Kuma Hospital, Kobe, Japan.
Clin Endocrinol (Oxf). 2010 Jun;72(6):845-50. doi: 10.1111/j.1365-2265.2009.03745.x. Epub 2009 Nov 11.
Combined treatment with anti-thyroid drugs (ATDs) and potassium iodide (KI) has been used only for severe thyrotoxicosis or as a pretreatment before urgent thyroidectomy in patients with Graves' disease. We compared methimazole (MMI) treatment with MMI + KI treatment in terms of rapid normalization of thyroid hormones during the early phase and examined the later induction of disease remission.
A total of 134 untreated patients with Graves' disease were randomly assigned to one of four regimens: Group 1, MMI 30 mg; Group 2, MMI 30 mg + KI; Group 3, MMI 15 mg and Group 4, MMI 15 mg + KI. For easy handling, KI tablets were used instead of saturated solution of KI. KI was discontinued when patients showed normal free thyroxine (FT4) levels but MMI was continued with a tapering dosage until remission. Remission rate was examined during a 4- to 5-year observation.
Serum FT4, FT3 and TSH were measured by chemiluminescent immunoassays. TSH receptor antibody (TRAb) was assayed with TRAb-ELISA. Goitre size was estimated by ultrasonography.
After 2 weeks of treatment, normal FT4 was observed in 29% of patients in Group 1 and 59% (P < 0.05) of patients in Group 2. Furthermore, normal FT4 after 2 weeks of treatment was observed in 27% of patients in Group 3 and 54% (P < 0.05) of patients in Group 4. Similarly, FT3 normalized more rapidly in Groups 2 and 4 than in Groups 1 and 3. None of the patients showed an increase in thyroid hormones or aggravation of disease during combined treatment with MMI and KI. The remission rates in Groups 1, 2, 3 and 4 were 34%, 44%, 33% and 51%, respectively, and were higher in the groups receiving combined therapy but differences among four groups did not reach significance.
Combined treatment with MMI and KI improved the short-term control of Graves' hyperthyroidism and was not associated with worsening hyperthyroidism or induction of thionamide resistance.
抗甲状腺药物（ATD）与碘化钾（KI）联合治疗仅用于严重甲状腺毒症或格雷夫斯病患者紧急甲状腺切除术前的预处理。我们比较了甲巯咪唑（MMI）治疗与 MMI+KI 治疗在早期甲状腺激素快速正常化方面的效果，并检查了疾病缓解的后期诱导情况。
共 134 例未经治疗的格雷夫斯病患者被随机分为四组中的一组：组 1，MMI 30mg；组 2，MMI 30mg+KI；组 3，MMI 15mg；组 4，MMI 15mg+KI。为便于处理，使用碘化钾片代替饱和碘化钾溶液。当患者表现出正常游离甲状腺素（FT4）水平时，停用 KI，但继续使用 MMI 逐渐减少剂量，直至缓解。在 4 至 5 年的观察期间检查缓解率。
用化学发光免疫分析法测定血清 FT4、FT3 和 TSH。用 TRAb-ELISA 法测定促甲状腺素受体抗体（TRAb）。通过超声检查估计甲状腺肿大小。
治疗 2 周后，组 1 中有 29%的患者 FT4 正常，组 2 中有 59%（P<0.05）的患者 FT4 正常。此外，组 3 中有 27%的患者和组 4 中有 54%（P<0.05）的患者在治疗 2 周后 FT4 正常。同样，组 2 和组 4 的 FT3 比组 1 和组 3 更快地正常化。在 MMI 和 KI 联合治疗期间，没有患者出现甲状腺激素升高或病情加重。组 1、2、3 和 4 的缓解率分别为 34%、44%、33%和 51%，联合治疗组的缓解率更高，但四组之间的差异无统计学意义。
MMI 和 KI 联合治疗改善了格雷夫斯甲亢的短期控制，且与甲亢恶化或诱导硫脲类药物耐药无关。
