Discussion
leucopoenia, fatigue, fever, hepatotoxicity, rash, Graves’ hyperthyroidism, infection, Nausea, renal damage, arthralgia
RECURRENCE, SIDE EFFECT, INFECTION, REMISSION, HYPOTHYROIDISM
Although ATDs, surgical thyroidectomy, and RAI therapy are the traditional methods widely used for the treatment of GD, they have lifelong impacts on patients. ATDs are associated with side effects and a high rate of GD recurrence, while RAI ablation and thyroidectomy can result in permanent hypothyroidism. In recent years, new agents such as biologics, small-molecule peptides, and immunomodulators have emerged as potential treatments for GD. However, these new treatments also have their own limitations (Our study introduces a promising therapeutic approach for the management of GD by adding AZA as an adjuvant to ATDs treatment. We found that this approach led to significantly higher rates of remission compared with conventional treatment alone. Additionally, the relapse rate in patients who received AZA as an adjuvant therapy was lower than that of the control group, although this difference was not statistically significant. Additionally, adjuvant AZA therapy is associated with a reduction in the total cost of treatment compared with conventional therapy alone.AZA has been used for the treatment of GO for a long time. Recent studies have investigated the mechanisms of AZA and found that it can induce apoptosis of CD4+ T lymphocytes by modulating the activation of Rac1 (Ras-related C3 botulinum toxins substrate 1) (Our study found that patients with GD who received AZA in combination with ATDs had significantly lower levels of TRAb compared with those who only received ATDs (87.5, 87.5, and 33.4%), respectively. The remission rate after ATDs was only 33.4% which is lower what was reported in literature. The rate of remission of Graves’ hyperthyroidism after a course of ATDs is less than 50% in clinical trials (This finding suggests that the use of AZA may contribute to higher remission rates, as TRAb is considered to be the most important predictor of remission in GD. The study conducted by Cappelli et al. (A review by Barbesino and colleagues (Despite the achieved remission with AZA, the reduction of thyroid gland volume was not statistically significant. In the same vein, Benker et al. (Despite being an effective adjuvant therapy for GD, AZA can cause side effects in some patients. Nausea is the most common side effect, followed by fever, fatigue, arthralgia, leucopoenia, rash, infection, hepatotoxicity, and renal damage, which can affect 15–28% of patients (