Matsushita Rie, Nakagawa Yuichi, Nagata Eiko, Satake Eiichiro, Sano Shinichiro, Yamaguchi Rie, Fujisawa Yasuko, Masui Ayako, Nakanishi Toshiki, Endo Akira, Kagawa Jiro, Ohzeki Takehiko
Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan.
Clin Pediatr Endocrinol. 2010 Oct;19(4):101-8. doi: 10.1297/cpe.19.101. Epub 2010 Dec 29.
Antithyroid drugs are widely used in the therapy of Graves' disease (GD), and methimazole (MMI) is preferred for treatment of pediatric GD. The recommended initial dosage of MMI is 0.5-1.0 mg/kg/d for pediatric GD, although there are few studies on the optimal MMI dosage for initial treatment in children. We retrospectively compared the efficacy of different doses of MMI in 35 children with GD. Eight children were excluded due to lack of follow-up, etc. The remaining 27 children were divided into a high-dose group (HD; MMI≥0.7 (0.85 ± 0.13) mg/kg/d, n=8) and a low-dose group (LD; MMI<0.7 (0.51 ± 0.12) mg/kg/d, n=19), and we compared the time needed for the serum FT4 levels to normalize (≤1.6 ng/dl) between the groups. There were no significant differences between the FT4 levels (HD: 5.5 ± 2.8 ng/dl; LD: 5.0 ± 2.4 ng/dl p=0.59) or thyroid stimulating hormone receptor antibody levels (HD: 56.2 ± 29.3%; LD: 60.9 ± 27.2% p=0.69) between the groups before treatment. The mean time required to normalize the FT4 levels was 22.5 ± 7.4 d in the HD group and 28.8 ± 16.2 d in the LD group (p=0.30). In addition, no other factor influenced the time to efficacy of MMI. A dose of MMI<0.7 (0.51 ± 0.12) mg/kg/d appears to as effective as a higher dose in normalizing the serum FT4 level in children with mild or moderate GD.
抗甲状腺药物广泛应用于格雷夫斯病（GD）的治疗，甲巯咪唑（MMI）是治疗儿童GD的首选药物。儿童GD的MMI推荐初始剂量为0.5 - 1.0 mg/kg/d，尽管关于儿童初始治疗的最佳MMI剂量的研究很少。我们回顾性比较了35例GD患儿不同剂量MMI的疗效。8例患儿因缺乏随访等原因被排除。其余27例患儿分为高剂量组（HD；MMI≥0.7（0.85±0.13）mg/kg/d，n = 8）和低剂量组（LD；MMI<0.7（0.51±0.12）mg/kg/d，n = 19），我们比较了两组间血清FT4水平恢复正常（≤1.6 ng/dl）所需的时间。治疗前两组间FT4水平（HD：5.5±2.8 ng/dl；LD：5.0±2.4 ng/dl，p = 0.59）或促甲状腺激素受体抗体水平（HD：56.2±29.3%；LD：60.9±27.2%，p = 0.69）无显著差异。HD组FT4水平恢复正常的平均时间为22.5±7.4天，LD组为28.8±16.2天（p = 0.30）。此外，没有其他因素影响MMI起效的时间。对于轻度或中度GD患儿，MMI剂量<0.7（0.51±0.12）mg/kg/d在使血清FT4水平恢复正常方面似乎与较高剂量同样有效。
