Propylthiouracil Levels in Hyperthyroid Patients Unresponsive to Large Doses: Evidence of Poor Patient Compliance
Abstract
Nine patients with hyperthyroidism due to Graves' disease did not respond to therapy with very large doses (800 to 2000 mg/d) of propylthiouracil. In eight patients, studies showed propylthiouracil was absorbed and metabolized normally. Five patients had no detectable propylthiouracil in their serum 2 to 3 hours after supposedly taking their medication at home, and three patients had markedly abnormal results of perchlorate discharge tests after receiving propylthiouracil under supervision. After evaluation, noncompliance was thought to be the reason for treatment failure in six of the nine patients; one patient was possibly resistant. In two patients, data were insufficient, although intermittent noncompliance could not be ruled out. Among patients who respond poorly to propylthiouracil therapy, noncompliance is the most likely reason. In such patients, methimazole should be substituted for continued massive doses of propylthiouracil.
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When ATDs fail to achieve euthyroidism, the usual cause is nonadherence.
“When they fail to achieve euthyroidism, the usual cause is nonadherence (110).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [110]
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References 28 · Cited by 45
- Authors
- COOPER, D. S.
- Affiliations
- Harvard University (US)
- Corresponding author
- COOPER, DAVID S.
- ORCID
- COOPER, DAVID S.
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1985-03-01
- Volume
- 102
- Issue
- 3
- Pages
- 328-331
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2019423685
- Cited by
- 45
- References
- 28
- Citations by year
- 2026: 1 · 2025: 1 · 2022: 1 · 2021: 1 · 2019: 2 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 1 · 2013: 1 · 2012: 1
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- propylthiouracil, hyperthyroidism, Graves' disease, medication non-adherence, drug resistance, serum drug concentration, perchlorate discharge test, methimazole, antithyroid drug therapy
- MeSH terms
- Adolescent, Adult, Drug Resistance, Female, Graves Disease, Humans, Hyperthyroidism, Iodides, Male, Middle Aged, Patient Compliance, Perchlorates, Pregnancy, Propylthiouracil, Thyroxine, Sodium Compounds
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