If there is no improvement, the dose is increased. Patients on Methimazole go into remission sooner than patients on PTU and are thought to have less trouble with side effects or eye complications. Although PTU is reported to be more expensive than Methimazole, several online patients have reported Methimazole as being significantly more expensive. ATDs are used until patients go into spontaneous remission. Remission occurs as a result of the natural disease course although it may be amiably affected by the immunosuppressive effects of ATDs.
Relapses are more likely in the postpartum period.
If large ATD doses continue to be required for control, remission is considered unlikely. Autoantibody levels may be required to confirm this since sustained high antibody titers are also seen in patients unlikely to achieve remission. In this case, an integrative approach employing craniosacral therapy, traditional Chinese medicine, acupuncture or other energy healing methods may prove to be beneficial. Also, the adjunctive use of ionic inhibitors has shown benefits in patients who show resistance to ATDs. Although patients in Europe are kept on ATDs as long as necessary until remission is achieved, many American doctors are hesitant to do so and recommend a more aggressive approach if remission isn t achieved within 18 months.