{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:41:57Z","timestamp":1787236917609,"version":"build-2736575974"},"reference-count":31,"publisher":"The Endocrine Society","issue":"2","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although antithyroid drugs (ATDs) are widely used as the first-line therapy for Graves\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using electronic medical records from a thyroid specialty hospital in Japan. Patients newly diagnosed with Graves\u2019 disease between 2008 and 2024 who had discontinued methimazole (MMI) after receiving a minimal maintenance dose (\u22642.5\u2005mg\/day) were included. Patients were categorized into 4 groups based on their final maintenance dose before discontinuation: 2.5\u2005mg\/day, &amp;gt;1.25 to \u22642.5\u2005mg\/day, 1.25\u2005mg\/day, and &amp;lt;1.25\u2005mg\/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\u2013matched analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 4352 eligible patients, multivariable regression showed that, compared with the 2.5\u2005mg\/day group, the 1.25\u2005mg\/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 &amp;lt;1.25\u2005mg\/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\u2005mg\/day group had a lower risk of relapse compared with the 2.5\u2005mg\/day group (RR: 0.44, 95% CI: 0.23-0.85; 172 matched pairs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lower minimum maintenance doses of MMI before discontinuation, particularly doses &amp;lt;2.5\u2005mg\/day, may be associated with a reduced risk of relapse in patients with Graves\u2019 disease. Clinicians should recognize the clinical relevance of the minimum maintenance dose in the treatment of Graves\u2019 disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf433","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T11:40:59Z","timestamp":1753962059000},"page":"e368-e374","source":"Crossref","is-referenced-by-count":6,"title":["Impact of Minimal Dose Strategy Before Antithyroid Drug Discontinuation on Relapse Risk in Graves\u2019 Disease"],"prefix":"10.1210","volume":"111","author":[{"given":"Keitaro","family":"Miyamura","sequence":"first","affiliation":[{"name":"Center for Excellence in Thyroid Care, Kuma Hospital , Kobe 650-0011 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Ito","sequence":"additional","affiliation":[{"name":"Center for Excellence in Thyroid Care, Kuma Hospital , Kobe 650-0011 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Yamaoka","sequence":"additional","affiliation":[{"name":"Center for Excellence in Thyroid Care, Kuma Hospital , Kobe 650-0011 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mako","family":"Hisakado","sequence":"additional","affiliation":[{"name":"Center for Excellence in Thyroid Care, Kuma Hospital , Kobe 650-0011 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1786-0077","authenticated-orcid":false,"given":"Eijun","family":"Nishihara","sequence":"additional","affiliation":[{"name":"Center for Excellence in Thyroid Care, Kuma Hospital , Kobe 650-0011 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuji","family":"Fukata","sequence":"additional","affiliation":[{"name":"Center for Excellence in Thyroid Care, Kuma Hospital , Kobe 650-0011 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsushige","family":"Nishikawa","sequence":"additional","affiliation":[{"name":"Center for Excellence in Thyroid Care, Kuma Hospital , Kobe 650-0011 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0041-197X","authenticated-orcid":false,"given":"Akira","family":"Miyauchi","sequence":"additional","affiliation":[{"name":"Center for Excellence in Thyroid Care, Kuma Hospital , Kobe 650-0011 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4960-8271","authenticated-orcid":false,"given":"Takashi","family":"Akamizu","sequence":"additional","affiliation":[{"name":"Center for Excellence in Thyroid Care, Kuma Hospital , Kobe 650-0011 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"issue":"5","key":"2026012214024343200_dgaf433-B1","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/j.1365-2265.2008.03338.x","article-title":"The incidence of autoimmune thyroid disease: a systematic review of the literature","volume":"69","author":"McGrogan","year":"2008","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"5","key":"2026012214024343200_dgaf433-B2","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1530\/EJE-10-1155","article-title":"Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study","volume":"164","author":"Carl\u00e9","year":"2011","journal-title":"Eur J Endocrinol"},{"issue":"11","key":"2026012214024343200_dgaf433-B3","doi-asserted-by":"crossref","first-page":"2956","DOI":"10.1210\/clinem\/dgae222","article-title":"A 2023 international survey of clinical practice patterns in the management of Graves disease: a decade of change","volume":"109","author":"Villagelin","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2026012214024343200_dgaf433-B4","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1007\/s40618-021-01730-1","article-title":"Appropriate duration of antithyroid drug treatment as a predictor for relapse of Graves\u2019 disease: a systematic scoping review","volume":"45","author":"Azizi","year":"2022","journal-title":"J Endocrinol Invest"},{"issue":"11","key":"2026012214024343200_dgaf433-B5","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1007\/s40618-019-01054-1","article-title":"Safety of long-term antithyroid drug treatment? 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