Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, I.R.Iran.
J Clin Endocrinol Metab. 2024 Sep 16;109(10):e1881-e1888. doi: 10.1210/clinem/dgae456.
Antithyroid drugs (ATD) are the treatment of choice for the majority of patients with Graves' hyperthyroidism worldwide. However, relapse of hyperthyroidism after withdrawal of arbitrarily chosen conventional 12 to 18 months of therapy is very common. In the last 2 decades, many studies have shown that treatment with long-term ATD (LT-ATD) is effective and safe in the maintenance of euthyroidism. In addition, it has been reported that serum TSH receptor antibody may not decrease permanently before 5 to 6 years of ATD treatment, and clinical trials have shown that ≥5 years of ATD treatment is accompanied by remission in the majority of patients with Graves' hyperthyroidism. The objective of this article is to discuss the optimal time to withdraw of conventional ATD therapy, to illustrate the decision-making of the management of recurrent hyperthyroidism, to review the proper management of LT-ATD, and to generate suggestions for lifelong ATD treatment by discussing 4 scenarios of decision-making in patients with Graves' disease.
抗甲状腺药物（ATD）是治疗全球大多数格雷夫斯甲亢患者的首选方法。然而，在任意选择的常规 12 至 18 个月治疗后停药后，甲状腺功能亢进症的复发非常常见。在过去的 20 年中，许多研究表明，长期使用 ATD（LT-ATD）在维持甲状腺功能正常方面是有效和安全的。此外，据报道，在接受 ATD 治疗 5 至 6 年之前，血清 TSH 受体抗体可能不会永久下降，临床试验表明，接受 ATD 治疗≥5 年可使大多数格雷夫斯甲亢患者缓解。本文的目的是讨论常规 ATD 治疗停药的最佳时间，说明复发性甲状腺功能亢进症的管理决策，回顾 LT-ATD 的适当管理，并通过讨论格雷夫斯病患者的 4 种决策情况，为终身 ATD 治疗提供建议。
