Saadat Navid, Masoumi Safdar, Shahrzad Mohammad Karim, Azizi Fereidoun
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Endocrinol Metab. 2024 Jan 2;22(1):e140956. doi: 10.5812/ijem-140956. eCollection 2024 Jan.
Extended low serum thyrotropin (TSH) levels may increase the risk of cardiovascular events in patients with hyperthyroidism.
This study aimed to compare the time spent with sustained normal TSH concentration following short- and long-term methimazole treatment.
A total of 258 patients with Graves' hyperthyroidism completed 18 - 24 months of methimazole therapy and were randomized to discontinue treatment (n = 128, short-term group) or continue an additional 36 - 102 months of methimazole therapy (n = 130, long-term group). Clinical and laboratory evaluations were performed every 6 months for 132 months after randomization.
There was no difference in serum-free thyroxine, triiodothyronine, and TSH concentrations between the 2 groups at the time of randomization. Of 128 patients in the short-term group, 5 left in follow-up, 2 became hypothyroid, 67 (54%) had a relapse of hyperthyroidism, and only 54 (44%) were euthyroid at the end of the study. Among 130 patients on the long-term methimazole therapy, 4 were left in follow-up, 24 developed hyperthyroidism, 4 developed hypothyroidism, and 98 (78%) were euthyroid 132 months post-randomization. Total time spent on euthyroidism was 90.4% ± 8.1% of the study period in the short-term and 95.8% ± 7.0% in the long-term treatment groups (P < 0.001). The lowest time spent in euthyroidism (74.6% ± 6.4% of the study period) belonged to 29 (24%) patients in the short-term group under levothyroxine therapy because of fluctuation in serum TSH. Patients in both groups with hyperthyroidism relapse who chose methimazole therapy spent >90% of the study time in euthyroidism.
In patients with Graves' hyperthyroidism, sustained normal serum TSH levels were more common in the long term as compared to the short-term methimazole treatment.
甲状腺功能亢进症患者血清促甲状腺激素（TSH）水平持续降低可能会增加心血管事件的风险。
本研究旨在比较短期和长期服用甲巯咪唑治疗后促甲状腺激素（TSH）浓度维持正常的时间。
共有258例格雷夫斯甲状腺功能亢进症患者完成了18至24个月的甲巯咪唑治疗，并被随机分为停药组（n = 128，短期组）或继续接受36至102个月的甲巯咪唑治疗（n = 130，长期组）。随机分组后132个月内每6个月进行一次临床和实验室评估。
随机分组时两组患者的血清游离甲状腺素、三碘甲状腺原氨酸和TSH浓度无差异。短期组的128例患者中，5例失访，2例发生甲状腺功能减退，67例（54%）甲状腺功能亢进复发，研究结束时仅有54例（44%）甲状腺功能正常。长期接受甲巯咪唑治疗的130例患者中，4例失访，24例发生甲状腺功能亢进，4例发生甲状腺功能减退，随机分组132个月后98例（78%）甲状腺功能正常。短期治疗组甲状腺功能正常的总时间占研究期的90.4%±8.1%，长期治疗组为95.8%±7.0%（P < 0.001）。短期组中因血清TSH波动而接受左甲状腺素治疗的29例（24%）患者甲状腺功能正常的时间最短（占研究期的74.6%±6.4%）。两组中选择甲巯咪唑治疗的甲状腺功能亢进复发患者在研究期间甲状腺功能正常的时间均超过90%。
在格雷夫斯甲状腺功能亢进症患者中，与短期甲巯咪唑治疗相比，长期治疗血清TSH水平持续正常更为常见。
