Vitti P, Rago T, Chiovato L, Pallini S, Santini F, Fiore E, Rocchi R, Martino E, Pinchera A
Istituto di Endocrinologia, University of Pisa, Italy.
Thyroid. 1997 Jun;7(3):369-75. doi: 10.1089/thy.1997.7.369.
The clinical course of 306 Graves' patients treated with methimazole (MMI) was reviewed with the aim of establishing criteria able to predict remission of hyperthyroidism after medical treatment. One hundred and ninety-four (149 females, 45 males) of 306 (63.4%) patients had relapse of hyperthyroidism after antithyroid drug (ATD) withdrawal. Relapse was more frequent during the first months of the follow-up, but still it was observed 3 years after MMI withdrawal. The relapse rate was dependent on the age of the patient, the size of goiter, and the level of TSH-receptor antibody (TRAb) at diagnosis, being observed in 40 of 47 (85%) patients with high (> 30 U/L) TRAb level and in 54 of 101 (53%) patients with low TRAb level (< or = 30 U/L; p <.0002). Remission was more frequent (43.3%) in patients having the combination goiter size < or = 40 mL, TRAb level < or = 30 U/L, than in patients with goiter size > 40 mL and high TRAb levels (9%). In the subgroup of patients with the combination: goiter < or = 40 mL- TRAb < or = 30 U/L - age at onset > 40 years, the remission rate was 80%, and all relapses occurred within the first 9 months after MMI withdrawal. In conclusion, our study confirms that hyperthyroidism relapses in the majority of patients with Graves' disease treated with ATD. Among different clinical and laboratory features, age at onset of hyperthyroidism, goiter size and TRAb level are particularly helpful in identifying those patients who are more prone to undergo a remission of hyperthyroidism after medical treatment and may be useful to select the minority of Graves' patients who will benefit from antithyroid drug treatment as a first choice.
回顾了306例接受甲巯咪唑（MMI）治疗的格雷夫斯病患者的临床病程，目的是建立能够预测药物治疗后甲状腺功能亢进症缓解的标准。306例患者中有194例（149例女性，45例男性，占63.4%）在停用抗甲状腺药物（ATD）后出现甲状腺功能亢进症复发。复发在随访的最初几个月更为频繁，但在停用MMI 3年后仍有观察到。复发率取决于患者年龄、甲状腺肿大小以及诊断时促甲状腺素受体抗体（TRAb）水平，在47例TRAb水平高（>30 U/L）的患者中有40例（85%）复发，在101例TRAb水平低（≤30 U/L）的患者中有54例（53%）复发（p<0.0002）。甲状腺肿大小≤40 mL且TRAb水平≤30 U/L的患者缓解更为频繁（43.3%），高于甲状腺肿大小>40 mL且TRAb水平高的患者（9%）。在甲状腺肿≤40 mL - TRAb≤30 U/L - 发病年龄>40岁的患者亚组中，缓解率为80%，所有复发均发生在停用MMI后的前9个月内。总之，我们的研究证实，大多数接受ATD治疗的格雷夫斯病患者会出现甲状腺功能亢进症复发。在不同的临床和实验室特征中，甲状腺功能亢进症的发病年龄、甲状腺肿大小和TRAb水平对于识别那些药物治疗后更易缓解甲状腺功能亢进症的患者特别有帮助，并且可能有助于选择少数将从抗甲状腺药物治疗作为首选中获益的格雷夫斯病患者。
