Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand.
Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand.
Clin Endocrinol (Oxf). 2018 Jun;88(6):977-984. doi: 10.1111/cen.13611. Epub 2018 Apr 25.
Thyrotoxicosis, most often caused by Graves' disease (GD), when treated inadequately may result in premature mortality. There is little consensus as to which of the 3 treatment options available - antithyroid drugs (ATD), radioactive iodine (RAI) and surgery, is better.
(i) To assess factors involved in treatment choice and treatment satisfaction in patients treated for Graves' disease; (ii) To assess quality of life (QoL) following treatment of Graves' disease.
Participants were selected from a prospective study cohort assessing thyrotoxicosis incidence and severity. Of the 172 eligible patients with Graves' disease, 123 treated patients participated (64% had received ATD only, 11% RAI and 25% total thyroidectomy, the latter 2 usually after a period of ATD), along with 18 untreated patients with newly diagnosed Graves' disease (overall participation rate, 73%). Consented patients completed a questionnaire detailing factors involved in treatment choice, QoL and satisfaction with treatment.
Participants reported that the most important factors in choosing a treatment were the following: the effects on activities of daily living, concern about use of radioiodine, possibility of depression or anxiety, and doctor's recommendations. Satisfaction levels were high across all 3 treatment types. QoL 1-year following treatment was higher than in untreated patients, and comparable with other international studies.
Patient satisfaction with therapy and QoL does not differ by treatment type. Therefore, clinical and social factors, in combination with patient choice and resource availability, should determine which treatment modality patients with Graves' disease should receive.
甲状腺功能亢进症（甲亢），最常见的病因是格雷夫斯病（GD），如果治疗不充分，可能导致过早死亡。目前对于三种治疗选择（抗甲状腺药物（ATD）、放射性碘（RAI）和手术）哪种更好，尚无共识。
（i）评估治疗 GD 患者的治疗选择和治疗满意度的相关因素；（ii）评估 Graves 病治疗后的生活质量（QoL）。
参与者选自评估甲亢发病率和严重程度的前瞻性研究队列。在 172 例符合条件的 GD 患者中，有 123 例治疗患者（64%仅接受 ATD 治疗，11%接受 RAI 治疗，25%接受甲状腺全切除术，后者通常在 ATD 治疗后进行），以及 18 例未经治疗的新诊断 Graves 病患者（总参与率为 73%）。同意参与的患者填写了一份详细说明治疗选择、QoL 和治疗满意度相关因素的问卷。
参与者报告说，选择治疗方法时最重要的因素包括：对日常生活活动的影响、对使用放射性碘的担忧、抑郁或焦虑的可能性，以及医生的建议。三种治疗类型的满意度都很高。治疗 1 年后的 QoL 高于未经治疗的患者，且与其他国际研究相当。
患者对治疗的满意度和 QoL 不因治疗类型而异。因此，临床和社会因素，结合患者选择和资源可用性，应决定 GD 患者应接受哪种治疗方式。
