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THYROTOXIC SYMPTOMS ARE RELIEVED BY DILTIAZEM

Clinical Bottom Line:

Diltiazem 60mg qid is probably as effective as propranolol 40mg qid in acutely controlling the hyperadrenergic symptoms of thyrotoxicosis; it should be used when b-blockers are contraindicated.

Appraiser: HN Lee, H Gerstein; April 18th 1993

The Evidence: [1] One small double-blind, randomized crossover trial. Six patients received one drug for 7 days, followed by a washout period of 3 days and then the other drug. There were no losses to followup although 1 patient was non-compliant with diltiazem. Analysis was by intention-to-treat.

Outcomes:

Clinical Scale (8 items, max 40)	Symptom Score (self-reported 18 items, out of 54)
Grading: 0 to max +5	Grading: Improved + 1 to +3	Worsening -1 to -3
Lid lag	sense of well-being	anxiety
Lid retraction	palpitations	hyperactivity
Tremor	chest pains	diaphoresis
Hyperkinesis	insomnia	fatigue
Warm hands	dyspnea	heat intolerance
Moist hands	bowel frequency	dizziness
Palmar erythema	hyperphagia	weight loss
Hyperreflexia	skin texture	dizziness
	polyuria	muscle weakness

Outcome	Baseline	Diltiazem score p value	Propranolol score p value	DILT vs PROP
Subjective response score	0.0	13.7 <.10	14.5 <.01	NS
Clinical Sign Index	13.5	9.8 <.10	7.0 <.01	NS

Comments:

1. There were no significant differences between treatment groups for EKG, hemodynamic or thyroid hormone levels.

2. Because of its small size and the compliance problem, the diltiazem result was borderline and they may have missed differences between groups.

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REFERENCES:
[1] Milner MR, Gelman KM, Philips RA et al. Double-Blind Crossover Trial vs Propranolol in the Management of Thyrotoxic Symptoms. Pharmocotherapy 1990;10(2):100-106.

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