Document Detail

Hypothyroidism during antithyroid drug treatment with methimazole is a favorable prognostic indicator in patients with Graves' disease.
MedLine Citation:
PMID:  20629556     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: A major problem with antithyroid drug (ATD) therapy in Graves' disease is the high relapse rate. Therefore, clinicians have sought prognostic indicators of permanent remission. Suppression of serum thyrotropin (TSH) when ATD therapy is stopped carries a poor prognosis, but little is known regarding the significance of elevated serum TSH concentrations in the course of ATD therapy. The objective of this study was to determine if elevated serum TSH concentrations during methimazole (MMI) therapy is associated with a favorable long-term prognosis.
METHODS: We retrospectively studied patients with Graves' disease who were initially on MMI, in whom this drug was stopped because they had undetectable thyroid-stimulating antibodies (TSAbs) or were euthyroid after at least 24 months on MMI treatment. A strategy of high MMI doses plus T4 was not used in these patients. We identified 40 patients with elevated serum TSH concentration (>10 microIU/mL) during MMI therapy (H-TSH group). Eighty-five percent of the H-TSH group had negative tests for TSAb. The H-TSH group was sex- and age-matched with 37 patients who had similar selection criteria, but did not have elevated serum TSH concentration during MMI therapy (N-TSH group). The H-TSH and N-TSH groups were similar in gross thyroid size, percentage of patients with exophthalmos, serum free thyroxine, duration of MMI treatment, TSAb status, duration that their TSAb tests remained negative, and thyroid peroxidase antibody titers. The patients were followed for 24 months after stopping MMI.
RESULTS: In the H-TSH group, MMI-associated hypothyroidism typically occurred after 7-8 months of treatment with daily doses of 10-15 mg MMI. No patient had severe symptoms of hypothyroidism. The percentage of patients in remission at 6, 12, and 24 months after discontinuation of MMI was 90.0, 87.5, and 85.0, respectively, in the H-TSH group and 70.3, 67.6, and 54.1, respectively, in the N-TSH group (p  <  0.05 for the comparison of groups at 6 and 12 months and p  <  0.001 for comparison of the groups at 24 months).
CONCLUSIONS: In patients with Graves' disease who are treated with MMI for at least 2 years and become euthyroid, the occurrence of elevated serum TSH concentrations during MMI treatment is a favorable indicator for long-term remission and is independent of multiple other factors including TSAb status, duration of MMI treatment, and gross parameters of goiter size.
Young Kwang Choo; Won Sang Yoo; Dong Woo Kim; Hyun-Kyung Chung
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  20     ISSN:  1557-9077     ISO Abbreviation:  Thyroid     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-09     Completed Date:  2011-01-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  United States    
Other Details:
Languages:  eng     Pagination:  949-54     Citation Subset:  IM    
Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Dankook University, Cheonan, Korea.
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MeSH Terms
Antithyroid Agents / therapeutic use*
Autoantibodies / blood
Exophthalmos / drug therapy
Goiter / drug therapy
Graves Disease / blood,  drug therapy*
Hypothyroidism / chemically induced*
Immunoglobulins, Thyroid-Stimulating / blood
Methimazole / therapeutic use*
Middle Aged
Retrospective Studies
Thyrotropin / blood
Thyroxine / blood
Reg. No./Substance:
0/Antithyroid Agents; 0/Autoantibodies; 0/Immunoglobulins, Thyroid-Stimulating; 0/thyroid microsomal antibodies; 60-56-0/Methimazole; 7488-70-2/Thyroxine; 9002-71-5/Thyrotropin
Comment In:
Thyroid. 2010 Sep;20(9):943-6   [PMID:  20825296 ]

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