Document Type: Review Paper
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
The thionamide drugs, i.e. carbimazole and its metabolite methimazole (MMI), and
propylthiouracil (PTU) have extensively been used in the management of various forms of
hyperthyroidism over the past eight decades. This review aims to summarize different aspects
of these outstanding medications. Thionamides have shown their own acceptable efficacy and
even safety profiles in treatment of hyperthyroidism, especially GD in both children and adults
and also during pregnancy and lactation. Of the antithyroid drugs (ATDs) available, MMI is
the preferred choice in most situations taking into account its better efficacy and less adverse
effects accompanied by once-daily dose prescription because of a long half-life and similar cost.
Considering the more severe teratogenic effects of MMI, PTU would be the selected ATD for
treatment of hyperthyroidism during pre-pregnancy months and the first 16 weeks of gestation.
Recent studies have confirmed the efficacy and safety of long-term MMI therapy with low
maintenance doses for GD and toxic multinodular goiter. Despite the long-term history of ATD
use, there is still ongoing debate regarding their pharmacology and diverse mechanisms of action,
viz. their immunomodulatory effects, and mechanisms and susceptibility factors to their adverse