There are two regimens to treat hyperthyroidism with drugs. Give thyroid blockers alone in doses that may or may not control thyroxine levels in a given patient (standard) or Give maximum dose of thyroid blockers and replace thyroxine(block and replace).
We don’t routinely use block and replace regimen, since, there is no evidence to suggest that it increases remission rate. However, there are other metrics we may care about, apart from long term remission rates.
Quality of life
Therapeutic certainty that there won’t be hypothyroidism or hyperthyroidism
Speed of attainment of euthyroidism
The best way to identify this is to do a randomized controlled trial. However, since we are testing QOL and due to differences in perception between individuals, we may get noisy data.
I can think of two options.
? Use mixed effects regression
Use a cross over design
Are there any better ways to approach this problem, if we care about things other than remission rate?