Lasting Remissions in Patients Treated for Graves’ Hyperthyroidism With Propranolol Alone: A Pattern of Spontaneous Evolution of the Disease*
Abstract
Twenty-six patients with Graves' hyperthyroidism treated only with propranolol for 1-21 months have been followed up to 5 years. The patients were evaluated before treatment, at 15, 30, and 90 days during treatment, and then at 90-day intervals during propranolol treatment by clinical examination and measurement of serum free T3, free T4, rT3, TSH, and sex hormone-binding globulin concentrations and serum anti-thyroglobulin, antithyroid microsomal, antithyroid peroxidase, and thyroid-stimulating autoantibodies. Eighteen patients who had no biochemical improvement during propranolol therapy or relapsed after initial improvement were treated conventionally. In contrast, eight patients had a biochemical remission, which has lasted 30-48 months after propranolol withdrawal. The biochemical values before and during treatment did not differ among the two groups of patients, except for the initial serum free T3 levels which were significantly higher in the patients who had no remission. Serum TSH levels returned to normal only in patients who had a long-lasting remission. While thyroid autoantibodies decreased or disappeared during follow-up, the evolution of thyroid-stimulating autoantibody values was grossly related to the clinical outcome. Long-lasting remissions may occur in patients with hyperthyroidism due to Graves' disease not given ablative or antithyroid drug therapy. Since propranolol is devoid of antithyroid and immunosuppressive actions, these remissions are probably spontaneous. Although they tended to occur in patients with less severe disease, no biological parameter was found that predicted the outcome.
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Remission of mild Graves' disease has been reported in up to 30% of patients without treatment.
“remission of mild GD has been reported in up to 30% of patients without treatment (15).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [15]
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Management of the Various Causes of Thyrotoxicosis
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Radioiodine therapy for hyperthyroidism
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Marek, Z., Ejzak, S., Wiktorowska, J., Lesisz, M., Palitsyna, K., Szabelski, M., & Rymuza, J. (2026) · Pediatria i Medycyna Rodzinna · doi:10.15557/pimr.2025.0032
- Authors
- CODACCIONI, J. L., ORGIAZZI, J., BLANC, P., PUGEAT, M., ROULIER, R., & CARAYON, P.
- Affiliations
- Inserm (FR)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1988-10
- Volume
- 67
- Issue
- 4
- Pages
- 656-662
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2078598631
- Cited by
- 76
- References
- 36
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 6 · 2020: 3 · 2019: 7 · 2018: 3 · 2017: 4 · 2016: 4 · 2015: 2 · 2014: 3 · 2013: 2
- FWCI
- 0.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (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' hyperthyroidism, propranolol, spontaneous regression, biochemical remission, thyroid-stimulating antibodies, thyroid autoantibodies, thyroid-stimulating hormone, free T3, free thyroxine, thyroid peroxidase antibodies, thyroglobulin antibodies, clinical course
- MeSH terms
- Adult, Autoantibodies, Female, Follow-Up Studies, Graves Disease, Humans, Male, Middle Aged, Propranolol, Remission Induction, Sex Hormone-Binding Globulin, Thyroid Hormones, Thyrotropin
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