Törring O, Tallstedt L, Wallin G, Lundell G, Ljunggren J G, Taube A, Sääf M, Hamberger B
Department of Endocrinology, Karolinska Hospital, Stockholm, Sweden.
J Clin Endocrinol Metab. 1996 Aug;81(8):2986-93. doi: 10.1210/jcem.81.8.8768863.
To analyze the benefits and risks of three common treatments, we randomly assigned 179 patients with Graves' hyperthyroidism as follows: 60 patients, 20-34 yr of age (young adults), received antithyroid drugs for 18 months (medical) or subtotal thyroidectomy (surgical), and 119 patients, 35-55 yr of age (old adults), received medical, surgical, or radioiodine (iodine-131) treatment. The follow-up time was at least 48 months. Antithyroid drugs, surgery, or iodine-131 treatment normalized the mean serum hormone levels within 6 weeks. The risk of relapse was highest in the medically treated young and old adults (42% vs. 34%), followed by that in those treated with iodine-131 (21%) and that in the surgically treated young and old adults (3% vs 8%), respectively. Elevated TSH receptor antibodies at the end of medical therapy or increasing TSH receptor antibodies values after medical or surgical treatment increased the probability of relapse. Development or worsening of ophthalmopathy was not associated with relapse per se. Ninety percent of the subjects in all groups were satisfied with the treatment they received. No significant difference in sick-leave due to Graves' or other diseases was seen during the first 2 yr after initiation of therapy. The increased risk of ophthalmopathy in patients with high serum T3 levels, especially when treated with iodine-131, and the relatively high frequency of relapse after treatment with antithyroid drugs are important factors to consider when selecting therapy for Graves' disease.
为分析三种常见治疗方法的益处和风险,我们将179例格雷夫斯甲亢患者随机分组如下:60例年龄在20 - 34岁的患者(年轻成年人)接受抗甲状腺药物治疗18个月(药物治疗组)或甲状腺次全切除术(手术治疗组),119例年龄在35 - 55岁的患者(年长成年人)接受药物治疗、手术治疗或放射性碘(碘 - 131)治疗。随访时间至少为48个月。抗甲状腺药物、手术或碘 - 131治疗在6周内使平均血清激素水平恢复正常。药物治疗的年轻和年长成年人复发风险最高(分别为42%和34%),其次是接受碘 - 131治疗的患者(21%),以及接受手术治疗的年轻和年长成年人(分别为3%和8%)。药物治疗结束时促甲状腺素受体抗体升高或药物或手术治疗后促甲状腺素受体抗体值升高会增加复发概率。眼病的发生或恶化本身与复发无关。所有组中90%的受试者对所接受的治疗感到满意。治疗开始后的前2年,因格雷夫斯病或其他疾病导致的病假天数无显著差异。血清T3水平高的患者,尤其是接受碘 - 131治疗时,眼病风险增加,以及抗甲状腺药物治疗后相对较高的复发频率,是选择格雷夫斯病治疗方法时需要考虑的重要因素。