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Cited by 88Thyroid Disorders and TreatmentsOphthalmology and Eye DisordersThyroid and Parathyroid Surgery

Long-term follow-up of patients with hyperthyroidism due to Graves’ disease treated with methimazole. Comparison of usual treatment schedule with drug discontinuation vs continuous treatment with low methimazole doses: A retrospective study

Mazza, E., Carlini, M., Flecchia, D., Blatto, A., Zuccarini, O., Gamba, S., Beninati, S., Messina, M.·2008·Journal of Endocrinological Investigation
DOI 10.1007/bf03346433
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Abstract

Antithyroid drugs may be proposed as the firstline therapy for hyperthyroidism due to Graves' disease since some patients undergo prolonged remission after drug withdrawal. On the other hand, some studies, though controversial, indicated that methimazole (MMI) has some immunomodulating activity. We retrospectively analyzed 384 consecutive patients newly diagnosed with Graves' disease in the years 1990-2002 to ascertain whether long-term therapy with low doses of MMI may prevent relapse of thyrotoxicosis. Two hundred and forty-nine patients were included in our study. The date of reduction of MMI dose to 5 mg/day was considered time 0 for survival analysis. In 121 MMI was discontinued in less than 15 months after time 0 (group D), while in the remaining 128 a daily MMI 2.5-5 mg dose was maintained (group M). One hundred and thirty-five patients were excluded for inadequate response to MMI, relapse of thyrotoxicosis that could be related to an improper withdrawal or reduction of MMI, inadequate or too short followup, iodide contamination, steroid or interferon therapy, pregnancy or post-partum. D and M groups did not differ for clinical and hormonal parameters except age, which was lower in D (p=0.019). Age > vs < 35 yr was relevant in survival analysis; therefore patients were divided in 2 groups according to this age cut-off. In younger patients relapse of thyrotoxicosis occurred in 15 patients of group D 2.4-39.6 months (median 19.0) after time 0, and 8 M after 5.9-40.0 (21.3) months, while 14 D and 5 M maintained euthyroidism until the end of the observation after 31.8-95.3 (56.6) months and 30.4-62.1 (46.5) months, respectively. Survival analysis indicated that the risk of relapse was similar in group D and M. In older patients relapse of thyrotoxicosis occurred in 40 patients of group D after 8.2-65.8 (25.4) months and 29 M after 5.8-62.5 (22.4) months, while 52 D and 86 M maintained euthyroidism until the end of the observation, 20.1-168.0 (46.7) months and 24.1-117.4 (53.4) months respectively. Survival analysis indicated that the risk of relapse was increased in group D. Therefore long-term treatment with low doses of MMI seems to prevent relapse in Graves' disease in patients above 35 yr of age. This should be confirmed in a prospective study.

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Crossref · 10.1007/bf03346433

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Authors
Mazza, E., Carlini, M., Flecchia, D., Blatto, A., Zuccarini, O., Gamba, S., Beninati, S., & Messina, M.
Affiliations
Ospedale Maria Vittoria (IT)
Corresponding author
Mazza, E.
ORCID
Mazza, E.
Venue
Journal of Endocrinological Investigation
Publisher
Springer Science and Business Media LLC
Published
2008-10
Volume
31
Issue
10
Pages
866-872
ISSN
  • 0391-4097 (ISSN-L)
  • 1720-8386
DOI
10.1007/bf03346433
OpenAlex
W2024735968
Cited by
88
References
42
Citations by year
2026: 2 · 2025: 6 · 2024: 9 · 2023: 2 · 2022: 7 · 2021: 8 · 2020: 7 · 2019: 8 · 2018: 5 · 2017: 6 · 2016: 4 · 2015: 5 · 2014: 2 · 2013: 6 · 2012: 2
FWCI
2.16
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of Endocrinological Investigation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords
Graves' disease, hyperthyroidism, methimazole, antithyroid drug withdrawal, long-term follow-up, age as risk factor, remission, immunomodulation, TSH receptor antibodies
MeSH terms
Adult, Aged, Aged, 80 and over, Drug Administration Schedule, Female, Graves Disease, Humans, Hyperthyroidism, Male, Methimazole, Middle Aged, Recurrence, Retrospective Studies, Substance Withdrawal Syndrome, Antithyroid Agents, Thyrotropin, Treatment Outcome, Immunoglobulins, Thyroid-Stimulating, Kaplan-Meier Estimate

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