ArticleThe Journal of clinical endocrinology and metabolism2026
Impact of Minimal Dose Strategy Before Antithyroid Drug Discontinuation on Relapse Risk in Graves' Disease.
Article in The Journal of clinical endocrinology and metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.
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1 citing paper in PubMed.
- Impact of Minimal Dose Strategy Before Antithyroid Drug Discontinuation on Relapse Risk in Graves' Disease.The Journal of clinical endocrinology and metabolism · 2026Article
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- Erratum issued
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9 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough antithyroid drugs (ATDs) are widely used as the first-line therapy for Graves' disease, relapse after treatment discontinuation remains common. While a prolonged low-dose ATD therapy has been associated with improved remission rates, the impact of the minimal maintenance dose before discontinuation on relapse risk remains unclear.
methodWe conducted a retrospective cohort study using electronic medical records from a thyroid specialty hospital in Japan. Patients newly diagnosed with Graves' disease between 2008 and 2024 who had discontinued methimazole (MMI) after receiving a minimal maintenance dose (≤2.5 mg/day) were included. Patients were categorized into 4 groups based on their final maintenance dose before discontinuation: 2.5 mg/day, >1.25 to ≤2.5 mg/day, 1.25 mg/day, and <1.25 mg/day. We evaluated the association between the minimal MMI dose before discontinuation and the 1-year risk of relapse using multivariable regression and propensity score-matched analyses.
resultsAmong 4352 eligible patients, multivariable regression showed that, compared with the 2.5 mg/day group, the 1.25 mg/day group had a significantly lower risk of relapse within 1 year [risk ratio (RR) 0.46, 95% confidence interval (CI) 0.28-0.75], and the <1.25 mg/day group had the lowest risk (RR: 0.18, 95% CI: 0.05-0.73). The propensity score-matched analysis, consistent with the multivariable regression, showed that the 1.25 mg/day group had a lower risk of relapse compared with the 2.5 mg/day group (RR: 0.44, 95% CI: 0.23-0.85; 172 matched pairs).
conclusionLower minimum maintenance doses of MMI before discontinuation, particularly doses <2.5 mg/day, may be associated with a reduced risk of relapse in patients with Graves' disease. Clinicians should recognize the clinical relevance of the minimum maintenance dose in the treatment of Graves' disease.
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