Zha Xiao-Yun, Xu Ze-Hong, Dong Jia-Jia, Xie Liang-Xiao, Lai Peng-Bin, Wei Chang-Shun, Zheng Hua-Qiang, Huang Duo-Bin, Wu Jin-Zhi
The First Department of Endocrinology and Metabolism, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China.
Front Endocrinol (Lausanne). 2025 Mar 12;16:1551983. doi: 10.3389/fendo.2025.1551983. eCollection 2025.
This study aims to evaluate the utility of shear wave elastography (SWE) in predicting the recurrence risk of Graves' disease(GD), to construct a recurrence risk prediction model that integrates SWE and clinical characteristics, and to develop a risk scoring system aimed at enhancing the survival rate of patients with GD following drug treatment and prognosis management.
A prospective cohort study was conducted involving with 169 patients diagnosed with first-episode GD. By analyzing SWE parameters, three-dimensional thyroid volume, TRAb levels, and other clinical indicators, the Cox proportional hazards model was used to construct a recurrence risk prediction model for GD. Bootstrap resampling was employed to verify the model's reliability. A simple recurrence risk scoring system was also developed based on independent risk factors for clinical use.
The study identified several factors significantly associated with GD recurrence: age <35 years, a family history of GD, an initial TRAb level≧15 IU/ml, a thyroid volume≧19 cm³, an initial SWE≧2.0 m/s, and a TSH(thyroid stimulating hormone) normalization duration <4 months. Notably, SWE was found to be a strong predictor, with patients exhibiting SWE ≥2.0 m/s having a recurrence risk that is 4.54 times greater than those with lower values. Based on these risk factors, a scoring system was developed with a cutoff of 4 points for recurrence risk, demonstrating a sensitivity of 74% and a specificity of 91.8%. The area under the curve (AUC) of the final model was 0.91, indicating high predictive accuracy.
SWE is an independent predictor of recurrence risk in GD. When combined with traditional clinical indicators, it significantly enhances the predictive capability for GD recurrence. The risk score model provides a simple and effective tool for individualized management and optimization of treatment strategies.
本研究旨在评估剪切波弹性成像（SWE）在预测Graves病（GD）复发风险中的效用，构建整合SWE和临床特征的复发风险预测模型，并开发一个风险评分系统，以提高GD患者药物治疗后的生存率及预后管理水平。
对169例初发GD患者进行前瞻性队列研究。通过分析SWE参数、甲状腺三维体积、促甲状腺素受体抗体（TRAb）水平及其他临床指标，采用Cox比例风险模型构建GD复发风险预测模型。采用Bootstrap重抽样法验证模型的可靠性。还基于独立危险因素开发了一个简单的复发风险评分系统供临床使用。
该研究确定了几个与GD复发显著相关的因素：年龄<35岁、GD家族史、初始TRAb水平≧15 IU/ml、甲状腺体积≧19 cm³、初始SWE≧2.0 m/s以及促甲状腺激素（TSH）恢复正常的持续时间<4个月。值得注意的是，SWE被发现是一个强有力的预测指标，SWE≥2.0 m/s的患者复发风险是SWE值较低患者的4.54倍。基于这些危险因素，开发了一个复发风险评分系统，临界值为4分，敏感性为74%，特异性为91.8%。最终模型的曲线下面积（AUC）为0.91，表明预测准确性高。
SWE是GD复发风险的独立预测指标。与传统临床指标相结合时，它能显著提高GD复发的预测能力。风险评分模型为个体化管理和优化治疗策略提供了一个简单有效的工具。
