Liu Xingjun, Shi Bingyin, Li Hao
Department of Endocrinology, First Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an, China.
Department of Endocrinology, First Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an, China.
Ann Endocrinol (Paris). 2015 Dec;76(6):679-83. doi: 10.1016/j.ando.2015.08.004. Epub 2015 Oct 27.
Antithyroid drug treatment (ATDT) effectively achieves euthyroidism in patients with Graves' disease (GD). However, apparently successful treatment may be followed by relapse. We investigated the outcome of ATDT in Chinese patients with GD to identify predictive features of relapse.
In total, 133 patients with mild to moderate goiter were included in this analysis. All patients received methimazole for 12 to 40 months and were subsequently followed up for at least 1 year. Lasting remission was defined as the presence of clinical and laboratory features of euthyroidism for ≥ 1 year after stopping methimazole.
Most patients (118 of 133, 88.7%) remained in remission after the follow-up period; 15 patients (11.3%) developed relapse. A history of GD, larger goiter at the time of drug withdrawal, a positive thyroid-stimulating antibody titer and restauration of low thyroid-stimulating hormone levels during the maintenance period were related to a subsequent risk of relapse according to stepwise logistic regression analysis results. However, other clinical and biological features (age, sex, initial goiter, ophthalmopathy, thyroxine and triiodothyronine levels and thyroglobulin antibody and thyroid microsomal antibody titers) did not reach statistical significance.
Regular, individualized ATDT achieved an 88.7% remission rate in Chinese patients with GD. The features associated with probable relapse were a history of GD, larger goiter at the time of drug withdrawal, a positive thyroid-stimulating antibody titer at the time of drug withdrawal and redevelopment of low thyroid-stimulating hormone levels during the maintenance period.
抗甲状腺药物治疗（ATDT）能有效使格雷夫斯病（GD）患者实现甲状腺功能正常。然而，看似成功的治疗之后可能会复发。我们研究了中国GD患者接受ATDT的结果，以确定复发的预测特征。
本分析共纳入133例轻至中度甲状腺肿大的患者。所有患者接受甲巯咪唑治疗12至40个月，随后至少随访1年。持久缓解定义为停用甲巯咪唑后甲状腺功能正常的临床和实验室特征持续≥1年。
随访期后，大多数患者（133例中的118例，88.7%）仍处于缓解状态；15例患者（11.3%）复发。根据逐步逻辑回归分析结果，GD病史、停药时甲状腺肿大较大、甲状腺刺激抗体滴度阳性以及维持期甲状腺刺激激素水平恢复正常与随后的复发风险相关。然而，其他临床和生物学特征（年龄、性别、初始甲状腺肿大、眼病、甲状腺素和三碘甲状腺原氨酸水平以及甲状腺球蛋白抗体和甲状腺微粒体抗体滴度）未达到统计学意义。
规律、个体化的ATDT使中国GD患者的缓解率达到88.7%。与可能复发相关的特征为GD病史、停药时甲状腺肿大较大、停药时甲状腺刺激抗体滴度阳性以及维持期甲状腺刺激激素水平再次降低。
