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Goiter size, thyroidal 123I uptake, serum thyroglobulin level, and TRAb positivity are reliable markers of thyroid stimulation. Attention must also be paid to the responsiveness of the thyroid gland due to the high prevalence of painless thyroiditis and spontaneous hypothyroidism during treatment. TRAbs disappeared at &lt;5 years entering remission in 36.6% of patients (smooth-type), while re-elevation of TRAb activity occurred in 37.7% (fluctuating-type) and remained positive for &gt;5 years in 21.1% (smoldering-type). Seven percent of patients remained positive for TRAbs for &gt;30 years, requiring life-long ATD treatment. Remission occurred after median 6.8 years (interquartile range, 4.0 to 10.9) of ATD treatment in 55% of patients. However, late relapse may occur after stressful events (dormant type). In apparently intractable Graves\u2019 disease (GD) with a large goiter (&gt;40 g), 131I therapy should be considered. For initial and long-term ATD treatment, we must choose effective, safe, and economical drugs such as 100 mg potassium iodide (KI), although KI sensitivity varies in patients with GD. Thionamide, which has notorious side effects, is added only during the KI-resistant period.<\/jats:p>","DOI":"10.3803\/enm.2024.2079","type":"journal-article","created":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T04:51:48Z","timestamp":1729054308000},"page":"827-838","update-policy":"https:\/\/doi.org\/10.3803\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Long-Term Antithyroid Drug Therapy in Smoldering or Fluctuating-Type Graves\u2019 Hyperthyroidism with Potassium Iodide"],"prefix":"10.3803","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3869-6800","authenticated-orcid":true,"given":"Ken","family":"Okamura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2119","reference":[{"key":"ref1","volume-title":"","author":"Goodman","year":"1965"},{"key":"ref2","volume-title":"","author":"Braverman","year":"2000"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1957.00260100126015"},{"key":"ref4","first-page":"869","volume-title":"Nonsurgical treatment of thyrotoxicosis","author":"Trotter","year":"1961"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1967.03130210080013"},{"key":"ref6","first-page":"327","volume-title":"Long-term result of antithyroid drug therapy for Grave\u2019s disease: follow up after more than 5 years","author":"Shizume","year":"1970"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj1954.25.377"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1979.03300220020015"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-64-6-1241"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1530\/acta.0.1250643"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1007\/bf03346433"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.ej18-0418"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1530\/etj-22-0226"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad538"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-1944"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2012.0612"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2010.0181"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2011.0039"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0229"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1159\/000490384"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1973.03230090011002"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2016.0652"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2019.0180"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-021-01730-1"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1530\/acta.0.0880703"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.287.6394.720"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-67-4-720"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1988.tb01220.x"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1530\/acta.0.1260253"},{"key":"ref30","first-page":"519","volume-title":"Immunological and chemical types of reversible hypothyroidism; 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