Honda Akira, Uchida Toyoyoshi, Komiya Koji, Goto Hiromasa, Takeno Kageumi, Sato Junko, Suzuki Ruriko, Himuro Miwa, Watada Hirotaka
Endocr Pract. 2017 Dec;23(12):1408-1413. doi: 10.4158/EP-2017-0044. Epub 2017 Nov 16.
Inorganic iodine is often used to treat patients with Graves thyrotoxicosis who do not tolerate thionamides due to adverse effects. However, predictors of continued inorganic iodine efficacy have not been fully elucidated. This study aimed to investigate the factors affecting the continued efficacy of potassium iodide (KI) in patients with Graves thyrotoxicosis.
In this study, among 1,197 patients with Graves disease who were initially treated with thionamides, we retrospectively studied 24 consecutive Japanese patients whose treatment was changed to KI alone due to the adverse effects of thionamides. We divided these patients into 2 groups: patients who had maintained euthyroid function for at least 180 days (nonrecurrence group, n = 11), and patients who had not maintained euthyroid function for 180 days (recurrence group, n = 13).
Free triiodothyronine (FT3) and free thyroxine (FT4) levels on the day of changing from thionamides to KI were statistically higher in the recurrence group than in the nonrecurrence group (FT3, 9.3 [range, 5.2-11.6] vs. 3.7 [3.3-4.8] pg/mL, P = .02 and FT4, 3.6 [1.8-4.5] vs. 1.4 [1.2-1.9] ng/dL, P = .02). FT4 levels on the day of drug change were significantly higher in the recurrence group, even after adjusting for thionamide or KI dose. In the recurrence group, the duration of KI effect was inversed correlated with FT3 and FT4 levels on the day of drug change.
Continued efficacy of KI after thionamides might be inversely correlated with thyrotoxicosis severity on the day of drug change.
ANOVA = analysis of variance eTV = estimated thyroid volume FT3 = free triiodothyronine FT4 = free thyroxine IQR = interquartile range KI = potassium iodide MMI = thiamazole PTU = propylthiouracil RAIT = radioactive iodine therapy TRAb = TSH receptor antibody TSH = thyroid stimulating hormone.
无机碘常用于治疗因不良反应而不耐受硫代酰胺类药物的格雷夫斯甲状腺毒症患者。然而，无机碘持续疗效的预测因素尚未完全阐明。本研究旨在调查影响格雷夫斯甲状腺毒症患者碘化钾（KI）持续疗效的因素。
在本研究中，在1197例最初接受硫代酰胺类药物治疗的格雷夫斯病患者中，我们回顾性研究了24例因硫代酰胺类药物不良反应而改为单独使用KI治疗的连续日本患者。我们将这些患者分为两组：甲状腺功能正常至少维持180天的患者（非复发组，n = 11）和甲状腺功能正常未维持180天的患者（复发组，n = 13）。
从硫代酰胺类药物改为KI当天，复发组的游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）水平在统计学上高于非复发组（FT3，9.3 [范围，5.2 - 11.6] 对比 3.7 [3.3 - 4.8] pg/mL，P = .02；FT4，3.6 [1.8 - 4.5] 对比 1.4 [1.2 - 1.9] ng/dL，P = .02）。即使在调整硫代酰胺类药物或KI剂量后，复发组换药当天的FT4水平仍显著更高。在复发组中，KI作用持续时间与换药当天的FT3和FT4水平呈负相关。
硫代酰胺类药物治疗后KI的持续疗效可能与换药当天甲状腺毒症的严重程度呈负相关。
ANOVA = 方差分析；eTV = 估计甲状腺体积；FT3 = 游离三碘甲状腺原氨酸；FT4 = 游离甲状腺素；IQR = 四分位数间距；KI = 碘化钾；MMI = 甲巯咪唑；PTU = 丙硫氧嘧啶；RAIT = 放射性碘治疗；TRAb = TSH受体抗体；TSH = 促甲状腺激素
