Endocrinology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland2Uniformed Services University of Health Sciences, Bethesda, Maryland.
The Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA. 2015 Dec 15;314(23):2544-54. doi: 10.1001/jama.2015.16535.
Graves disease is the most common cause of persistent hyperthyroidism in adults. Approximately 3% of women and 0.5% of men will develop Graves disease during their lifetime.
We searched PubMed and the Cochrane database for English-language studies published from June 2000 through October 5, 2015. Thirteen randomized clinical trials, 5 systematic reviews and meta-analyses, and 52 observational studies were included in this review. Patients with Graves disease may be treated with antithyroid drugs, radioactive iodine (RAI), or surgery (near-total thyroidectomy). The optimal approach depends on patient preference, geography, and clinical factors. A 12- to 18-month course of antithyroid drugs may lead to a remission in approximately 50% of patients but can cause potentially significant (albeit rare) adverse reactions, including agranulocytosis and hepatotoxicity. Adverse reactions typically occur within the first 90 days of therapy. Treating Graves disease with RAI and surgery result in gland destruction or removal, necessitating life-long levothyroxine replacement. Use of RAI has also been associated with the development or worsening of thyroid eye disease in approximately 15% to 20% of patients. Surgery is favored in patients with concomitant suspicious or malignant thyroid nodules, coexisting hyperparathyroidism, and in patients with large goiters or moderate to severe thyroid eye disease who cannot be treated using antithyroid drugs. However, surgery is associated with potential complications such as hypoparathyroidism and vocal cord paralysis in a small proportion of patients. In pregnancy, antithyroid drugs are the primary therapy, but some women with Graves disease opt to receive definitive therapy with RAI or surgery prior to becoming pregnant to avoid potential teratogenic effects of antithyroid drugs during pregnancy.
Management of Graves disease includes treatment with antithyroid drugs, RAI, or thyroidectomy. The optimal approach depends on patient preference and specific patient clinical features such as age, history of arrhythmia or ischemic heart disease, size of goiter, and severity of thyrotoxicosis. Physicians should be familiar with the advantages and disadvantages of each therapy to best counsel their patients.
格雷夫斯病是成年人持续性甲状腺功能亢进症最常见的原因。大约 3%的女性和 0.5%的男性在其一生中会患上格雷夫斯病。
我们在 PubMed 和 Cochrane 数据库中检索了 2000 年 6 月至 2015 年 10 月 5 日发表的英文文献。本综述纳入了 13 项随机临床试验、5 项系统评价和荟萃分析以及 52 项观察性研究。格雷夫斯病患者可以接受抗甲状腺药物、放射性碘（RAI）或手术（近全甲状腺切除术）治疗。最佳治疗方法取决于患者的偏好、地理位置和临床因素。为期 12-18 个月的抗甲状腺药物治疗可能会使大约 50%的患者缓解，但可能会引起潜在的严重（尽管罕见）不良反应，包括粒细胞缺乏症和肝毒性。不良反应通常发生在治疗的前 90 天内。使用 RAI 和手术治疗格雷夫斯病会导致腺体破坏或切除，需要终身接受左甲状腺素替代治疗。RAI 的使用还与大约 15%-20%的患者甲状腺眼病的发生或加重有关。对于同时伴有可疑或恶性甲状腺结节、并存甲状旁腺功能亢进症、大甲状腺肿或中度至重度甲状腺眼病且不能用抗甲状腺药物治疗的患者，手术是首选。然而，手术与少数患者潜在的并发症相关，如甲状旁腺功能减退症和声带麻痹。在妊娠期间，抗甲状腺药物是主要治疗方法，但一些患有格雷夫斯病的女性选择在怀孕前接受 RAI 或手术的确定性治疗，以避免抗甲状腺药物在怀孕期间的潜在致畸作用。
格雷夫斯病的治疗包括抗甲状腺药物、RAI 或甲状腺切除术。最佳治疗方法取决于患者的偏好和特定的患者临床特征，如年龄、心律失常或缺血性心脏病史、甲状腺肿大小和甲状腺毒症的严重程度。医生应熟悉每种治疗方法的优缺点，以便为患者提供最佳咨询。
