Curso de Pós-Graduação em Medicina Interna, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.
Endocrinologia e Metabolismo, Hospital da Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil.
Arch Endocrinol Metab. 2021 May 18;64(5):514-520. doi: 10.20945/2359-3997000000265.
Graves' disease (GD) is the main cause of hyperthyroidism among adults. It is an autoimmune condition classically marked by the Merserburg Triad (goiter, thyrotoxicosis, and orbitopathy), but the change in presentation of GD over time has rarely been studied. To determine changes in the clinical presentation of patients with GD in the last 30 years.
The study evaluated 475 patients diagnosed with GD between 1986 and 2016 in a single center. Patients were evaluated regarding epidemiological aspects, thyroid function, inflammatory activity of the eyes evaluated by the Clinical Activity Score; CAS, severity evaluated by NOSPECS classification and thyroid volume estimated by ultrasonography.
Patients assessment identified an increase in the mean age of diagnosis of GD (p < 0.02), a reduction in thyroid volume (p < 0.001) and less intense orbital involvement from 2007-2016 compared to 1986-2006 (p = 0.04). The number of smoking patients was smaller from 2007 to 2016 (28.7%) than 1986 to 2006 (42.8% p = 0.001). The TSH and TRAb values did not had significant changes.
GD presentation appears to be changed in the last years compared to the typical initial presentation. There is a less frequent inflammatory involvement of orbital tissue, smaller goiters, a lower number of smokers and diagnosis at older age.
Graves 病（GD）是成人甲亢的主要原因。它是一种自身免疫性疾病，经典表现为 Merserburg 三联征（甲状腺肿、甲状腺功能亢进和眼病），但 GD 随时间推移的表现变化很少被研究。为了确定过去 30 年来 GD 患者临床表现的变化。
本研究在单中心评估了 1986 年至 2016 年间诊断为 GD 的 475 例患者。对患者进行流行病学方面、甲状腺功能、眼炎症活动的评估（临床活动评分；CAS）、NOSPECS 分类评估的严重程度和超声检查估计的甲状腺体积的评估。
患者评估发现 GD 的诊断平均年龄增加（p < 0.02），甲状腺体积减少（p < 0.001），2007-2016 年与 1986-2006 年相比，眼眶受累程度较轻（p = 0.04）。2007 年至 2016 年，吸烟患者的数量较 1986 年至 2006 年减少（28.7%比 42.8%，p = 0.001）。TSH 和 TRAb 值没有明显变化。
与典型的初始表现相比，GD 的表现似乎在过去几年发生了变化。眼眶组织炎症受累较少，甲状腺肿较小，吸烟者较少，诊断年龄较大。
