Vaidya Bijay, Wright Ailsa, Shuttleworth Joanna, Donohoe Mollie, Warren Roderick, Brooke Antonia, Gericke Christian A, Ukoumunne Obioha C
Department of Endocrinology, Royal Devon & Exeter Hospital, Exeter, UK; NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK.
Clin Endocrinol (Oxf). 2014 Oct;81(4):610-3. doi: 10.1111/cen.12478. Epub 2014 May 19.
Two widely used antithyroid drug (ATD) regimes for Graves' disease (GD) include the 'block & replace' (B&R) regime (a fixed high-dose of ATD combined with levothyroxine) and the 'titration' regime (a titrating dose of ATD). Anecdotally, it is believed that B&R is less prone to fluctuating thyroid function.
To study whether, in routine clinical practice, the B&R regime, compared with the titration regime, is associated with more stable thyroid function.
We retrospectively analysed case-records for 450 patients treated with ATDs for GD at a secondary care hospital. Exclusion criteria included treatment with ATDs for <6 months, thyrotoxicosis due to other causes, treatment with radioiodine or thyroidectomy and pregnancy.
Two hundred and twenty three patients were treated with the B&R regime ('B&R group'), 149 with the titration regime ('titration group') and 78 with both regimes. The number of thyroid function tests (TFTs) performed per year (mean(SD): 3·2(1·2) vs 3·4(1·5); adjusted mean difference = -0·4; 95% CI: -0·7 to -0·1; and P = 0·008) and the number of hospital clinic visits per year (mean (SD): 2·9 (1·0) vs 3·2 (1·3); adjusted mean difference = -0·4; 95% CI: -0·7 to -0·2; and P = 0·002) were lower in the B&R group than the titration group. The number of abnormal TFT results per year was similar in the two groups (mean(SD): 1·8(1·3) vs 1·8(1·4); adjusted mean difference = 0·05; 95%CI: -0·3 to 0·4; and P = 0·74).
In this retrospective study, there was little evidence that patients under B&R have more stable thyroid function. Further data from prospective studies, however, are needed to confirm this finding.
治疗格雷夫斯病（GD）的两种广泛使用的抗甲状腺药物（ATD）方案包括“阻断并替代”（B&R）方案（固定高剂量的ATD联合左甲状腺素）和“滴定”方案（滴定剂量的ATD）。据传闻，人们认为B&R方案较少出现甲状腺功能波动。
研究在常规临床实践中，与滴定方案相比，B&R方案是否与更稳定的甲状腺功能相关。
我们回顾性分析了一家二级护理医院中450例接受ATD治疗GD患者的病例记录。排除标准包括ATD治疗时间不足6个月、其他原因导致的甲状腺毒症、放射性碘或甲状腺切除术治疗以及妊娠。
223例患者接受B&R方案治疗（“B&R组”），149例接受滴定方案治疗（“滴定组”），78例接受两种方案治疗。B&R组每年进行的甲状腺功能检查（TFT）次数（均值（标准差）：3.2（1.2）对3.4（1.5）；调整后均值差异=-0.4；95%置信区间：-0.7至-0.1；P=0.008）和每年医院门诊就诊次数（均值（标准差）：2.9（1.0）对3.2（1.3）；调整后均值差异=-0.4；95%置信区间：-0.7至-0.2；P=0.002）低于滴定组。两组每年异常TFT结果的数量相似（均值（标准差）：1.8（1.3）对1.8（1.4）；调整后均值差异=0.05；95%置信区间：-0.3至0.4；P=0.并74）。
在这项回顾性研究中，几乎没有证据表明接受B&R方案的患者甲状腺功能更稳定。然而，需要前瞻性研究的进一步数据来证实这一发现。
