The Wellness Q&A with Elaine Moore

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APRIL 2020


long term low dose methimazole therapy
Last Post 21 Sep 2018 03:34 PM by Elaine Moore. 1 Replies.
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renoUser is Offline New Member New Member Posts:
18 Sep 2018 07:44 PM
    Hello there, I have 2 questions regarding the new study on the effectiveness of long term (6-10 years) very low dose methimazole therapy showing very low remission rates. First, this study was done on a population of Graves patients after coming out of remission. My question is: since a good proportion of people do not stay in remission with this disease, why not continue on very low dose methimazole after becoming euthyroid in the first occurrence of the disease? In other words, why not just stay on tiny doses of methimazole for many years rather than risking coming out of remission? Second, how do people continue on these small doses for many years (as they did in the study I am noting) and not end up hypo? Do they supplement with synthroid so they can stay on the methimazole for nearly a decade? I ask this as I was just diagnosed with Graves, am quickly reducing my thyroid hormone levels with methimazole, but prefer to not rebound once in remission (well, who does?). Can I titrate down methimazole to that very low dose given T4 levels, add synthroid if needed, and hit the benchmark or 6-10 years in which remission rates are only around 16%? Thank you so much.
    Elaine MooreUser is Offline Veteran Member Veteran Member Posts:3413
    21 Sep 2018 03:34 PM
    I'm not sure what study you're referring to but the original Chinese study showing this did involve the use of block and replace (adding levothyroxine to the ATD) when thyroid hormone levels fell too low.

    Everyone with Graves' disease, however, is unique. Worldwide, anti-thyroid drugs are the most commonly used treatment and as Harvard's P. Reed Larsen said, most everyone can achieve remission on ATDs when they're prescribed appropriately. The true first time remission rate worldwide is around 60% but rates are much higher when patients are treated until remission is confirmed. Too often, doctors rely on a timeframe.
    Most patients do not need to be on ATDs for a decade although some do. Most patients achieve remission within 3-4 years and some will achieve it within a few months.
    what's important is staying on the lowest dose needed, lowering (and rarely increasing) the dose over time. Once you're down to a low dose like 1.25 mg MMI daily, then remission can be assessed by evaluating lab results, including the TSI result if TSH remains suppressed.
    If a relapse occurs, then resuming meds typically results in remission within one year. Common causes for relapse are stress, especially the stress of bereavement, and pregnancy.
    Anytime thyroid hormone levels fall too low on MMI but remission hasn't yet occurred, block and replace is a good solution.
    Your point about just staying on meds is a good one and many patients stay on a low dose of meds longer than necessary, especially in European countries. best, elaine
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