Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 May;84(2):577-588.
doi: 10.1007/s12020-023-03656-5. Epub 2024 Jan 2.

Risk of recurrence at the time of withdrawal of short- or long-term methimazole therapy in patients with Graves' hyperthyroidism: a randomized trial and a risk-scoring model

Fereidoun Azizi  1 , Atieh Amouzegar  2 , Davood Khalili  3 , Hengameh Abdi  2 , Maryam Tohidi  3 , Mehdi Hedayati  4 , Leila Cheraghi  5 , Yadollah Mehrabi  6 , Miralireza Takyar  2
Affiliations
Randomized Controlled Trial

Risk of recurrence at the time of withdrawal of short- or long-term methimazole therapy in patients with Graves' hyperthyroidism: a randomized trial and a risk-scoring model

Fereidoun Azizi et al. Endocrine. 2024 May.

Abstract

Purpose: In Graves' disease, administration of low-dose methimazole for more than 60 months induces higher remission rates compared with the conventional duration of 12-18 months. However, the risk of recurrence and its predictors beyond 48 months of drug withdrawal are not known. The aims of this study were to determine the risk of recurrence during 84 months after withdrawal of short- or long-term methimazole therapy and a risk stratification for recurrence of hyperthyroidism.

Methods: A total of 258 patients were treated with methimazole for a median of 18 months and randomized to discontinuation of the drug(conventional short-term group; n = 128) or continuation of the treatment up to 60-120 months(long-term group; n = 130). Patients were followed for 84 months after methimazole withdrawal. Cox proportional hazards modeling was performed to identify factors associated with relapse and develop a risk-scoring model at the time of discontinuing the treatment.

Results: Hyperthyroidism recurred in 67 of 120(56%) of conventionally-treated patients versus 20 of 118(17%) of those who received long-term methimazole treatment, p < 0.001. Age, sex, goiter grade, triiodothyronine, thyrotropin, and thyrotropin receptor antibodies were significant predictors of recurrence in both "conventional" and "long-term" groups but free thyroxine just in the "long-term" group. The risk-scoring model had a good discrimination power (optimism corrected c-index = 0.78,95%CI = 0.73-0.82) with a range of 0-14 and sensitivity of 86% and specificity of 62% at the risk-score of eight.

Conclusion: A relapse-free state was achieved in 83% of patients with Graves' hyperthyroidism 84 months after cessation of long-term methimazole treatment which could be predicted by some significant predictors in a simple risk-scoring system.

Keywords: Graves’ disease; Methimazole; Predictor; Recurrence.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. J.P. Brito, S. Payne, N. Singh Ospina, R. Rodriguez-Gutierrez, S. Maraka, L.R. Sangaralingham, N.M. Iñiguez-Ariza, V.M. Montori, M.N. Stan, Patterns of use, efficacy, and safety of treatment options for patients with Graves’ disease: a nationwide population-based study. Thyroid 30(3), 357–364 (2020) - DOI - PubMed
    1. C.M. van Kinschot, V.R. Soekhai, E.W. de Bekker-Grob, W.E. Visser, R.P. Peeters, T.M. van Ginhoven, C. van Noord, Preferences of patients and clinicians for treatment of Graves’ disease: a discrete choice experiment. Eur. J. Endocrinol. 184(6), 803–812 (2021) - DOI - PubMed
    1. F. Azizi, R. Malboosbaf, Long-term antithyroid drug treatment: a systematic review and meta-analysis. Thyroid 27(10), 1223–1231 (2017) - DOI - PubMed
    1. F. Azizi, V. Yousefi, A. Bahrainian, F. Sheikholeslami, M. Tohidi, Y. Mehrabi, Long-term continuous methimazole or radioiodine treatment for hyperthyroidism. Arch. Iran. Med. 15(8), 0–0 (2012)
    1. O.M. El Kawkgi, D.S. Ross, M.N. Stan, Comparison of long‐term antithyroid drugs versus radioactive iodine or surgery for Graves’ disease: a review of the literature. Clin. Endocrinol. 95(1), 3–12 (2021) - DOI

Publication types

LinkOut - more resources