Short-Term Effects of β-adrenergic Antagonists and Methimazole in New-Onset Thyrotoxicosis Caused by Graves' Disease

Tetsuya Tagami; Yuko Yambe; Tsuyoshi Tanaka; Takashi Tanaka; Atsushi Ogo; Hideyuki Yoshizumi; Kazuo Kaise; Kiichiro Higashi; Makito Tanabe; Satoko Shimazu; Takeshi Usui; Akira Shimatsu; Mitsuhide Naruse; for the BBGD Study Group

doi:10.2169/internalmedicine.51.7302

ORIGINAL ARTICLES

Short-Term Effects of β-adrenergic Antagonists and Methimazole in New-Onset Thyrotoxicosis Caused by Graves' Disease

Tetsuya Tagami, Yuko Yambe, Tsuyoshi Tanaka, Takashi Tanaka, Atsushi Ogo, Hideyuki Yoshizumi, Kazuo Kaise, Kiichiro Higashi, Makito Tanabe, Satoko Shimazu, Takeshi Usui, Akira Shimatsu, Mitsuhide Naruse, for the BBGD Study Group

Author information

Tetsuya Tagami
Clinical Research Institute, Division of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
Yuko Yambe
Department of Endocrinology and Metabolism, National Hospital Organization Nagoya Medical Center, Japan
Tsuyoshi Tanaka
Department of Internal Medicine, National Hospital Organization Mie Chuou Medical Center, Japan
Takashi Tanaka
Department of Internal Medicine, National Hospital Organization Mie Chuou Medical Center, Japan
Atsushi Ogo
Department of Metabolism and Endocrinology, National Hospital Organization Kyushu Medical Center, Japan
Hideyuki Yoshizumi
Department of Metabolism and Endocrinology, National Hospital Organization Kyushu Medical Center, Japan
Kazuo Kaise
Department of General Medicine, National Hospital Organization Sendai Medical Center, Japan
Kiichiro Higashi
Department of Diabetes and Endocrinology, National Hospital Organization Kumamoto Medical Center, Japan
Makito Tanabe
Division of Internal Medicine, National Hospital Organization Kokura Medical Center, Japan
Satoko Shimazu
Clinical Research Institute, Division of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
Takeshi Usui
Clinical Research Institute, Division of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
Akira Shimatsu
Clinical Research Institute, Division of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
Mitsuhide Naruse
Clinical Research Institute, Division of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan
for the BBGD Study Group

Keywords: Graves' disease, β-blocker, quality of life, anti-thyroid drug

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 17 Pages 2285-2290

DOI https://doi.org/10.2169/internalmedicine.51.7302

Details

Abstract

Objective β-adrenergic antagonists (β-blockers) are often used to attenuate the hyperadrenergic symptoms of Graves' disease (GD), including palpitation. Although β-blockers reduce the heart rate, cardiac output and oxygen consumption, no firm evidence exists regarding the effects of combined therapy with β-blockers and anti-thyroid drugs. The objective is to elucidate the effects of β-blockers on anti-thyroid drug therapy in GD.
Methods Patients newly diagnosed with mild GD were randomly assigned to receive methimazole with or without β-blockers in a prospective multi-center survey. The heart rate and thyroid function were measured and the quality of life was assessed using original and SF-36 questionnaires at 0 and 4 weeks.
Results A total of 28 patients were enrolled in the study. Fourteen patients (one man, 13 women) were randomly assigned to the group treated with β-blockers and 14 patients (one man, 13 women) were randomly assigned to the group not treated with β-blockers. Although no significant differences in the improvement of thyroid function were observed between the two groups, the heart rates improved more significantly in the group treated with β-blockers. Specific symptoms, such as easy fatigability and shortness of breath, also improved more significantly with the β-blocker treatment. In addition, 'physical functioning' assessed with the SF-36 questionnaires significantly improved only in the group treated with β-blockers.
Conclusion Although β-blockers may not reinforce the effects of anti-thyroid drugs on thyroid function, at least during the course of one month, they are effective in reducing heart rates and ameliorating specific symptoms in patients with mild GD.

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