Mashio Y, Beniko M, Matsuda A, Koizumi S, Matsuya K, Mizumoto H, Ikota A, Kunita H
Department of Internal Medicine, Kin-ikyo Sapporo Kita-ku Hospital, Japan.
Endocr J. 1997 Aug;44(4):553-8. doi: 10.1507/endocrj.44.553.
A prospective long-term follow-up study was performed with conventional divided doses (group C: 10 mg 3 times daily, N = 58) and a small single daily dose (group S: 15 mg once daily, N = 54) of methimazole (MMI) for the treatment of Graves' hyperthyroidism. Within 8 weeks, almost 80% of the patients in both groups became euthyroid. The mean time required to achieve a euthyroid state was 5.6 +/- 2.7 weeks in group C and 5.8 +/- 3.1 in group S. TSH binding inhibitor immunoglobulin (TBII) levels before therapy were 44.2 +/- 22.7% and 47.1 +/- 23.9% in group C and group S, respectively. A similar gradual fall in TBII levels was observed in both groups over a two-year period of treatment. MMI doses were gradually reduced to a maintenance dose (5 mg daily) after the patients became euthyroid. The patients were treated for 28 +/- 9 months and were followed up after therapy was stopped (observation period in patients who remained in remission was 12-130 (75 +/- 34) months and the interval to relapse in recurred cases was 1-98 (20 +/- 27) months). The rates of recurrence in group C were 41% at 1 yr, 54% at 2 yrs, 56% at 4 yrs and 61% at 6 yrs. In group S, these were 44%, 53%, 56% and 63%, respectively. No differences between relapse rates were observed with the two different dosage regimens. Adverse effects occurred more frequently in group C patients (24%) than in group S patients (13%). These results show that there is no difference in the clinical and immunological course or in the long-term remission rate of Graves' hyperthyroidism when the treatment is initiated with either a small single daily dose (15 mg) or the conventional regimen (10 mg 3 times daily).
对接受常规分次剂量（C组：每日3次，每次10mg，N = 58）和小剂量单次每日剂量（S组：每日1次，每次15mg，N = 54）甲巯咪唑（MMI）治疗的格雷夫斯甲亢患者进行了一项前瞻性长期随访研究。在8周内，两组中近80%的患者甲状腺功能恢复正常。C组达到甲状腺功能正常状态所需的平均时间为5.6±2.7周，S组为5.8±3.1周。治疗前C组和S组促甲状腺素结合抑制免疫球蛋白（TBII）水平分别为44.2±22.7%和47.1±23.9%。在两年的治疗期间，两组均观察到TBII水平有类似的逐渐下降。患者甲状腺功能恢复正常后，MMI剂量逐渐减至维持剂量（每日5mg）。患者接受治疗28±9个月，治疗停止后进行随访（仍处于缓解期患者的观察期为12 - 130（75±34）个月，复发患者的复发间隔为1 - 98（20±27）个月）。C组1年复发率为41%，2年为54%，4年为56%，6年为61%。S组分别为44%、53%、56%和63%。两种不同给药方案的复发率无差异。C组患者不良反应发生率（24%）高于S组患者（13%）。这些结果表明，无论是采用小剂量单次每日剂量（15mg）还是常规方案（每日3次，每次10mg）开始治疗，格雷夫斯甲亢的临床和免疫过程以及长期缓解率均无差异。
