Escobar Jiménez F, Luna López V, Fernández Soto M L, Quezada Charneco M, Glinoer D
Departamento de Medicina Interna I, Hospital Clínico Universitario de Granada.
Med Clin (Barc). 1998 Sep 5;111(6):205-10.
To assess the new diagnostic and therapeutic trends for hyperthyroidism due to Graves' disease in Spain and the differences with respect to a previous study performed in 1987.
A questionnaire about a typical clinical case of hyperthyroidism due to Graves' disease and 10 variations to it, in which different diagnostic and therapeutic options are exposed. These questionnaires were mailed to 70 Spanish units of endocrinology during 1995, and 51 participated finally in the study. The results are compared with those obtained in Spain with a similar study in 1987.
Thyrotropin (98%) and free thyroxine (88%) were the most used tests for diagnosis of Graves' disease, with a significant decrease (p < 0.001) in the use of total T4 and total T3 in comparison with the results of the questionnaire performed in 1987. The measurement of antibodies against thyrotropin receptor (TSH-R-Ab) was the most frequently used immune marker for the diagnosis (78%), with significant differences (p < 0.001) with respect to questionnaire in 1987. The use of anti-thyroperoxidase antibodies (anti-TPO-Ab) (36%) in diagnosis of this disease, significantly increased (p < 0.05) with respect to 1987. Antithyroid drugs were the most frequent initial treatment (98%) with significant differences (p < 0.001) in use of radioiodine (24%) as treatment of choice in elderly patients respect to 1987. Surgery was mainly used for large-size goiters (33%) and radioiodine for recurrences after medical (61%) or surgical (80%) treatment. Antithyroid drugs were the most frequent treatment for children and for recurrences during gestation.
In Spain, the measurements of TSH, FT4 and TSH-R-Ab are the main diagnostic test of hyperthyroidism. Antithyroid drugs are still the treatment of choice in typical case of hyperthyroidism due to Graves' disease, in recurrences during gestation and children. Surgery is only used for large goiters and radioiodine is the treatment of choice in recurrences after medical or surgical treatment.
评估西班牙格雷夫斯病所致甲状腺功能亢进症的新诊断和治疗趋势，以及与1987年之前一项研究所作比较的差异。
一份关于格雷夫斯病所致甲状腺功能亢进症典型临床病例及其10种变体的问卷，其中展示了不同的诊断和治疗选择。1995年，这些问卷被邮寄给70个西班牙内分泌科单位，最终51个单位参与了该研究。将结果与1987年在西班牙进行的一项类似研究所得结果进行比较。
促甲状腺激素（98%）和游离甲状腺素（88%）是诊断格雷夫斯病最常用的检测指标，与1987年问卷结果相比，总T4和总T3的使用显著减少（p < 0.001）。促甲状腺激素受体抗体（TSH-R-Ab）检测是诊断中最常使用的免疫标志物（78%），与1987年问卷相比有显著差异（p < 0.001）。抗甲状腺过氧化物酶抗体（anti-TPO-Ab）（36%）在该疾病诊断中的使用相较于1987年显著增加（p < 0.05）。抗甲状腺药物是最常用的初始治疗方法（98%），与1987年相比，老年患者中选择放射性碘作为治疗方法的使用有显著差异（p < 0.001）。手术主要用于治疗大体积甲状腺肿（33%），放射性碘用于药物治疗（61%）或手术治疗（80%）后的复发情况。抗甲状腺药物是儿童及妊娠期复发的最常用治疗方法。
在西班牙，TSH、FT4和TSH-R-Ab检测是甲状腺功能亢进症的主要诊断方法。抗甲状腺药物仍然是格雷夫斯病所致典型甲状腺功能亢进症、妊娠期复发及儿童患者的首选治疗方法。手术仅用于治疗大甲状腺肿，放射性碘是药物或手术治疗后复发的首选治疗方法。
