Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Republic of Korea.
Eur Thyroid J. 2023 Mar 17;12(2). doi: 10.1530/ETJ-22-0226. Print 2023 Apr 1.
This study evaluated the efficacy of antithyroid drugs (ATDs) and risk factors associated with the recurrence of Graves' hyperthyroidism using a comprehensive retrospective cohort.
We included 1829 patients newly diagnosed with Graves' hyperthyroidism, with sufficient follow-up data. Clinical outcomes of the patients and risk factors associated with recurrence-free survival, including the changes in thyrotropin receptor antibody, were evaluated.
The median age of the patients was 44.5 years, and 69% were female. Among the patients, 1235 had a chance to withdraw ATD after a median of 23 (interquartile range (IQR) 17.0-35.5) months of treatment. The first remission rate was 55.6% during a median of 72.7 months of follow-up. After the first recurrence, 95% of patients underwent the second course of ATD treatment for a median of 21.1 (IQR 14.8-31.7) months, and the remission rate was 54.1%. During a median of 67 months of follow-up, 7.7% of patients underwent surgery, and 10.5% underwent radioactive iodine therapy. Approximately 30% were still on ATD therapy for recurrent disease or prolonged low-dose maintenance. Younger age (<45 years), male sex, and fluctuating or smoldering of TRAb levels were independent risk factors of the first recurrence after ATD treatment.
ATD treatment is an acceptable option for the initial treatment of Graves' hyperthyroidism as well as for recurrent disease. The optimal treatment period for ATD treatment needs to be determined using the individual risk factors of recurrence.
本研究通过全面回顾性队列评估抗甲状腺药物（ATD）的疗效和 Graves 甲亢复发的相关危险因素。
纳入了 1829 例新诊断的 Graves 甲亢患者，这些患者有足够的随访数据。评估了患者的临床结局和无复发生存的相关危险因素，包括促甲状腺素受体抗体的变化。
患者的中位年龄为 44.5 岁，69%为女性。在这些患者中，1235 例患者有机会在接受 ATD 治疗 23 个月后（中位数为 23 个月，四分位距为 17.0-35.5）停药。中位随访 72.7 个月后，首次缓解率为 55.6%。第一次复发后，95%的患者接受了第二次 ATD 治疗，中位时间为 21.1 个月（中位数为 14.8-31.7），缓解率为 54.1%。中位随访 67 个月期间，7.7%的患者接受了手术，10.5%的患者接受了放射性碘治疗。约 30%的患者仍因疾病复发或需要低剂量维持而继续服用 ATD。年龄较小（<45 岁）、男性、TRAb 水平波动或不活动是 ATD 治疗后首次复发的独立危险因素。
ATD 治疗是 Graves 甲亢初始治疗和复发性疾病的一种可接受的选择。需要根据复发的个体危险因素来确定 ATD 治疗的最佳治疗期。
