甲状腺血流作为 Graves 病患者正常分娩后 Graves 病复发的有用预测指标。

Thyroid blood flow as a useful predictor of relapse of Graves' disease after normal delivery in patients with Graves' disease.

机构信息

Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Asahi-machi, Abeno-ku, Japan.

出版信息

Biomed Pharmacother. 2010 Feb;64(2):113-7. doi: 10.1016/j.biopha.2009.04.038. Epub 2009 Oct 20.

DOI:10.1016/j.biopha.2009.04.038

PMID:20006462

Abstract

OBJECTIVE

Measurement of the peak systolic velocity (PSV) in the inferior thyroid artery (ITA) before withdrawal of an anti-thyroid drug (ATD) is useful for predicting relapse of Graves' disease (GD). We further investigated whether the ITA-PSV can be used for prediction of GD relapse after delivery in euthyroid women with GD who stopped ATD administration during mid- to late pregnancy.

PATIENTS AND METHODS

ITA-PSV was monitored monthly for three months after delivery in 42 women with GD aged from 24 to 45 years old (mean+/-SE: 34.7+/-0.92 years old) who met the above criteria. To confirm the stability of the measurement, ITA-PSV was also measured monthly in 32 age-matched non-pregnant normal women and for three months after delivery in 10 age-matched women.

RESULTS

ITA-PSV and thyroid volume were higher in women with GD immediately after delivery compared to normal women, but the levels of TSH receptor antibody (TRAb) and thyroid-stimulating antibody (TSAb) did not differ significantly between the two groups. Of the 42 patients, 23 had relapse of GD and the smoker/non-smoker ratio and thyroid volume in these patients immediately after delivery were significantly higher than those in the 19 patients who did not undergo relapse (10/23 vs. 0/19, p<0.0001; 24280.3+/-2280.9 vs. 19670.0+/-2103.7mm(3), p=0.046), while ITA-PSV, TRAb and TSAb did not differ between the two groups of patients. The ITA-PSV ratio was calculated by dividing each value in the follow-up period by that obtained immediately after delivery. A significant increase in the mean ITA-PSV ratio occurred at least one month before the time of relapse (1.00+/-0.00 at -3 months before relapse vs. 1.46+/-0.12 at -1 month, p=0.010; 1.00+/-0.00 at -3 months vs. 1.77+/-0.13 at the time of relapse, p=0.0048). In contrast, there were no significant changes in this ratio during the follow-up period in non-relapse patients.

CONCLUSION

Monthly measurement of ITA-PSV after delivery in remitted euthyroid women with GD may assist in early prediction of GD relapse.

摘要

目的

在停用抗甲状腺药物（ATD）之前测量甲状腺下动脉（ITA）的收缩期峰值速度（PSV），对于预测格雷夫斯病（GD）的复发是有用的。我们进一步研究了在中晚期妊娠期间停止 ATD 治疗的 GD 孕妇中，ITAPSV 是否可用于预测产后甲状腺功能正常的 GD 复发。

方法

我们监测了 42 名年龄在 24 至 45 岁（平均+/-SE：34.7+/-0.92 岁）的 GD 妇女的 ITA-PSV，这些妇女符合上述标准，并在产后三个月内每月监测一次。为了确认测量的稳定性，我们还在 32 名年龄匹配的非妊娠正常女性中每月测量一次 ITA-PSV，并在 10 名年龄匹配的女性中测量产后三个月。

结果

产后即刻，GD 妇女的 ITA-PSV 和甲状腺体积高于正常女性，但两组间 TSH 受体抗体（TRAb）和甲状腺刺激抗体（TSAb）水平无显著差异。在 42 例患者中，23 例 GD 复发，这些患者产后即刻的吸烟/不吸烟比例和甲状腺体积明显高于未复发的 19 例患者（10/23 比 0/19，p<0.0001；24280.3+/-2280.9 比 19670.0+/-2103.7mm（3），p=0.046），而 ITA-PSV、TRAb 和 TSAb 在两组患者之间无差异。通过将随访期间的每个值除以产后即刻的值来计算 ITA-PSV 比值。在复发前至少一个月，平均 ITA-PSV 比值显著增加（复发前-3 个月时为 1.00+/-0.00，复发前-1 个月时为 1.46+/-0.12，p=0.010；复发前-3 个月时为 1.00+/-0.00，复发时为 1.77+/-0.13，p=0.0048）。相比之下，在非复发患者的随访期间，该比值没有显著变化。