OBJECTIVE: The objective of this study was to assess the outcomes of various treatment strategies in patients with relapsed Graves' disease (GD) after standard antithyroid drug therapy (ATD). The three treatment strategies evaluated were radioiodine therapy (RAI), continuous low-dose methimazole (MMI), and a second course of MMI. SUBJECTS AND METHODS: This was a retrospective cohort study of 330 patients with GD who received initial MMI therapy for 12 to 24 months, of whom 159 subsequently relapsed. The cohort was categorized into three groups: 39 patients received RAI therapy plus levothyroxine, 46 patients received continuous low-dose MMI, and 74 patients received a second course of MMI. The analysis included thyroid function monitoring, progression of thyroid eye disease (TED), quality-of-life measures, and changes in body weight during follow-up. Results: The group receiving continuous low-dose MMI had a longer period of euthyroidism compared with the other groups. The TED outcomes and body weight changes were similar across all groups. Quality of life did not differ significantly across groups. Notably, 45% of patients in the group receiving a second MMI course relapsed when MMI was discontinued after a mean treatment duration of approximately 42 months. CONCLUSION: The administration of continuous low-dose MMI is an alternative for managing patients with relapsed GD, particularly for those who prefer to avoid definitive treatments.
Carlini et al. (Mon,) studied this question.