PMID- 37519546
OWN - NLM
STAT- Publisher
LR  - 20230801
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 6
DP  - 2023 Jun
TI  - Safety of Antithyroid Drugs in Avoiding Hyperglycemia or Hypoglycemia in Patients 
      With Graves' Disease and Type 2 Diabetes Mellitus: A Literature Review.
PG  - e41017
LID - 10.7759/cureus.41017 [doi]
LID - e41017
AB  - Graves' disease (GD) may increase the difficulty of glucose control in patients 
      with type 2 diabetes mellitus (T2DM). Therefore, selecting a drug with limited 
      blood glucose side effects is an important issue in patients with T2DM and GD. 
      Antithyroid drugs (ATDs) including propylthiouracil (PTU), methimazole, and 
      carbimazole are commonly prescribed for the treatment of GD. Here, we review and 
      summarize the literature from the last 10 years and discuss the effects of 
      current ATDs used for GD for blood glucose control in patients with T2DM. A 
      search of the literature published between January 1, 2012 and December 1, 2022 
      was conducted using three major medical databases: Google Scholar, Ovid Medline, 
      and Scopus. An initial search was conducted on PubMed using the MeSH terms 
      "propylthiouracil," "methimazole," "carbimazole," and "hyperglycemia" or 
      "hypoglycemia" in academic databases. All articles included "Graves' disease" and 
      "type 2 diabetes mellitus" in the title. Based on the results of previous 
      studies, the hyperglycemic and hypoglycemic side effects of ATDs can be explained 
      by several possible mechanisms. The most widely accepted hypothesis is that 
      sulfhydryl group drugs (e.g., methimazole and carbimazole) cleave the disulfide 
      bond of insulin and enhance its immunogenicity, resulting in hypoglycemia. 
      Moreover, some reports have indicated that methimazole is associated with 
      hypoglycemia; therefore, if the patient has a history of autoimmune diseases, it 
      is necessary to consider whether to change drugs or actively track the production 
      of autoimmune antibodies. In non-diabetic and diabetic patients with GD, the 
      hyperglycemic and hypoglycemic side effects of PTU (on glycemic variation) were 
      less than that of thiamazole. However, as relatively few reports have 
      investigated the side effects of blood sugar changes, further research is 
      necessary to confirm these effects. In addition to autoimmune diseases, drug side 
      effects may need to be considered. These findings provide considerations for 
      clinicians to select more appropriate ATDs for patients with GD and T2DM, and 
      implement improved care guidelines.
CI  - Copyright (c) 2023, Hsieh et al.
FAU - Hsieh, Yu-Shan
AU  - Hsieh YS
AD  - School of Nursing, National Taipei University of Nursing and Health Sciences, 
      Taipei City, TWN.
AD  - Department of Research, Taipei Medical University Hospital, Taipei City, TWN.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20230627
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10372709
OTO - NOTNLM
OT  - antithyroid drugs
OT  - blood sugar control
OT  - carbimazole
OT  - glucose stability
OT  - graves' disease
OT  - hyperthyroidism
OT  - methimazole
OT  - propylthiouracil
OT  - thyroid disease
OT  - type 2 diabetes mellitus
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/07/31 06:43
MHDA- 2023/07/31 06:43
PMCR- 2023/06/27
CRDT- 2023/07/31 04:38
PHST- 2023/06/26 00:00 [accepted]
PHST- 2023/07/31 06:43 [medline]
PHST- 2023/07/31 06:43 [pubmed]
PHST- 2023/07/31 04:38 [entrez]
PHST- 2023/06/27 00:00 [pmc-release]
AID - 10.7759/cureus.41017 [doi]
PST - epublish
SO  - Cureus. 2023 Jun 27;15(6):e41017. doi: 10.7759/cureus.41017. eCollection 2023 
      Jun.