Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Thyroid. 2019 Sep;29(9):1192-1200. doi: 10.1089/thy.2019.0180. Epub 2019 Aug 28.
Studies differ regarding whether, compared with courses of conventional duration, longer-term antithyroid drug treatment increases frequency of remission in patients with Graves' hyperthyroidism. We prospectively conducted a randomized, parallel-group study comparing relapse rates in patients receiving longer-term versus conventional-length methimazole therapy. We also sought variables associated with relapse following the latter. We enrolled 302 consecutive patients with untreated first episodes of Graves' hyperthyroidism. After 18-24 months of methimazole, 258 patients (85.4%) were randomized to an additional 36-102-month courses ("long-term group": = 130; scheduled total time on methimazole: 60-120 months) or discontinuation of methimazole ("conventional group": = 128). Patients were followed 48 months postmethimazole cessation. We performed Cox proportional hazards modeling to identify factors associated with relapse after conventional courses. Methimazole was given for 95 ± 22 months in long-term patients and 19 ± 3 months in the conventional group. Fourteen patients experienced cutaneous reactions and 2 liver enzyme elevations during the first 18 months of treatment; no further methimazole-related reactions were observed despite therapy for up to another 118 months. Hyperthyroidism recurred within 48 months postmethimazole withdrawal in 15% (18/119) of long-term patients versus 53% (65/123) of conventional group patients. In the conventional group, older age, higher triiodothyronine or thyrotropin receptor antibody concentrations, lower thyrotropin concentration, or possession of the rs1879877 polymorphism or the polymorphism were independently associated with relapse. Administration of low-dose methimazole for a total of 60-120 months safely and effectively treats Graves' hyperthyroidism, with much higher remission rates than those attained by using conventional 18-24-month courses.
关于与传统疗程相比，长期抗甲状腺药物治疗是否会增加 Graves 甲亢患者缓解的频率，研究结果存在差异。我们前瞻性地进行了一项随机、平行组研究，比较了接受长期和传统疗程甲巯咪唑治疗的患者的复发率。我们还寻找了与后者复发相关的变量。
我们纳入了 302 例未经治疗的 Graves 甲亢首次发作患者。在甲巯咪唑治疗 18-24 个月后，258 例患者（85.4%）被随机分为接受另外 36-102 个月疗程的患者（“长期组”=130；计划使用甲巯咪唑的总时间为 60-120 个月）或停止使用甲巯咪唑的患者（“常规组”=128）。在停止甲巯咪唑后，患者接受了 48 个月的随访。我们采用 Cox 比例风险模型来确定与常规疗程后复发相关的因素。
长期组患者接受甲巯咪唑治疗 95±22 个月，常规组患者接受甲巯咪唑治疗 19±3 个月。在治疗的前 18 个月，14 例患者出现皮肤反应，2 例患者出现肝酶升高；尽管治疗时间最长可达 118 个月，但未观察到其他与甲巯咪唑相关的反应。在停止甲巯咪唑后 48 个月内，15%（18/119）的长期组患者和 53%（65/123）的常规组患者出现甲状腺功能亢进复发。在常规组中，年龄较大、三碘甲状腺原氨酸或促甲状腺素受体抗体浓度较高、促甲状腺素浓度较低、或携带 rs1879877 多态性或 多态性与复发独立相关。
使用低剂量甲巯咪唑总疗程为 60-120 个月，安全有效地治疗 Graves 甲亢，缓解率远高于使用传统 18-24 个月疗程。
