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Published Online: 1 April 2017

The Second Antithyroid Drug Treatment Is Effective in Relapsed Graves' Disease Patients: A Median 11-Year Follow-Up Study

Publication: Thyroid
Volume 27, Issue Number 4


Background: Antithyroid drug (ATD) is a widely used treatment for Graves' disease (GD). However, its long-term efficiency remains unclear. This study investigated the long-term disease prognosis and predictive factors for relapse in ATD-treated GD patients.
Methods: Newly diagnosed, ATD-treated GD patients with at least four years of follow-up were recruited (n = 187). Remission was defined as maintaining a euthyroid status for more than one year after ATD withdrawal.
Results: During 11.1 years (range 4.0–23.7 years) of median follow-up, overall, 51.9% of the newly diagnosed ATD-treated GD patients achieved remission, 32.1% continued ATD treatment, and 13.4% underwent other ablation treatments. The 10-year remission rates were higher in the first (34.2%) and second (25.5%) ATD courses than in any of the other subsequent ATD courses, and decreased as ATD treatments were repeated. The 10-year relapse rate was the highest after the third ATD treatment (71.4%) compared with that after the first (60.5%) and second (58.3%) courses. Longer duration of ATD treatment (odds ratio [OR] = 1.4 [confidence interval (CI) 1.2–1.7], p < 0.001), higher number of relapses (OR = 4.7 [CI 2.3–9.8], p < 0.001), and moderate to severe Graves' ophthalmopathy (OR = 4.1 [CI 1.1–15.2], p = 0.032) were associated with persistent disease status.
Conclusions: A second course of ATD can be considered for GD patients after the first relapse because the chance of remission and the relapse rate are similar to the one after the first ATD treatment course. For GD patients with more than two relapses, or with an ATD treatment duration of more than four to five years, low-dose maintenance of ATD or ablative treatment needs to be considered.

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Published In

cover image Thyroid®
Volume 27Issue Number 4April 2017
Pages: 491 - 496
PubMed: 28001121


Published in print: April 2017
Published online: 1 April 2017
Published ahead of print: 24 January 2017
Published ahead of production: 21 December 2016


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Ye An Kim*
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
Sun Wook Cho*
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Hoon Sung Choi
Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
Shinje Moon
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Jae Hoon Moon
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Kyung Won Kim
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
Do Joon Park
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Ka Hee Yi
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
Young Joo Park
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Bo Youn Cho
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.


These authors contributed equally to this work.
Address correspondence to:Young Joo Park, MD, PhDDepartment of Internal MedicineSeoul National University College of Medicine101 Daehak-roJongno-guSeoul 03080KoreaE-mail: [email protected]
Ka Hee Yi, MD, PhDDepartment of Internal MedicineSeoul National University Boramae Medical Center20 Boramae-ro 5-gilDongjak-guSeoul 07061KoreaE-mail: [email protected]

Author Disclosure Statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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