Abraham Prakash, Avenell Alison, McGeoch Susan C, Clark Louise F, Bevan John S
Endocrinology (Ward 28), Aberdeen Royal Infirmary, NHS Grampian, Foresterhill, Aberdeen, Scotland, UK, AB25 2ZN.
Cochrane Database Syst Rev. 2010 Jan 20;2010(1):CD003420. doi: 10.1002/14651858.CD003420.pub4.
Antithyroid drugs are widely used in the therapy of hyperthyroidism. There are wide variations in the dose, regimen or duration of treatment used by health professionals.
To assess the effects of dose, regimen and duration of antithyroid drug therapy for Graves' hyperthyroidism.
We searched seven databases and reference lists.
Randomised and quasi-randomised trials of antithyroid medication for Graves' hyperthyroidism.
Two authors independently extracted data and assessed risk of bias. Pooling of data for primary outcomes, and select exploratory analyses were undertaken.
Twenty-six randomised trials involving 3388 participants were included. Overall the quality of trials, as reported, was poor. None of the studies investigated incidence of hypothyroidism, changes in weight, health-related quality of life, ophthalmopathy progression or economic outcomes. Four trials examined the effect of duration of therapy on relapse rates, and when using the titration regimen 12 months was superior to six months, but there was no benefit in extending treatment beyond 18 months. Twelve trials examined the effect of block-replace versus titration block-regimens. The relapse rates were similar in both groups at 51% in the block-replace group and 54% in the titration block-group (OR 0.86, 95% confidence interval (CI) 0.68 to1.08) though adverse effects (rashes (10% versus 6%) and withdrawing due to side effects (16% versus 9%)) were significantly higher in the block-replace group. Three studies considered the addition of thyroxine with continued low dose antithyroid therapy after initial therapy with antithyroid drugs. There was significant heterogeneity between the studies and the difference between the two groups was not significant (OR 0.58, 95% CI 0.05 to 6.21). Four studies considered the addition of thyroxine alone after initial therapy with antithyroid drugs. There was no significant difference in the relapse rates between the groups after 12 months follow-up (OR 1.15, 95% CI 0.79 to 1.67). Two studies considered the addition of immunosuppressive agents. The results which were in favour of the interventions would need to be validated in other populations.
AUTHORS' CONCLUSIONS: The evidence suggests that the optimal duration of antithyroid drug therapy for the titration regimen is 12 to 18 months. The titration (low dose) regimen had fewer adverse effects than the block-replace (high dose) regimen and was no less effective. Continued thyroxine treatment following initial antithyroid therapy does not appear to provide any benefit in terms of recurrence of hyperthyroidism. Immunosuppressive therapies need further evaluation.
抗甲状腺药物广泛应用于甲状腺功能亢进症的治疗。医疗专业人员使用的治疗剂量、方案或疗程存在很大差异。
评估抗甲状腺药物治疗格雷夫斯甲亢的剂量、方案和疗程的效果。
我们检索了七个数据库和参考文献列表。
抗甲状腺药物治疗格雷夫斯甲亢的随机和半随机试验。
两位作者独立提取数据并评估偏倚风险。对主要结局进行数据合并，并进行了选定的探索性分析。
纳入了26项随机试验，涉及3388名参与者。总体而言，所报告的试验质量较差。没有研究调查甲状腺功能减退的发生率、体重变化、健康相关生活质量、眼病进展或经济结局。四项试验研究了治疗疗程对复发率的影响，采用滴定方案时，12个月优于6个月，但治疗超过18个月并无益处。十二项试验研究了阻断替代方案与滴定阻断方案的效果。两组的复发率相似，阻断替代组为51%，滴定阻断组为54%（比值比0.86，95%置信区间（CI）0.68至1.08），尽管阻断替代组的不良反应（皮疹（10%对6%）和因副作用退出（16%对9%））明显更高。三项研究考虑在抗甲状腺药物初始治疗后加用甲状腺素并持续低剂量抗甲状腺治疗。各研究之间存在显著异质性，两组之间的差异不显著（比值比0.58，95%CI 0.05至6.21）。四项研究考虑在抗甲状腺药物初始治疗后单独加用甲状腺素。随访12个月后，两组的复发率无显著差异（比值比1.15，95%CI 0.79至1.67）。两项研究考虑加用免疫抑制剂。支持这些干预措施的结果需要在其他人群中得到验证。
证据表明，滴定方案的抗甲状腺药物治疗的最佳疗程为12至18个月。滴定（低剂量）方案比阻断替代（高剂量）方案的不良反应更少，且效果不差。抗甲状腺药物初始治疗后持续使用甲状腺素治疗在甲亢复发方面似乎没有任何益处。免疫抑制疗法需要进一步评估。
