A short review of current knowledge regarding long-term treatment of Graves' disease with antithyroid drugs

Abstract

Graves' disease is the most common form of hyperthyroidism, especially in younger people. Current European guidelines recommend antithyroid drugs as initial treatment for a period limited to 12-18 months. Definitive treatment such as surgery or radioactive iodine is proposed in the case of contraindication to antithyroid drugs or in the case of recurrence after medical treatment. However, more recent studies show that long-term antithyroid treatment is associated with reduced risk of recurrence without an increase in adverse effects. Such data support the option of long-term treatment of Graves' disease with antithyroid drugs and suggest the necessity for a change to long-standing practices in the field. Herein, after reviewing some general knowledge on Graves' disease treatment, we discuss the evidence regarding long-term treatment of Graves' disease with antithyroid drugs for endocrinologists, internists, and other specialists involved in the management of these patients. We consider the main studies in the field, outline their respective strengths and limitations, and, finally, present our opinion on when, in the light of this new evidence, endocrinologists should consider long-term treatment with antithyroid drugs.

Keywords: Antithyroid drugs; Graves’ disease; Hyperthyroidism; Long-term treatment.

Fig. 1

Proposed algorithm for the treatment of hyperthyroidism. *Studies on the long-term use of ATD have only been done in patients with Graves’ disease during their first course of ATD. There are no data so far on the long-term use of ATD after a relapse