Gossage A A, Crawley J C, Copping S, Hinge D, Himsworth R L
Clin Endocrinol (Oxf). 1983 Jul;19(1):87-96. doi: 10.1111/j.1365-2265.1983.tb00746.x.
The variable clinical course of Graves' disease has been followed in 27 patients each studied for 2 years from the time of diagnosis. Thyroid hormone synthesis was blocked with large doses of antithyroid drugs for the first 12 months while euthyroidism was maintained with triiodothyronine. The latter was given alone from 12 to 18 months, and for the last 6 months the patients received no treatment. The activity of the disease was determined by repeated measurements of thyroid uptake of pertechnetate and by assay of thyrotrophin receptor antibodies (TSH binding inhibitory immunoglobulins). Retrospectively there were no features on presentation which singly or in combination indicated the clinical outcome: 16 patients remained in remission (Group 1) whilst in 11 hyperthyroidism had recurred before the end of the study (Group 2). Both measures of disease activity (thyroid uptake and antibody levels) fell during the first 12 months in patients of both groups. Recurrence of Graves' disease could be predicted in some but not all patients of Group 2 at 12 months by higher thyroid uptakes and levels of thyrotrophin receptor antibodies. There was, however, evidence of abnormal thyroid function, from which we infer continuing activity of the disease, 12 to 18 months after diagnosis in all patients of Group 1, even though these patients had normal TRH tests during the last phase of the study. The difference in the course of Graves' disease 12 to 24 months after diagnosis between those patients who remained in remission and those who did not was relative: in no patient was completely normal physiological control of thyroid function re-established. Clinical remission from hyperthyroidism at this time is a level of disease activity at which the normal physiological output of thyroid hormones is not exceeded.
对27例格雷夫斯病患者进行了为期2年的跟踪研究，从确诊时开始。在最初的12个月里，用大剂量抗甲状腺药物阻断甲状腺激素合成，同时用三碘甲状腺原氨酸维持甲状腺功能正常。在12至18个月期间单独给予三碘甲状腺原氨酸，在最后6个月患者不接受治疗。通过反复测量高锝酸盐的甲状腺摄取量和检测促甲状腺素受体抗体（促甲状腺素结合抑制性免疫球蛋白）来确定疾病的活动度。回顾性分析发现，就诊时没有任何单一或综合的特征能够表明临床结局：16例患者仍处于缓解期（第1组），而11例患者在研究结束前复发了甲亢（第2组）。两组患者的疾病活动度指标（甲状腺摄取量和抗体水平）在最初12个月内均下降。在第2组的部分但并非所有患者中，在12个月时甲状腺摄取量和促甲状腺素受体抗体水平较高可预测格雷夫斯病的复发。然而，有证据表明，在诊断后12至18个月，第1组所有患者均存在甲状腺功能异常，我们据此推断疾病仍在持续活动，尽管这些患者在研究最后阶段促甲状腺激素释放激素试验结果正常。确诊后12至24个月，格雷夫斯病病程在缓解患者和未缓解患者之间的差异是相对的：没有患者重新建立完全正常的甲状腺功能生理控制。此时甲亢的临床缓解是指疾病活动度处于不超过甲状腺激素正常生理输出量的水平。
