BRT- From our Archives

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On BRT <Block and Replace Therapy> from Kathyrn in Japan.

A World of Differences

There have been some recent posts about trying, or wanting to try BRT, block

and replacement therapy. When I joined this group a year ago and said I

lived in Japan I remember several people responding with posts on how

successful Japanese doctors have been with BRT and asking me for more

information on this subject should I come across it here. Since then I have

seen the Japanese BRT remission rate quoted a number of times and Simon has

provided information on papers from other countries throwing doubt on the

high success rate quoted by the Japanese doctors. Then this past weekend

Zoey posted on her visit with her new endo and gave an excellent summary of

his comments on a lot of GD issues including BRT. This has prompted me to

write because I think what Zoey's endo said needs to be reinforced and

emphasized as perhaps he has hit on the differences between the reported

high Japanese remission rate and the lack of great success using BRT

elsewhere.

I stress that I am not on BRT, I have been on atds (Mercazole) for a year

now starting out at 45mg a day and am now down to 5mgs every two days with

another drop in dosage coming soon, I hope. My doctor is in general medicine

but he has consulted with an endo specializing in thyroid on several

occasions regarding my dosages. I took advantage of one of these specialist

consultations to ask about BRT and its usage in Japan.

I was told the following:

ATD's are always the preferred treatment where possible. Carefully monitored

BRT is not widely used at all because it is SO difficult to persevere with.

It is only considered as a treatment option if for some reason the GD

patient is not responding to a normal course of atds. The decision to put a

patient on BRT is not taken lightly. It is a long and complicated treatment

and requires a lot of commitment from both patient and doctor as Zoey's endo

mentioned. It requires patience and dedication to a regime of pill taking

that virtually takes over your life. It has to be monitored very carefully

and the timing of the daily meds intake has to be adhered to like clockwork.

The doctor has to decide if the patient has the ability to follow the regime

precisely every day for 3-5 years!! For this reason endos here are very

selective about who they put on BRT. When they do they are reasonably

confident the patient will stay the course and I think this perhaps explains

the

success rate they have had.

When I read here in this group of the much more " casual " approach to BRT

elsewhere, where the doctor decides to add a bit of thyroxin or similar to

the daily med intake for a few months to see what happens, I realise that

there is a considerable difference in BRT as it is practiced here and BRT as

it is offered elsewhere. Could this be the reason that the remission rate

using BRT elsewhere has not equalled the success in Japan?

By the way, if Japanese doctors think the patient cannot sustain this regime

then surgery is the alternative. RAI is rarely used and never on a women of

childbearing age.

<Note: Kathyrn's explanation on BRT is the same as 's who lives in Spain.

The true block and replace for remission is a committment and does take 3-5

years from start to finish. What they do in the US is NOT BRT, but they are

leaving patients on ATD's longer, and adding a bit of T4 replacement hormone so

a patient does not have to feel hypOT symptoms..