Veríssimo David, Pereira Beatriz, Vinhais Joana, Ivo Catarina, Martins Ana C, E Silva João N, Passos Dolores, Lopes Luís, de Castro João J, Marcelino Mafalda
Department of Endocrinology, Portuguese Armed Forces Hospital, Lisboa, Portugal.
Endocrine. 2025 Jan;87(1):234-242. doi: 10.1007/s12020-024-04000-1. Epub 2024 Aug 16.
Hyperthyroidism guidelines have not been updated over the past five years, despite numerous data on the subject, and recent studies providing a wide variation in treatment success rates. We aim to compare the effectiveness and safety of treatment modalities in patients with Graves' disease or toxic nodular disease.
Single center retrospective cohort study of Graves' disease and toxic nodular disease patients treated between 1983 and 2023.
A total of 411 patients were treated for hyperthyroidism, 245 due to Graves' disease and 166 due to or toxic nodular disease, followed for a median of 7 years. In Graves' disease, 90.2% were treated with antithyroid drugs over 250 cycles, achieving 41.7% cumulative remission. Half of all relapses (50.9%) occurred in the first year, 76.3% in the first three years, and 98.3% within nine years. Treatment periods of 12-24 months showed higher remission and lower relapse rates than longer periods. I-131 was used in 103 cycles with 82.5% remission and 7.1% relapse. A total of 29 thyroidectomies resulted in 100% remission, with no relapse. In toxic nodular disease, surgery was the most frequently used treatment (54.5%), followed by I-131 (37.1%).
Our findings support antithyroid drugs as the preferential first-line treatment for Graves' disease, allowing for euthyroidism with minimal adverse effects. Given the propensity for relapse, we suggest a rigorous monitoring, particularly within the first three years. In toxic nodular disease, surgery should be the preferred option, with I-131 being reserved for single adenomas and small goiters.
尽管有大量关于该主题的数据，且近期研究显示治疗成功率差异很大，但过去五年甲状腺功能亢进症指南尚未更新。我们旨在比较格雷夫斯病或毒性结节性疾病患者不同治疗方式的有效性和安全性。
对1983年至2023年间接受治疗的格雷夫斯病和毒性结节性疾病患者进行单中心回顾性队列研究。
共有411例患者接受了甲状腺功能亢进症治疗，其中245例因格雷夫斯病，166例因毒性结节性疾病，中位随访时间为7年。在格雷夫斯病患者中，250多个疗程使用了抗甲状腺药物治疗，累积缓解率为41.7%。所有复发患者中有一半（50.9%）在第一年复发，76.3%在头三年复发，98.3%在九年内复发。12至24个月的治疗期缓解率较高，复发率低于更长疗程。103个疗程使用了碘-131，缓解率为82.5%，复发率为7.1%。共进行了29例甲状腺切除术，缓解率达100%，无复发。在毒性结节性疾病中，手术是最常用的治疗方法（54.5%），其次是碘-131（37.1%）。
我们的研究结果支持将抗甲状腺药物作为格雷夫斯病的首选一线治疗方法，可实现甲状腺功能正常，且副作用最小。鉴于复发倾向，我们建议进行严格监测，尤其是在头三年。在毒性结节性疾病中，手术应是首选方案，碘-131则适用于单个腺瘤和小结节性甲状腺肿。
