title: The Second Antithyroid Drug Treatment Is Effective in Relapsed Graves' Disease Patients: A Median 11-Year Follow-Up Study.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: 1 Department of Internal Medicine, Seoul National University Hospital , Seoul, Korea.|2 Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center , Seoul, Korea.
authors.forename: Ye An
authors.initials: YA
authors.lastname: Kim
authors.affiliation: 1 Department of Internal Medicine, Seoul National University Hospital , Seoul, Korea.
authors.forename: Sun Wook
authors.initials: SW
authors.lastname: Cho
authors.affiliation: 3 Department of Internal Medicine, Kangwon National University School of Medicine , Chuncheon, Korea.
authors.forename: Hoon Sung
authors.initials: HS
authors.lastname: Choi
authors.affiliation: 1 Department of Internal Medicine, Seoul National University Hospital , Seoul, Korea.
authors.forename: Shinje
authors.initials: S
authors.lastname: Moon
authors.affiliation: 4 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Moon
authors.affiliation: 1 Department of Internal Medicine, Seoul National University Hospital , Seoul, Korea.|2 Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center , Seoul, Korea.
authors.forename: Kyung Won
authors.initials: KW
authors.lastname: Kim
authors.affiliation: 1 Department of Internal Medicine, Seoul National University Hospital , Seoul, Korea.
authors.forename: Do Joon
authors.initials: DJ
authors.lastname: Park
authors.affiliation: 5 Department of Internal Medicine, Seoul National University Boramae Medical Center , Seoul, Korea.
authors.forename: Ka Hee
authors.initials: KH
authors.lastname: Yi
authors.affiliation: 1 Department of Internal Medicine, Seoul National University Hospital , Seoul, Korea.
authors.forename: Young Joo
authors.initials: YJ
authors.lastname: Park
authors.affiliation: 6 Department of Internal Medicine, Chung-Ang University College of Medicine , Seoul, Korea.
authors.forename: Bo Youn
authors.initials: BY
authors.lastname: Cho
mesh_terms: D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D019233:Retreatment; D012189:Retrospective Studies; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000097:blood
chemical_list: D013956:Antithyroid Agents; D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine
keywords: Graves' disease; antithyroid agents; long-term prognosis