Long-term continuous methimazole or radioiodine treatment for hyperthyroidism

Area of Science:

• Endocrinology
• Internal Medicine
• Clinical Research

Background:

• Hyperthyroidism treatment lacks a definitive best approach.
• Continuous methimazole (MMI) effectiveness and neuropsychological outcomes were investigated.
• Comparison was made between long-term MMI and thyroxine post-radioiodine-induced (RAI) hypothyroidism.

Purpose of the Study:

• To evaluate the effectiveness of continuous methimazole (MMI) treatment.
• To compare neuropsychological test results in patients on long-term MMI versus those on thyroxine after RAI hypothyroidism.
• To assess cardiac function, lipid profiles, and bone mineral density in both treatment groups.

Main Methods:

• 239 patients with diffuse toxic goiter and hyperthyroidism recurrence were enrolled.
• 104 patients were randomized; 135 voluntarily enrolled into MMI or RAI groups.
• Follow-up included thyroid function tests, lipid profiles, echocardiography, BMD, and neuropsychological tests.

Main Results:

• The RAI group had higher incidences of elevated TSH, triglycerides, and poorer cardiac function indicators.
• MMI-treated patients demonstrated superior performance in neuropsychological tests, including mood, memory, and IQ.
• Long-term follow-up (mean 14 years) revealed significant differences between the MMI and RAI groups.

Conclusions:

• Long-term MMI treatment is superior to RAI therapy for diffuse toxic goiter.
• MMI offers better outcomes regarding mood, cognition, and cardiac function.
• MMI treatment is associated with a lower occurrence of thyroid dysfunction compared to RAI.