Antithyroid Treatment as Effective as RAI for Graves Relapse and better for TED

Low-dose antithyroid drug therapy for Graves' disease relapse is as effective as radioiodine (RAI) treatment in preventing further relapse, with Graves' ophthalmopathy showing even greater improvement with the drug therapy, according to a new study published in the journal Thyroid.

"Our findings demonstrated that for patients who relapse from the conventional use of antithyroid drugs after 12 to 18 months and do not desire a definitive treatment with RAI or surgery, the use of a prolonged low methimazole [MMI] dose is a feasible option," lead author Danilo Villagelin, MD, of the School of Medicine at Pontifical University Catholic of Campinas, Campinas, Brazil, told Medscape Medical News.

While antithyroid drug therapy is well-established as a treatment option for hyperthyroidism due to Graves' disease, research shows remission rates can range from 30% to as high as 70%, prompting some doctors to recommend RAI treatment or thyroid surgery as more definitive resolutions.

The latter approaches have their own undesirable effects, however, including the need for lifetime thyroid-hormone replacement and increased risk of hypothyroidism.


16 Replies

  • Clutter that's good news for many people some of whom are forced into RAI etc.

  • Shaws, and hopefully for people like my sister who was badly advised to have RAI to prevent TED worsening.

  • And it's the patients who have to live with the consequences.

  • I had many relapse over the 30 odd years I had Graves, anti thyroid meds were not working, I had to have surgery in my teens because it was badly affecting my heart, then RAI in my 40s because I was sick of messing around with the constant dose changes. I don't regret either for one second.

  • Bantam12, RAI was the right decision for you then. My sister's only regret is the RAI she was told would improve her eyes has made it worse. Thyroidectomy would have been a better option with respect to TED.

  • I possibly had very mild Ted before the RAI so was given several months of steroids to prevent any problems, thankfully it worked.

    One of my sisters had severe ted, she was hypo (never had graves)

    and her eyes although much better never fully recovered.

  • Bantam, I don't know whether sis had steroids, I assume she would have, but cosmetically eyes are worse and she needs lubricating drops.

    She's so determined not to feel hyper she keeps herself a little undermedicated with TSH >2.0.

  • hi clutter , my lady has found that when she is out/visiting/shopping or wherever it is too difficult to use drops , but , she now uses an advertised brand of spray [ p.m. me if you want ] she just sprays it onto the outside of her eyelids.....blinks ---- and this seems to be a short term fix for the ' eye-dryness/ soreness ' until she can use the drops ....... maybe it could be of help ......alan xx

  • Alan, the dryness isn't so bad that she needs rehydrating constantly. Thanks anyway.

  • but , it does seem to help when not at home though

  • Thanks for that Clutter - very interesting :)

  • I had RAI 21 year ago, I was lead to believe it would be the answer, it isn't! 😐

  • Sorry to hear that, Suin.

  • Aw that's life, live and learn.

    Great to be so much better informed, with WWW, but

    more so, yourselves on healthunlocked ✋🏼💞

  • like bantam12 I also had to have RAI as after many years on medication my thyroid medication was no longer working for my Graves disease. Rai was strongly recommended because of the strain on my heart and due to being post menopausal the additional risk of brittle bones.

  • Mothsballs, the article may be of more interest to patients who felt well on anti-thyroid drugs or B&R and are pushed towards RAI when remission fails.

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