Laurberg P, Buchholtz Hansen P E, Iversen E, Eskjaer Jensen S, Weeke J
Acta Endocrinol (Copenh). 1986 Jan;111(1):39-43. doi: 10.1530/acta.0.1110039.
One hundred and twenty-four patients with newly diagnosed hyperthyroidism received a combined thionamid-thyroxine medical therapy for approximately 2 years. According to the estimated goitre size before therapy and the type of goitre the patients were divided into 4 groups: Graves' disease no goitre (n = 19), Graves' disease small goitre (n = 57), Graves' disease medium or large goitre (n = 23), multinodular goitre (n = 25). The median follow-up period after cessation of medication was 64 (range 11-141) months. The remission rates in the different groups during follow-up were calculated using life table analysis. Graves' patients with no goitre or a small goitre had a significantly better outcome (remission % after 5 years 82.5 +/- 15.4 (SE) and 71.5 +/- 7.8, respectively) than Graves' patients with a medium size or large goitre (remission % after 5 years 37.0 +/- 11.1)(P less than 0.025). Most patients with multinodular goitre had a relapse within the first year after stop of medication (remission % after 5 years 15.5 +/- 10.1). Hence patients with Graves' disease having a small thyroid gland should be treated medically while surgery or radioiodine may be a more reasonable choice in Graves' patients with medium size or large goitres. Medically treated patients with toxic multinodular goitres have a very small chance of prolonged remission if medication is stopped.
124例新诊断的甲状腺功能亢进患者接受硫代酰胺-甲状腺素联合药物治疗约2年。根据治疗前估计的甲状腺肿大小和甲状腺肿类型，将患者分为4组：无甲状腺肿的格雷夫斯病（n = 19）、小甲状腺肿的格雷夫斯病（n = 57）、中或大甲状腺肿的格雷夫斯病（n = 23）、多结节性甲状腺肿（n = 25）。停药后的中位随访期为64（范围11 - 141）个月。采用寿命表分析计算随访期间不同组别的缓解率。无甲状腺肿或小甲状腺肿的格雷夫斯病患者的预后明显优于中或大甲状腺肿的格雷夫斯病患者（5年后缓解率分别为82.5 +/- 15.4（SE）和71.5 +/- 7.8）（5年后缓解率为37.0 +/- 11.1）（P < 0.025）。大多数多结节性甲状腺肿患者在停药后第一年内复发（5年后缓解率为15.5 +/- 10.1）。因此，甲状腺小的格雷夫斯病患者应接受药物治疗，而对于中或大甲状腺肿的格雷夫斯病患者，手术或放射性碘可能是更合理的选择。药物治疗的毒性多结节性甲状腺肿患者如果停药，长期缓解的机会非常小。
