Meling Stokland Ann-Elin, Austdal Marie, Nedrebø Bjørn Gunnar, Carlsen Siri, Hetland Hanne Brit, Breivik Lars, Ueland Hans Olav, Watt Torquil, Cramon Per Karkov, Løvås Kristian, Husebye Eystein Sverre, Ueland Grethe Åstrøm
Department of Endocrinology, Stavanger University Hospital, 4011 Stavanger, Norway.
Department of Clinical Science, University of Bergen, 5021 Bergen, Norway.
J Clin Endocrinol Metab. 2024 Feb 20;109(3):827-836. doi: 10.1210/clinem/dgad538.
Graves disease (GD) is a leading cause of hyperthyroidism. Detailed investigations and predictors of long-term outcomes are missing.
This work aimed to investigate the outcomes in GD 25 years after initiating antithyroid drug treatment, including disease course, clinical and biochemical predictors of relapse, and quality of life.
A retrospective follow-up was conducted of GD patients that participated in a randomized trial from 1997 to 2001. Demographic and clinical data were obtained from medical records and questionnaires. Biobank samples were analyzed for inflammatory biomarkers and compared with age- and sex-matched healthy individuals.
We included 83% (182/218) of the patients from the original study. At the end of follow-up, normal thyroid function was achieved in 34%. The remaining had either active disease (1%), spontaneous hypothyroidism (13%), or had undergone ablative treatment with radioiodine (40%) or thyroidectomy (13%). Age younger than or equal to 40 years, thyroid eye disease (TED), smoking, and elevated levels of interleukin 6 and tumor necrosis factor receptor superfamily member 9 (TNFRS9) increased the risk of relapsing disease (odds ratio 3.22; 2.26; 2.21; 1.99; 2.36). At the end of treatment, CD40 was lower in patients who maintained normal thyroid function (P = .04). At the end of follow-up, 47% had one or more autoimmune diseases, including vitamin B12 deficiency (26%) and rheumatoid arthritis (5%). GD patients who developed hypothyroidism had reduced quality of life.
Careful lifelong monitoring is indicated to detect recurrence, hypothyroidism, and other autoimmune diseases. Long-term ATD treatment emerges as a beneficial first-line treatment option, especially in patients with young age at onset or presence of TED.
格雷夫斯病（GD）是甲状腺功能亢进的主要病因。目前缺乏详细的调查以及长期预后的预测指标。
本研究旨在调查抗甲状腺药物治疗25年后GD患者的预后情况，包括疾病进程、复发的临床和生化预测指标以及生活质量。
对1997年至2001年参加一项随机试验的GD患者进行回顾性随访。从病历和问卷中获取人口统计学和临床数据。对生物样本库中的样本进行炎症生物标志物分析，并与年龄和性别匹配的健康个体进行比较。
我们纳入了原研究中83%（182/218）的患者。随访结束时，34%的患者甲状腺功能恢复正常。其余患者要么患有活动性疾病（1%）、自发性甲状腺功能减退（13%），要么接受了放射性碘消融治疗（40%）或甲状腺切除术（13%）。年龄小于或等于40岁、甲状腺眼病（TED）、吸烟以及白细胞介素6和肿瘤坏死因子受体超家族成员9（TNFRS9）水平升高会增加疾病复发风险（比值比分别为3.22、2.26、2.21、1.99、2.36）。治疗结束时，维持甲状腺功能正常的患者CD40水平较低（P = 0.04）。随访结束时，47%的患者患有一种或多种自身免疫性疾病，包括维生素B12缺乏（26%）和类风湿关节炎（5%）。发生甲状腺功能减退的GD患者生活质量下降。
需要进行仔细的终身监测以发现复发、甲状腺功能减退和其他自身免疫性疾病。长期抗甲状腺药物治疗是一种有益的一线治疗选择，尤其是对于发病年龄较轻或患有TED的患者。
