Kashiwai Taku, Hidaka Yoh, Takano Toru, Tatsumi Ke-ita, Izumi Yukiko, Shimaoka Yuki, Tada Hisato, Takeoka Keiko, Amino Nobuyuki
Department of Laboratory Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.
Endocr J. 2003 Feb;50(1):45-9. doi: 10.1507/endocrj.50.45.
Although many researchers have reported clinical and laboratory parameters for prediction of remission in Graves' disease during or after anti-thyroid drug therapy, there is no reliable one to assure the complete remission. We prospectively examined a practical therapy with minimum maintenance dose of anti-thyroid drugs for prediction of remission in Graves' disease. Fifty-seven patients with Graves' disease were treated with anti-thyroid drugs at the initial dose of 30 mg/day of methimazole (MMI) or 300 mg/day of propylthiouracil (PTU). Then, doses were gradually decreased, and finally discontinued when the patients were able to maintain euthyroid (normal FT4 and TSH) for at least 6 months with the minimum maintenance dose (MMI 5 mg every other day or PTU 50 mg every other day). After discontinuation of drugs, FT4, FT3, TSH and TSH-binding inhibitory immunoglobulin (TBII) were measured every one to two months for the first 6 months and every 3-4 months for the next 18 months to confirm continuous remission. After 2 years of drug cessation, 46 (81%) of 57 patients were in remission and the other 11 patients had relapsed into thyrotoxicosis. At the time of drug discontinuation, the serum concentration of FT4, FT3 and TSH, titers of anti-thyroglobulin antibodies and anti-thyroid microsomal antibodies, goiter size were not different between the remission and relapse groups. At the time of drug cessation, the activities of TBII and thyroid-stimulating antibodies (TSAb) overlapped between the two groups, although they were significantly lower in the remission group than in the relapse group (p<0.01). Forty percent (4/10) of TBII positive patients and 71% (23/32) of TSAb positive patients continued to be in remission. On the other hand, thyrotoxicosis relapsed in 5 (11%) of 47 TBII negative and 2 (8%) of 25 TSAb negative patients. These data indicate that minimum maintenance therapy to keep euthyroid (normal FT4 and TSH) for 6 months is a practical measure for 81% prediction of remission in Graves' disease. The measurement of TBII or TSAb gave little additional information for predicting remission.
尽管许多研究人员报告了抗甲状腺药物治疗期间或之后预测Graves病缓解的临床和实验室参数，但尚无可靠的参数能确保完全缓解。我们前瞻性地研究了一种使用最低维持剂量抗甲状腺药物的实用疗法，以预测Graves病的缓解情况。57例Graves病患者接受抗甲状腺药物治疗，初始剂量为甲巯咪唑（MMI）30mg/天或丙硫氧嘧啶（PTU）300mg/天。然后，剂量逐渐减少，当患者能够使用最低维持剂量（MMI每隔一天5mg或PTU每隔一天50mg）维持甲状腺功能正常（FT4和TSH正常）至少6个月时，最终停药。停药后，在最初6个月内每1至2个月测量一次FT4、FT3、TSH和TSH结合抑制性免疫球蛋白（TBII），在接下来的18个月内每3至4个月测量一次，以确认持续缓解。停药2年后，57例患者中有46例（81%）缓解，另外11例患者复发为甲状腺毒症。停药时，缓解组和复发组之间的FT4、FT3和TSH血清浓度、抗甲状腺球蛋白抗体和抗甲状腺微粒体抗体滴度、甲状腺肿大小并无差异。停药时，两组之间TBII和甲状腺刺激抗体（TSAb）的活性有重叠，尽管缓解组明显低于复发组（p<0.01）。TBII阳性患者中有40%（4/10）和TSAb阳性患者中有71%（23/32）继续缓解。另一方面，47例TBII阴性患者中有5例（11%）和25例TSAb阴性患者中有2例（8%）复发为甲状腺毒症。这些数据表明，维持甲状腺功能正常（FT4和TSH正常）6个月的最低维持治疗是预测Graves病缓解的一种实用措施，81%的患者可实现缓解。TBII或TSAb的测量对于预测缓解几乎没有额外的信息价值。
