Sim Sing Yang, Lethem Claudia, Coppini David Vincent
Poole Hospital, NHS Foundation Trust Poole UK.
Endocrinol Diabetes Metab. 2018 Nov 28;2(1):e00046. doi: 10.1002/edm2.46. eCollection 2019 Jan.
A study looking at the distribution, management and outcomes of patients referred to a secondary care endocrine clinic with a diagnosis of hyperthyroidism.
Retrospective longitudinal study of 442 patients referred over a 15-year period (2002-2017) with a diagnosis of hyperthyroidism to a secondary care endocrine clinic. Information on demographics, diagnosis, treatments and outcomes was recorded as patients attended for clinic visits. Patients were initially treated with 1-2 courses of thionamides and subsequently referred for radioiodine or surgery in cases of relapse.
Patients (75% female, age range 17-91 years) were treated with thionamides for an average of 295 days. As expected, the majority of patients had Graves Disease (GD) (80%), followed by those with multinodular goitre (MNG) (8.6%), amiodarone-induced hyperthyroidism (6.7%) and toxic nodule (3.7%). Drug-induced remission rates were best seen in patients with GD (43%), and side effects necessitating change in treatment were relatively low (2.5%). In 121 patients who received radioiodine, hypothyroidism occurred in 50% of patients and was commoner in patients with GD (65%) than in those with MNG (22%) and toxic nodule (6.3%).
This study is only one of a few reporting on the characteristics of patients with hyperthyroidism attending a typical secondary care endocrine clinic. Whilst we appreciate its limitations, we encourage similar methods of collecting valuable real world data to facilitate conduction of specialist peer review visits in other similar clinic settings.
一项关于被转诊至二级医疗内分泌诊所且诊断为甲状腺功能亢进症患者的分布、管理及治疗结果的研究。
对在15年期间(2002 - 2017年)被转诊至二级医疗内分泌诊所且诊断为甲状腺功能亢进症的442例患者进行回顾性纵向研究。随着患者前来门诊就诊,记录其人口统计学信息、诊断、治疗及治疗结果。患者最初接受1 - 2个疗程的硫代酰胺治疗,若复发则随后转诊接受放射性碘治疗或手术治疗。
患者中75%为女性,年龄范围为17 - 91岁,接受硫代酰胺治疗的平均时长为295天。正如预期,大多数患者患有格雷夫斯病(GD)(80%),其次是多结节性甲状腺肿(MNG)患者(8.6%)、胺碘酮所致甲状腺功能亢进症患者(6.7%)及毒性结节患者(3.7%)。GD患者的药物诱导缓解率最高(43%),因副作用而需要改变治疗方案的比例相对较低(2.5%)。在121例接受放射性碘治疗的患者中,50%的患者出现甲状腺功能减退,GD患者中出现甲状腺功能减退的情况(65%)比MNG患者(22%)和毒性结节患者(6.3%)更为常见。
本研究只是少数几项报告典型二级医疗内分泌诊所甲状腺功能亢进症患者特征的研究之一。尽管我们认识到其局限性,但我们鼓励采用类似方法收集有价值的真实世界数据,以促进在其他类似诊所环境中进行专科同行评审。