If a patient requires more than 5 mg per day of methimazole long term do you recommend alternative treatment options such as radio-iodine ablation or surgery?  

Long term use of methimazole is generally safe as long as no history of LFT elevation or abnormally low white blood cell counts. Typically, toxic multinodular goiters respond well to low dose methimazole and patients can be managed in this fashion long-term without any issues. Graves patients may re...

No. Methimazole has been shown to be safe at even higher doses for long term use, so if the patient is well controlled, I will continue Methimazole indefinitely (although I will offer definitive therapy if they are interested - particularly if it's a hot nodule where they are higher likelihood o...