ArticleJournal of endocrinological investigation2020
"Block-and-replace" treatment in Graves' disease: experience in a cohort of pediatric patients.
Article in Journal of endocrinological investigation, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- 2022 European Thyroid Association Guideline for the management of pediatric Graves' disease.European thyroid journal · 2022Guideline
- Effect of Addition of Thyroxine in the Treatment of Graves' Disease: A Systematic Review.Frontiers in endocrinology · 2020Pooled it
- The Free T3/Free T4 Ratio Predicts Relapse After Antithyroid Drug Withdrawal in Pediatric Autoimmune Hyperthyroidism.The Journal of clinical endocrinology and metabolism · 2026Article
- Pediatric Graves' Disease: Surgical Interventions in a Single Institution - A Comprehensive Case Series.Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India · 2024Article
- Updates in the Management of Graves Disease in Children.Ewha medical journal · 2023Review
- Preoperative preparation for Graves' disease.Frontiers in endocrinology · 2023Review
- Initial response of young people with thyrotoxicosis to block and replace or dose titration thionamide.European thyroid journal · 2022Article
- Hyperthyroidism in adolescents.Endocrine connections · 2021Review
- How to use thionamide anti-thyroid drug in the young- what's new?Thyroid research · 2021Review
- Prediction model for thyrotoxic atrial fibrillation: a retrospective study.BMC endocrine disorders · 2021Article
- Block-and-replace vs. titration antithyroid drug regimen for Graves' hyperthyroidism: two is not always better than one.Journal of endocrinological investigation · 2021Article
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe "block-and-replace" (BR) method involves the use of a high dose of antithyroid drugs (ATD) with levothyroxine (L-T4). Its use in the management of Graves' disease (GD) is still debated mainly because the frequency of side effects of ATD is dose dependent. We retrospectively studied the effect of medium dose of ATD with L-T4 versus monotherapy with ATD in pediatric patients with unstable GD.
methods28 pediatric patients with GD with unstable response to ATD were treated with L-T4 and medium dose of ATD. We compared the rate of euthyroidism, hypothyroidism and hyperthyroidism episodes observed during treatment with methimazole alone with those observed during the BR approach. We evaluated the occurrence of side effects and the rate of remission in patients treated with ATD + L-T4 therapy and the efficacy of combination therapy to postpone a definitive treatment (radioiodine and thyroidectomy).
resultsPatients showed a better control of thyroid function during the BR therapy, presenting fewer episodes of hyperthyroidism and hypothyroidism. No serious side effects during the BR approach were observed. Only one patient went into remission with the ATD + L-T4 therapy. Fifteen patients required a definitive therapy (4 radioiodine, 11 thyroidectomy). The use of BR method has delayed radioiodine treatment for 4.9 years and surgery for 2.9 years.
conclusionsThe BR method does not increase the remission rates. It may be useful to combine L-T4 with a medium dose of methimazole when GD is difficult to manage with methimazole alone. It may represent a therapeutic option to postpone definitive treatments to a suitable age.
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