Department of Endocrinology, Hippokration Hospital of Thessaloniki, 10 Sarantaporou Street, 54 640, Thessaloniki, Greece,
Endocrine. 2013 Oct;44(2):448-53. doi: 10.1007/s12020-013-9895-0. Epub 2013 Feb 11.
Antithyroid drugs (ATDs) remain the first-line therapy in patients with Graves' disease (GD), despite a high relapse rate. The purpose of this study was to identify the predictors of remission in patients with GD treated with ATDs-retrospective study at an endocrine referral service in Northern Greece. Two-hundred and eleven patients met the study's criteria. Females (p = 0.049), non-smokers (p = 0.017), patients without ophthalmopathy (p = 0.033), and those developing pharmaceutical hypothyroidism (p = 0.018) experienced longer duration of remission. Duration of remission was positively associated with therapy duration (r s = 0.151, p = 0.030), maximum TSH levels during (r s = 0.241, p = 0.001), at the end (r s = 0.280, p < 0.001) and 3 months after therapy (r s = 0.341, p = 0.003). There was a negative association with free T4 (FT4) (r s = -0.426, p < 0.001) and free triiodothyronine (FT3) (r s = -0.467, p = 0.038) levels at 6 months after ATDs discontinuation. In multiple-regression analysis, only duration of the first ATDs course for more than 24 months independently predicted duration of remission. Female gender, non-smoking, the absence of orbitopathy, treatment duration, pharmaceutical hypothyroidism, higher TSH levels during, at the end and 3 months after ATDs discontinuation, and lower FT4 and FT3 levels 6 months after therapy were associated with longer duration of remission. However, only duration of ATDs therapy for more than 24 months independently predicted predict long-term remission in GD.
抗甲状腺药物(ATD)仍然是格雷夫斯病(GD)患者的一线治疗方法,尽管复发率很高。本研究的目的是确定在希腊北部内分泌转诊服务处接受 ATD 治疗的 GD 患者缓解的预测因素。符合研究标准的有 211 名患者。女性(p=0.049)、不吸烟者(p=0.017)、无眼病患者(p=0.033)和发生药物性甲状腺功能减退症的患者(p=0.018)缓解持续时间更长。缓解持续时间与治疗持续时间呈正相关(rs=0.151,p=0.030),与治疗期间最大 TSH 水平呈正相关(rs=0.241,p=0.001),与治疗结束时最大 TSH 水平呈正相关(rs=0.280,p<0.001),与治疗结束后 3 个月最大 TSH 水平呈正相关(rs=0.341,p=0.003)。与 ATD 停药后 6 个月游离 T4(FT4)(rs=-0.426,p<0.001)和游离三碘甲状腺原氨酸(FT3)(rs=-0.467,p=0.038)水平呈负相关。在多因素回归分析中,只有首次 ATD 疗程超过 24 个月独立预测缓解持续时间。女性、不吸烟、无眼眶病、治疗持续时间、药物性甲状腺功能减退症、治疗期间、治疗结束时和治疗结束后 3 个月 TSH 水平较高,以及治疗结束后 6 个月 FT4 和 FT3 水平较低与缓解持续时间较长有关。然而,只有 ATD 治疗持续时间超过 24 个月才能独立预测 GD 的长期缓解。