methimazole compared to propylthiouracil (adjusted mean difference, $72 [95% CI, $48 to $97]; P < .001). Despite this, these results suggest that propylthiouracil and methimazole can be used interchangeably in the management of thyroid storm.
Click to read the study in JAMA Network Open
Image: PD
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