The longer the antithyroid drug is used, the lower the relapse rate in Graves' disease: a retrospective multicenter cohort study in Korea

[helvella]

Many have reported here that they have received an antithyroid medicine for a long period (whether carbimazole or propylthiouracil).

However, long-term use of an anti-thyroid medicine is frequently denied. There is often considerable pressure to choose RAI or thyroidectomy. Of course, if the patient has problems with the anti-thyroid medicine (which does happen) then that is understandable. If not, the rationale is less obvious.

Endocrine . 2021 Apr 15.

doi: 10.1007/s12020-021-02725-x. Online ahead of print.

The longer the antithyroid drug is used, the lower the relapse rate in Graves' disease: a retrospective multicenter cohort study in Korea

So Young Park # 1 2 , Bo Hyun Kim # 3 , Mijin Kim 3 , A Ram Hong 4 , Jun Park 1 , Hyunju Park 1 , Min Sun Choi 1 , Tae Hyuk Kim 1 , Sun Wook Kim 1 , Ho-Cheol Kang 5 , Jae Hoon Chung 6

• PMID: 33860431

• DOI: 10.1007/s12020-021-02725-x

Abstract

Purpose:

Current literature suggests 12-18 months of antithyroid drug (ATD) treatment for patients with Graves' disease, but the risk of relapse is high. Although some studies reported better outcomes of long-term ATD treatment, recent data that suggest the optimal treatment duration are limited.

Methods:

We performed a multicenter retrospective cohort study of 908 patients newly diagnosed with Graves' disease between 2006 and 2013. The relapse rate according to ATD treatment duration was analyzed.

Results:

After initial ATD treatment, 338 patients (37.2%) had relapsed. The relapse rate according to ATD treatment duration was 42.4% at 1 year, 38.5% at 2 years, 33.8% at 3 years, 31.7% at 4 years, 30.2% at 5 years, 27.8% at 6 years, and 19.1% at more than 6 years, respectively, demonstrating a significant decreasing trend (p = 0.003). In a multivariable Cox regression analysis, ATD treatment duration was an independent risk factor for relapse (p = 0.043).

Conclusions:

The longer that ATD therapy is used, the lower the relapse rate is in patients with Graves' disease. Long-term ATD treatment may be considered in Graves' patients who do not show complications or an economic burden from hyperthyroidism.

Keywords:

Antithyroid agents; Grave’s disease; Hyperthyroidism; Recurrence; Treatment outcome.

pubmed.ncbi.nlm.nih.gov/338...

[linda96]

Thank you Helvella. NICE NG145 state for obvious cost reasons that RAI is first choice of medicine in Graves/Hyperthyroidism. I’m so pleased that this paper shows that if you prescribe ATD for longer term than NG145 states and remission is achieved for many, the cost benefit of RAI can be eclipsed by comprehensively better patient safety benefit compared with invasive and damaging pill or surgery.

[tattybogle]

Nice Find ... Not that i've got any experience of either ATD's or galloping Hyperthyroidism but i think if i could function on it safely, i'd take 6 yrs on a low dose of carbimazole over a life sentence without any thyroid.

[helvella Administrator Thyroid UK in reply to tattybogle]

Most especially as there are glimmers of possible other treatments on the horizon.

Don't want to get into the prediction business, or over-egging, but we can hope.