Bartalena L, Masiello E, Magri F, Veronesi G, Bianconi E, Zerbini F, Gaiti M, Spreafico E, Gallo D, Premoli P, Piantanida E, Tanda M L, Ferrario M, Vitti P, Chiovato L
Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy.
Salvatore Maugeri Foundation and Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy.
J Endocrinol Invest. 2016 Dec;39(12):1445-1451. doi: 10.1007/s40618-016-0516-7. Epub 2016 Jul 27.
The Merseburg triad (hyperthyroidism, goiter, and orbitopathy) characterizes classical description of Graves' disease (GD). Aim of this observational, longitudinal study was to evaluate the current clinical features of newly diagnosed GD in Italy.
In two Northern Italy centers (Varese and Pavia), 283 consecutive patients (211 women, 72 men; mean age 47.4 years) with newly diagnosed GD were recruited in the years 2010-2014. Diagnosis was based on established criteria, and thyroid volume was assessed by ultrasonography. A clinical severity score (CSS) to assess the overall disease severity was developed by grading each component of the Merseburg triad.
At diagnosis, 45 % of patients had no goiter, and 30 % had a small goiter. The proportion of goitrous patients was much lower than in two Italian studies performed 20-30 years ago. Hyperthyroidism was subclinical in 16 % and mild in 29 % of patients, and Graves' orbitopathy was present in 20 %, usually mild, and active in only 2.5 % of patients. Using the CSS, less than half (44 %) of the patients had severe GD, while 22 % had mild and 34 % moderate disease. CSS was associated with a significantly higher risk of poorly controlled hyperthyroidism at 6 months.
In Italy, a relevant proportion of Graves' patients at diagnosis have mild to moderate GD; about half of them have no goiter, slightly less than one-fifth have subclinical hyperthyroidism, and only 20 % have GO. Thus, the clinical phenotype of GD is milder than in the past, possibly due to both earlier diagnosis and treatment, and improved iodine nutrition.
默瑟堡三联征（甲状腺功能亢进、甲状腺肿和眼眶病）是格雷夫斯病（GD）的经典描述特征。这项观察性纵向研究的目的是评估意大利新诊断GD的当前临床特征。
在意大利北部的两个中心（瓦雷泽和帕维亚），2010年至2014年期间连续招募了283例新诊断为GD的患者（211名女性，72名男性；平均年龄47.4岁）。诊断基于既定标准，甲状腺体积通过超声检查评估。通过对默瑟堡三联征的每个组成部分进行分级，制定了一个临床严重程度评分（CSS）来评估整体疾病严重程度。
诊断时，45%的患者无甲状腺肿，30%有小甲状腺肿。甲状腺肿患者的比例远低于20至30年前在意大利进行的两项研究中的比例。16%的患者甲状腺功能亢进为亚临床型，29%为轻度，20%的患者存在格雷夫斯眼眶病，通常为轻度，仅2.5%的患者病情活跃。使用CSS，不到一半（44%）的患者患有重度GD，而22%为轻度，34%为中度疾病。CSS与6个月时甲状腺功能亢进控制不佳的风险显著更高相关。
在意大利，相当一部分诊断为格雷夫斯病的患者患有轻度至中度GD；其中约一半无甲状腺肿，略少于五分之一有亚临床甲状腺功能亢进，只有20%有GO。因此，GD的临床表型比过去更轻，可能是由于早期诊断和治疗以及碘营养状况的改善。
