Remission of Graves’ disease is not related to early restoration of euthyroidism with high-dose methimazole therapy
Abstract
UNLABELLED: Introduction and aims: The most recent hypothesis postulated that early restoration of euthyroid state in patients with Graves' disease changes the course of the disease and leads to better disease control. Therefore, we analyzed the efficacy of methimazole therapy and the course of disease in patients with restored euthyroidism and in patients with active disease on first control visit. PATIENTS AND METHODS: We included 63 patients with total T4 level >190 nmol/L or T3 >7 nmol/L and diffuse goiter with no previous episodes of hyperthyroidism. All patients received initially high doses of methimazole (60-80 mg) followed by a rapid dose reduction. RESULTS: Ten percent of patients were excluded from the study due to side effects. Two different groups emerged after 5 weeks of treatment with same dose of methimazole: group 1 with active disease (48%) and group 2 with restored euthyroidism. Further controls on 12th, 24th and 68th weeks of treatment showed no difference in remission rates, number of iatrogenic hypothyroid episodes, and number of exacerbations between the two groups, regardless of methimazole dose. There was no association between age, gender, thyroid hormone levels, and remission and exacerbation rates. CONCLUSIONS: Initially, higher methimazole doses with rapid progressive decrease to maintenance dose result in similar remission rates and are followed by similar incidence of adverse side-effect as fixed low dose therapy. Our results indicate that neither an early restoration of euthyroidism nor the difference in methimazole doses influence the course of Graves' disease.
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Higher initial doses of MMI (60-80 mg/d) do not improve remission rates and increase the risk of side effects.
“Higher initial doses of MMI (60-80 mg/d) do not improve remission rates; they increase the risk of side effects and are not recommended (170).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [170]
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Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938 · see citing works
“Higher initial doses of MMI (60–80 mg/d) do not improve remission rates; they increase the risk of side effects and are not recommended (170).”
Background
- Authors
- Kruljac, I., Solter, D., Vrkljan, A. M., & Solter, M.
- Affiliations
- University of Zagreb (HR)
- University Hospital Centre Zagreb (HR)
- Corresponding author
- Kruljac, Ivan
- ORCID
- Kruljac, Ivan
- Venue
- Endocrine Research
- Publisher
- Informa UK Limited
- Published
- 2014-05-15
- Volume
- 40
- Issue
- 1
- Pages
- 25-28
- ISSN
- 0743-5800 (ISSN-L)
- 1532-4206
- OpenAlex
- W1992647607
- Cited by
- 9
- References
- 10
- Citations by year
- 2026: 1 · 2024: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 2 · 2016: 1
- FWCI
- 0.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Research (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, methimazole, remission, disease exacerbation, iatrogenic hypothyroidism, diffuse goiter
- MeSH terms
- Adolescent, Adult, Aged, Drug Administration Schedule, Female, Graves Disease, Humans, Male, Methimazole, Middle Aged, Remission Induction, Antithyroid Agents, Thyroxine, Triiodothyronine, Treatment Outcome, Young Adult
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