Fujikawa-Megumi Clinic, Mizutani 2-7-7, Higashi-ku, Fukuoka, Japan.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, Japan.
Eur Thyroid J. 2024 Nov 8;13(6). doi: 10.1530/ETJ-24-0085. Print 2024 Dec 1.
As thionamide is associated with various adverse effects, we re-evaluated the practical efficacy of potassium iodide (KI) therapy for Graves' hyperthyroidism (GD).
We administered KI (mainly 100 mg/day) to 324 untreated GD patients and added methimazole (MMI) only to those remaining thyrotoxic even at 200 mg/day. When the patient became hypothyroid, MMI, if taken was stopped, then levothyroxine (LT4) was added without reducing the KI dose. Radioactive iodine (RI) therapy or thyroidectomy was performed whenever required. We evaluated the early effects of KI at 2-4 weeks and followed patients for 2 years.
At 2 weeks, serum thyroid hormone levels decreased in all 324 patients. At 4 weeks, fT4, fT3, and both fT4 and fT3 levels became normal or low in 74.7%, 50.6%, and 50.6% of patients, respectively. In a cross-sectional survey over 2 years, GD was well-controlled with KI or KI + LT4 (KI-effective) in >50% of patients at all time points. Among 288 patients followed for 2 years, 42.7% remained 'KI-effective' throughout the 2 years (KI Group), 30.9% were well-controlled with additional MMI given for 1-24 months, and 26.4% were successfully treated with ablative therapy (mainly RI). Among 'KI-effective' patients at 4 weeks, 76.5% were classified into the KI Group. No patients experienced adverse effects from KI.
KI therapy was useful in the treatment of GD. A sufficient dose of KI was effective in >50% of GD patients from 4 weeks to 2 years, and 42.7% (76.5% of 'KI-effective' patients at 4 weeks) remained 'KI-effective' throughout the 2 years.
由于硫脲类药物与各种不良反应相关，我们重新评估了碘化钾（KI）治疗格雷夫斯病（GD）的实际疗效。
我们给 324 例未经治疗的 GD 患者使用 KI（主要为 100mg/天），仅对即使服用 200mg/天仍存在甲状腺毒症的患者加用甲巯咪唑（MMI）。当患者出现甲状腺功能减退时，如果停用 MMI，则不加用左甲状腺素（LT4），而不减少 KI 剂量。必要时行放射性碘（RI）治疗或甲状腺切除术。我们评估了 KI 在 2-4 周的早期效果，并随访患者 2 年。
在 324 例患者中，所有患者在 2 周时血清甲状腺激素水平下降。在 4 周时，fT4、fT3 和 fT4 和 fT3 水平分别在 74.7%、50.6%和 50.6%的患者中正常或降低。在 2 年的横断面研究中，超过 50%的患者在各个时间点均通过 KI 或 KI+LT4（KI 有效）得到良好控制。在 288 例随访 2 年的患者中，42.7%的患者在 2 年内一直保持“KI 有效”（KI 组），30.9%的患者通过 1-24 个月加用 MMI 得到良好控制，26.4%的患者通过消融治疗（主要是 RI）成功治疗。在 4 周时的“KI 有效”患者中，76.5%的患者被分类到 KI 组。没有患者因 KI 出现不良反应。
KI 治疗对 GD 有效。从 4 周到 2 年，足够剂量的 KI 对超过 50%的 GD 患者有效，42.7%（4 周时“KI 有效”患者的 76.5%）在 2 年内保持“KI 有效”。
