Low doses of cholestyramine in the treatment of hyperthyroidism
The enterohepatic circulation of thyroid hormones is increased in thyrotoxicosis. Bile-salt sequestrants bind thyroid hormones in the intestine and thereby increase their fecal excretion. Based on these observations, the use of cholestyramine has been tried. The present study evaluates the effect of low doses of cholestyramine as an adjunctive therapy in the management of hyperthyroidism. In a prospective, randomized, double-blind, placebo-controlled trial, 45 patients with newly diagnosed hyperthyroid Graves’ disease were randomly assigned into the following treatment protocols: group I, cholestyramine 2 g BID, methimazole and propranolol; group II, cholestyramine 1 g BID, methimazole and propranolol; group III, placebo powder, methimazole and propranolol. The fixed dose of methimazole (30 mg/d) and propranolol (40 mg/d) was used. The study period was 4 weeks. Serum total triiodothyronine and free thyroxin were measured at baseline, and at the ends of the second and the fourth week of the study. The serum thyroid hormone levels decreased more rapidly and to a greater extent in the cholestyramine-treated groups. All of the patients in group I had achieved euthyroid state at the end of the study. We conclude that low dose of cholestyramine is an effective and well-tolerated adjunctive agent in the treatment of hyperthyroid Graves’ disease. (ClinicalTrials.gov number, NCT00677469)
KeywordsHyperthyroidism Graves disease Treatment outcome Cholestyramine Anion exchange resins
We wish to thank the patients who participated in this study. We are grateful to Mr. M. Monjazeb and Mr. M. Moaiedifar (personnel of the Endocrine and Metabolism Research Center, Namazi Hospital) for their kind technical assistance. We thank the statistician Dr. Tabesh in the Center of Clinical Research Development at the Namazi Hospital. This study was supported by a grant from Shiraz University of Medical Sciences (Grant No. 2590).
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