Kasuga Y, Kobayashi S, Fujimori M, Shingu K, Asanuma K, Hama Y, Ito K, Maruyama M, Amano J
Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan.
Eur J Surg. 1998 Mar;164(3):173-8. doi: 10.1080/110241598750004607.
To find out whether subtotal thyroidectomy results in long term stable functional and immunological remission in patients with Graves' disease.
Retrospective study.
Teaching hospital, Japan.
176 patients who underwent subtotal thyroidectomy for Graves' disease, 1970-79.
Follow up surveys in 1984 and 1992.
Changes in thyroid function, antibody titres, and lymphocyte subsets.
29/79 patients (39%) who were euthyroid in 1984 had evidence of thyroid dysfunction in 1992. Of the 8 patients with latent hypothyroidism in 1984, 3 (38%) had become euthyroid by 1992, and none required treatment. Of the 29 patients who were hypothyroid in 1984, 5 had latent hypothyroidism and 1 was euthyroid in 1992, and of the 18 patients with recurrent hyperthyroidism in 1984, 1 had become euthyroid by 1992. The number of positive titres to TSH-binding inhibitory immunoglobulin was significantly higher in the recurrence group (31/36, 86%) compared with the hypothyroid (7/26, 27%), latent hypothyroidism (8/37, 22%), and euthyroid (22/77, 29%) groups (p < 0.01). There were also significant differences in the mean (SD) number of Leu HLA DR subsets between the control (17 (3), n = 18) and recurrence (21 (6), n = 38), hypothyroid (22 (6), n = 35), latent hypothyroidism (22 (6), n = 22), and euthyroid (22 (9), n = 64) groups (p < 0.002). There were no differences in the number of T cell subsets among the groups.
Treatment of Graves' disease by subtotal thyroidectomy does not necessarily result in stable late functional or immunological remission. Long term follow up of such patients may be necessary.
探究甲状腺次全切除术是否能使格雷夫斯病患者获得长期稳定的功能及免疫缓解。
回顾性研究。
日本教学医院。
1970 - 1979年间因格雷夫斯病接受甲状腺次全切除术的176例患者。
1984年和1992年进行随访调查。
甲状腺功能、抗体滴度及淋巴细胞亚群的变化。
1984年甲状腺功能正常的79例患者中，29例（39%）在1992年出现甲状腺功能障碍。1984年有8例潜在甲状腺功能减退患者，其中3例（38%）到1992年甲状腺功能恢复正常，且均无需治疗。1984年甲状腺功能减退的29例患者中，5例在1992年有潜在甲状腺功能减退，1例甲状腺功能恢复正常；1984年复发甲亢的18例患者中，1例到1992年甲状腺功能恢复正常。复发组促甲状腺素结合抑制性免疫球蛋白阳性滴度数（31/36，86%）显著高于甲状腺功能减退组（7/26，27%）、潜在甲状腺功能减退组（8/37，22%）及甲状腺功能正常组（22/77，29%）（p < 0.01）。对照组（17（3），n = 18）与复发组（21（6），n = 38）、甲状腺功能减退组（22（6），n = 35）、潜在甲状腺功能减退组（22（6），n = 22）及甲状腺功能正常组（22（9），n = 64）之间Leu HLA DR亚群的平均（标准差）数量也存在显著差异（p < 0.002）。各组间T细胞亚群数量无差异。
甲状腺次全切除术治疗格雷夫斯病不一定能实现晚期稳定的功能或免疫缓解。对此类患者可能需要进行长期随访。
