Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Endocrinol Metab (Seoul). 2021 Jun;36(3):491-499. doi: 10.3803/EnM.2021.1070. Epub 2021 Jun 16.
Graves' disease is associated with thyrotropin (TSH) receptor stimulating antibody, for which there is no therapeutic agent. This disease is currently treated through inhibition of thyroid hormone synthesis or destruction of the thyroid gland. Recurrence after antithyroid drug (ATD) treatment is common. Recent studies have shown that the longer is the duration of use of ATD, the higher is the remission rate. Considering the relationship between clinical outcomes and iodine intake, recurrence of Graves' disease is more common in iodine-deficient areas than in iodine-sufficient areas. Iodine restriction in an iodine-excessive area does not improve the effectiveness of ATD or increase remission rates. Recently, Danish and Korean nationwide studies noted significantly higher prevalence of birth defects in newborns exposed to ATD during the first trimester compared to that of those who did not have such exposure. The prevalence of birth defects was lowest when propylthiouracil (PTU) was used and decreased by only 0.15% when methimazole was changed to PTU in the first trimester. Therefore, it is best not to use ATD in the first trimester or to change to PTU before pregnancy.
格雷夫斯病与促甲状腺激素（TSH）受体刺激抗体有关，目前尚无治疗该疾病的药物。该疾病目前通过抑制甲状腺激素合成或破坏甲状腺来治疗。抗甲状腺药物（ATD）治疗后的复发较为常见。最近的研究表明，ATD 使用时间越长，缓解率越高。考虑到临床结果与碘摄入之间的关系，在碘缺乏地区，格雷夫斯病的复发比在碘充足地区更为常见。在碘过量地区限制碘摄入并不能提高 ATD 的疗效或增加缓解率。最近，丹麦和韩国的全国性研究表明，与未接触 ATD 的孕妇相比，在孕早期接触 ATD 的新生儿出生缺陷的患病率显著更高。使用丙基硫氧嘧啶（PTU）时出生缺陷的患病率最低，而在孕早期将甲巯咪唑换为 PTU 时，患病率仅降低 0.15%。因此，最好不要在孕早期使用 ATD，或在怀孕前换用 PTU。
