Goñi Iriarte M J, Forga Llenas L, Iriarte Beroiz A, Apiñániz E A, Rodríguez Erdozain R, Menéndez Torre E
Sección de Endocrinología, Hospital de Navarra, Pamplona.
Med Clin (Barc). 1995 Jan 14;104(1):11-4.
The aim of the present study was to evaluate the possible influence of 2 different methods of treatment (antithyroid drugs and antithyroid drugs plus levothyroxine) on the number of recurrences in Graves' disease, as well as to study the possible prognostic factors for the evolution of the disease.
Seventy-six patients allocated in to 2 treatment groups were studied. Group A included those patients treated with decreasing doses of carbimazole and group B included patients treated with high doses of carbimazole plus levothyroxine. The follow-up of these patients was carried out over a minimum of 36 months after discontinuation of treatment.
No significant differences were observed in either the clinical characteristics or hormonal or antibody values in both groups on initiation and at the end of treatment. The percentage of recurrence in group A patients during the first 12 months of follow-up was significantly greater (65% vs 23%, p < 0.001) than in group B. The percentage of recurrence equalled (62.8% vs 60.7%, p = NS) on prolongation of follow-up of up to 36 months. Recurrence was not correlated with either the clinical or biochemical parameters evaluated, although it did correlate with goiter size with recurrence observed in 100% of the patients with goiter greater than or equal to II.
The association of levothyroxine to treatment with carbimazole in Graves' disease delays the appearance of recurrence but does not significantly decrease it in comparison with the treatment with carbimazole in decreasing doses. Only the size of goiter on initiation of treatment may be a prognostic factor for disease evolution.
本研究旨在评估两种不同治疗方法（抗甲状腺药物和抗甲状腺药物加左甲状腺素）对格雷夫斯病复发次数的可能影响，并研究该疾病进展的可能预后因素。
对76例被分配到两个治疗组的患者进行了研究。A组包括接受递减剂量卡比马唑治疗的患者，B组包括接受高剂量卡比马唑加左甲状腺素治疗的患者。这些患者在停药后至少随访36个月。
在治疗开始时和结束时，两组患者的临床特征、激素或抗体值均未观察到显著差异。A组患者在随访的前12个月内的复发率显著高于B组（65%对23%，p<0.001）。随访延长至36个月时，复发率相等（62.8%对60.7%，p=无显著性差异）。复发与所评估的临床或生化参数均无相关性，尽管它与甲状腺肿大大小相关，在甲状腺肿大大于或等于II度的患者中复发率为100%。
在格雷夫斯病中，左甲状腺素与卡比马唑治疗联合使用可延迟复发的出现，但与递减剂量的卡比马唑治疗相比，并未显著降低复发率。仅治疗开始时的甲状腺肿大大小可能是疾病进展的一个预后因素。
