title: A second course of antithyroid drug therapy for recurrent Graves' disease: an experience in endocrine practice.
abstract: OBJECTIVE
  There are scarce reports regarding the prognosis of a second course of antithyroid drug (ATD) therapy on recurrent Graves' disease (GD). The aim of this study was to assess the long-term remission rate after a second ATD therapy and verify significant clinical predictors of a remission.
  
  
  METHODS
  A prospective randomized clinical trial with long-term follow-up was conducted to evaluate the effects of a second course of ATD therapy.
  
  
  METHODS
  A total of 128 recurrent GD patients who had finished a first regular ATD therapy were enrolled in this study, and prescribed methimazole (MMI) treatment with titration regimen. The patients were randomly assigned to two groups when the drug doses were reduced to 2.5 mg daily (qd). Group 1 was discontinued with 2.5 mg qd after about 5 months. Group 2 was continuously reduced to 2.5 mg every other day (qod) after 5 months and then discontinued with 2.5 mg qod after about a further 5 months. The patients were followed for 48 months after drug withdrawal.
  
  
  RESULTS
  Of the total number of patients, 97 cases (75.78%) achieved permanent remission at the end of follow-up, with the recurrence of 31 cases (24.22%). The remission rate of group 2 (84.62%) was significantly higher than that of group 1 (66.67%) (P=0.024). Cox regression showed that the hazard ratio for recurrence decreased under a high or high normal TSH level at drug withdrawal.
  
  
  CONCLUSIONS
  A second course of ATD therapy can bring about a satisfying long-term remission on recurrent GD. The drug dose of 2.5 mg qod and a high or high normal TSH level at drug withdrawal may increase the likelihood of permanent remission.
authors.affiliation: Department of EndocrinologyFirst Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi 710061, China.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of EndocrinologyFirst Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi 710061, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Qiang
authors.affiliation: Department of EndocrinologyFirst Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi 710061, China.
authors.forename: Xingjun
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of EndocrinologyFirst Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi 710061, China.
authors.forename: Lianye
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of EndocrinologyFirst Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi 710061, China.
authors.forename: Shu
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of EndocrinologyFirst Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi 710061, China.
authors.forename: Aibo
authors.initials: A
authors.lastname: Gao
authors.affiliation: Department of EndocrinologyFirst Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi 710061, China.
authors.forename: Shan
authors.initials: S
authors.lastname: Gao
authors.affiliation: Department of EndocrinologyFirst Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi 710061, China shibingy@126.com.
authors.forename: Bingyin
authors.initials: B
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D013956:Antithyroid Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006111:Graves Disease / Q000188:drug therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D013956:Antithyroid Agents