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格雷夫斯病甲状腺毒症的短期抗甲状腺药物治疗

Short-term antithyroid drug therapy for the thyrotoxicosis of Graves's disease.

作者信息

Greer M A, Kammer H, Bouma D J

出版信息

N Engl J Med. 1977 Jul 28;297(4):173-6. doi: 10.1056/NEJM197707282970401.

Abstract

We investigated whether thyrotoxic patients treated with short-term antithyroid therapy would achieve prolonged remissions. Thirty-one previously untreated and nine previously treated patients with thyrotoxic Graves's disease received a single daily dose of methimazole or propylthiouracil. The drug was stopped at, or shortly after, the time they became euthyroid. Twelve of the 31 previously untreated patients remained in remission for 29 +/- 3.5 months (mean +/- S.E.) after treatment for 4.5 +/- 0.3 months. Four of the nine previously treated have remained in remission of 13.0 +/- 2.1 months after treatment for 3.0 +/- 0.3 months. Of various possibilities analyzed, only a small goiter at the onset of therapy and tri-iodothyronine toxicosis were significantly favorable prognostic indicators that a remission would be maintained. The lasting remission rate is as good when antithyroid drugs are stopped as soon as the patient is euthyroid as when they are continued for one year or more.

摘要

我们研究了接受短期抗甲状腺治疗的甲状腺毒症患者是否能实现长期缓解。31例既往未接受过治疗以及9例既往接受过治疗的甲状腺毒性格雷夫斯病患者每日接受一次甲巯咪唑或丙硫氧嘧啶治疗。在他们甲状腺功能恢复正常时或之后不久停药。31例既往未接受过治疗的患者中,有12例在接受4.5±0.3个月治疗后保持缓解29±3.5个月(均值±标准误)。9例既往接受过治疗的患者中有4例在接受3.0±0.3个月治疗后保持缓解13.0±2.1个月。在分析的各种可能性中,只有治疗开始时甲状腺肿较小以及三碘甲状腺原氨酸中毒是显著有利的预后指标,提示缓解状态能够维持。当患者甲状腺功能恢复正常后立即停用抗甲状腺药物时,持久缓解率与持续使用一年或更长时间时一样好。

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