{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T15:12:11Z","timestamp":1772723531110,"version":"3.50.1"},"reference-count":29,"publisher":"Korean Endocrine Society","issue":"1","license":[{"start":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T00:00:00Z","timestamp":1736726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["HC21C0078"],"award-info":[{"award-number":["HC21C0078"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["e-enm.org"],"crossmark-restriction":true},"short-container-title":["Endocrinol Metab"],"published-print":{"date-parts":[[2025,2,28]]},"abstract":"<jats:p>Background: Antithyroid drug (ATD) treatment is the preferred initial treatment for Graves\u2019 disease (GD) in South Korea, despite higher treatment failure rates than radioactive iodine (RAI) therapy or thyroidectomy. This study aimed to evaluate the incidence of treatment failure associated with the primary modalities for GD treatment in real-world practice.Methods: We included 452,001 patients diagnosed with GD between 2004 and 2020 from the Korean National Health Insurance Service-National Health Information Database. Treatment failure was defined as switching from ATD, RAI, or thyroidectomy treatments, and for ATD specifically, inability to discontinue medication for over 2 years.Results: Mean age was 46.2 years, with females constituting 70.8%. Initial treatments for GD included ATDs (98.0%), thyroidectomy (1.3%), and RAI (0.7%), with a noted increment in ATD application from 96.2% in 2004 to 98.8% in 2020. During a median follow- up of 8.5 years, the treatment failure rates were 58.5% for ATDs, 21.3% for RAI, and 2.1% for thyroidectomy. Multivariate analysis indicated that the hazard ratio for treatment failure with ATD was 2.81 times higher than RAI. RAI treatments \u226510 mCi had 37% lower failure rates than doses &lt;10 mCi.Conclusion: ATDs are the most commonly used for GD in South Korea, followed by thyroidectomy and RAI. Although the risk of treatment failure for ATD is higher than that of RAI therapy, initial RAI treatment in South Korea is relatively limited compared to that in Western countries. Further studies are required to evaluate the cause of low initial RAI treatment rates in South Korea.<\/jats:p>","DOI":"10.3803\/enm.2024.2093","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T00:43:22Z","timestamp":1736815402000},"page":"125-134","update-policy":"https:\/\/doi.org\/10.3803\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Unveiling Risk Factors for Treatment Failure in Patients with Graves\u2019 Disease: A Nationwide Cohort Study in Korea"],"prefix":"10.3803","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6595-6551","authenticated-orcid":true,"given":"Jung A","family":"Kim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5878-6005","authenticated-orcid":true,"given":"Kyeong Jin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jimi","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyoung Jin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eyun","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji Hee","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nam Hoon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hye Jin","family":"Yoo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji A","family":"Seo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nan Hee","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyung Mook","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sei Hyun","family":"Baik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7430-3675","authenticated-orcid":true,"given":"Sin Gon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2119","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.19052"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2010.0417"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.3803\/enm.2021.1070"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-2802"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2019.0132"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.3803\/enm.2023.1684"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1530\/eje-13-0811"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-1954"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1210\/er.2012-1030"},{"key":"ref10","volume-title":"Thyroid disease: assessment and management. 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