Prevention of Relapse of Graves' Disease by Treatment with an Intrathyroid Injection of Dexamethasone

Introduction: Antithyroid drugs are widely used in the treatment of Graves' disease (GD), but the relapse rate is very high after therapy withdrawal. We evaluated the reduction effects of intrathyroid injection of dexamethasone (IID) on the relapse rate of hyperthyroidism in patients with newly diagnosed GD. Patients and Methods: A total of 191 patients with GD completed the study. After 6 months of treatment with methimazole (MMI), the patients were randomly assigned to receive either MMI (96 patients) alone or MMI combined with IID (MMI + IID; 95 patients) treatment for 3 months, followed by continuing a dose of MMI that would maintain euthyroidism for the next 9 months in all of the patients. After withdrawal of the medical therapy, patients were followed for 24 months, and the relapse rate of hyperthyroidism was evaluated. Results: No statistical difference was observed in the levels of serum FT4, TSH, or TSH receptor antibodies (TR-Ab), the thyroid volume, or the TR-Ab positive rate between the two groups at month 6. After the next 3 months of treatment with MMI + IID or MMI alone, the levels of TSH increased significantly, and the levels of serum TR-Ab, the TR-Ab positive rate, and thyroid volume decreased significantly in the MMI + IID group compared with the MMI group. Seven patients (7.4%) experienced a relapse of overt hyperthyroidism in the MMI + IID group and 49 patients (51%) in MMI group during the 2-yr follow-up period (P < 0.001). Conclusions: MMI + IID treatment is helpful to prevent relapse of hyperthyroidism in GD after medical therapy withdrawal. (J Clin Endocrinol Metab 94: 4984-4991, 2009)