Time to normalization and sustainable normal serum thyrotropin concentrations in patients with hyperthyroidism: Comparison of methimazole and radioiodine treatment

Elsevier

Available online 7 August 2022

Endocrine PracticeHighlights•

In patients with hyperthyroidism, low serum thyrotropin (TSH) concentrations may significantly increase the risk of cardiovascular events.

This risk correlates with the cumulative periods the patient spent in a low-TSH status.

Based on the findings of this study, compared with radioactive iodine (RAI) treatment, methimazole therapy is accompanied by faster achievement of euthyroid state and more sustained normal serum TSH values during long-term follow-up.

AbstractObjective

The aim of this study was to compare "time to euthyroidism" and "time spent in euthyroidism" following MMI and RAI treatment.

Methods

358 hyperthyroid patients,178 with long-term MMI, and 180 patients with RAI treatment were analyzed. The time to normalization of increased serum fT4 and T3 values and suppressed serum TSH values, and percent of time that thyroid hormone levels remained within normal ranges during the mean follow-up time of ≥12 years were compared.

Results

At the baseline, the mean age of the participants was 39.9±17.7 and 39.8±14.2 years in MMI and RAI groups, respectively. Mean time to euthyroidism was 4.59±2.63(range 2-16) months in MMI and 15.39±12.11(2-61) months in RAI groups, p<0.001. During follow-up, the time spent in euthyroidism was 94.5±7.3 and 82.5+11.0% in MMI and RAI patients, respectively, p<0.001. Serum TSH values above and below normal ranges were observed in 5.3% and 0.2% of patients in the MMI group and in 9.8% and 7.7% of patients in the RAI group, respectively, p<0.001.

Time to euthyroidism and time spent in euthyroidism in 40 RAI-treated euthyroid patients(22%) were similar to the MMI group and significantly shorter than RAI-treated hypothyroid or relapsed subgroups. In patients who continued MMI therapy for>10 years, time spent in euthyroidism was>99%. The mean change in body weight was 0.48±3.38 and 2.50±4.54 kg in MMI and RAI groups, respectively, p<0.006.

Conclusion

In our cohort of selected patients, MMI therapy was accompanied by faster achievement of euthyroid state and more sustained normal serum TSH during long-term follow-up, compared with patients treated with RAI.

Keywords

Hyperthyroidism

Graves' Disease

Antithyroid Drugs

Methimazole

Long-term

Radioactive iodine

Euthyroidism

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© 2022 Published by Elsevier Inc. on behalf of the AACE.

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