Sundaresh Vishnu, Brito Juan P, Thapa Prabin, Bahn Rebecca S, Stan Marius N
1 Division of Endocrinology, Metabolism, and Diabetes, University of Utah , Salt Lake City, Utah.
2 Geriatrics and Primary Care Internal Medicine, Mayo Clinic , Rochester, Minnesota.
Thyroid. 2017 Apr;27(4):497-505. doi: 10.1089/thy.2016.0343. Epub 2017 Feb 6.
The optimum therapy for Graves' disease (GD) is chosen following discussion between physician and patient regarding benefits, drawbacks, potential side effects, and logistics of the various treatment options, and it takes into account patient values and preferences. This cohort study aimed to provide useful information for this discussion regarding the usage, efficacy, and adverse-effect profile of radioactive iodine (RAI), antithyroid drugs (ATDs), and thyroidectomy in a tertiary healthcare facility.
The cohort included consecutive adults diagnosed with GD from January 2002 to December 2008, who had complete follow-up after treatment at the Mayo Clinic, Rochester, Minnesota. Data on treatment modalities, disease relapses, and adverse effects were extracted manually and electronically from the electronic medical records. Kaplan-Meier analyses were performed to evaluate the association of treatments with relapse-free survival.
The cohort included 720 patients with a mean age of 49.3 years followed for a mean of 3.3 years. Of these, 76.7% were women and 17.1% were smokers. The initial therapy was RAI in 75.4%, ATDs in 16.4%, and thyroidectomy in 2.6%, while 5.6% opted for observation. For the duration of follow-up, ATDs had an overall failure rate of 48.3% compared with 8% for RAI (hazard ratio = 7.6; p < 0.0001). Surgery had a 100% success rate; 80% of observed patients ultimately required therapy. Adverse effects developed in 43 (17.3%) patients treated with ATDs, most commonly dysgeusia (4.4%), rash (2.8%), nausea/gastric distress (2.4%), pruritus (1.6%), and urticaria (1.2%). Eight patients treated with RAI experienced radiation thyroiditis (1.2%). Thyroidectomy resulted in one (2.9%) hematoma and one (2.85%) superior laryngeal nerve damage, with no permanent hypocalcemia.
RAI was the most commonly used modality within the cohort and demonstrated the best efficacy and safety profile. Surgery was also very effective and relatively safe in the hands of experienced surgeons. While ATDs allow preservation of thyroid function, a high relapse rate combined with a significant adverse-effect profile was documented. These data can inform discussion between physician and patient regarding choice of therapy for GD.
格雷夫斯病（GD）的最佳治疗方案是在医生与患者就各种治疗选择的益处、缺点、潜在副作用及实际操作等方面进行讨论后选定的，同时要考虑患者的价值观和偏好。这项队列研究旨在为在三级医疗机构中关于放射性碘（RAI）、抗甲状腺药物（ATD）及甲状腺切除术的使用、疗效和不良反应情况的讨论提供有用信息。
该队列包括2002年1月至2008年12月连续诊断为GD的成年患者，他们在明尼苏达州罗切斯特市梅奥诊所接受治疗后进行了完整的随访。治疗方式、疾病复发及不良反应的数据通过手动和电子方式从电子病历中提取。采用Kaplan-Meier分析来评估治疗与无复发生存的相关性。
该队列包括720例患者，平均年龄49.3岁，平均随访3.3年。其中，76.7%为女性，17.1%为吸烟者。初始治疗采用RAI的占75.4%，采用ATD的占16.4%，采用甲状腺切除术的占2.6%，而5.6%选择观察。在随访期间，ATD的总体失败率为48.3%，而RAI为8%（风险比=7.6；p<0.0001）。手术成功率为100%；80%选择观察的患者最终需要治疗。接受ATD治疗的患者中有43例（17.3%）出现不良反应，最常见的是味觉障碍（4.4%）、皮疹（2.8%）、恶心/胃部不适（2.4%）、瘙痒（1.6%）和荨麻疹（1.2%）。8例接受RAI治疗的患者发生放射性甲状腺炎（1.2%）。甲状腺切除术导致1例（2.9%）血肿和1例（2.85%）喉上神经损伤，无永久性低钙血症。
RAI是该队列中最常用的治疗方式，显示出最佳的疗效和安全性。在经验丰富的外科医生手中，手术也非常有效且相对安全。虽然ATD可保留甲状腺功能，但记录显示其复发率高且不良反应明显。这些数据可为医生与患者关于GD治疗选择的讨论提供参考。
