Pineda G, Arancibia P, Mejía G
Departamento de Medicina, Hospital Salvador, Universidad de Chile y Laboratorio IEMA.
Rev Med Chil. 1998 Aug;126(8):953-62.
It is still debated which is the best treatment for Basedow-Graves' hyperthyroidism (BGH). We reviewed 195 patients treated and followed-up during the past 30 years: 88 treated with propylthiouracil (PTU), 70 with 131I and 37 thyroidectomized.
to analyze the efficacy of each therapy in terms of achieving euthyroidism and the search of possible indexes for success. Surgery attained euthyroidism in 70.2% but has disadvantages; 131I accounted for the highest hypothyroid rate (72.1%) irrespective of the dose administered; PTU alone was successful in only 26.4% but combined with T4, success rose to 62.5% (p < 0.025). Suppression test and/or TRAb measurements after 6 mo PTU therapy were used to decide if therapy continued or was changed to other form of treatment. Using this criteria, 87.5% of pts with positive results achieved longstanding euthyroidism. Pretreatment predictive indexes were goiter size, T4 levels and 24 h/RAI uptake.
As 131I induces hypothyroidism in over 2/3 of pts and surgery besides its cost is not devoid of serious complications, we advocate for the use of PTU as first line therapy; combined treatment (PTU + T4) seems promising. If after 6 mo on PTU, TRAb or Suppression test do not improve, we recommend 131I or surgery.
对于毒性弥漫性甲状腺肿（BGH）的最佳治疗方法仍存在争议。我们回顾了过去30年中接受治疗并随访的195例患者：88例接受丙硫氧嘧啶（PTU）治疗，70例接受¹³¹I治疗，37例行甲状腺切除术。
分析每种治疗方法在实现甲状腺功能正常方面的疗效，并寻找可能的成功指标。手术使70.2%的患者实现了甲状腺功能正常，但存在缺点；¹³¹I导致的甲状腺功能减退率最高（72.1%），与给药剂量无关；单独使用PTU仅26.4%取得成功，但联合T4后，成功率升至62.5%（p<0.025）。PTU治疗6个月后进行抑制试验和/或TRAb测量，以决定是否继续治疗或改为其他治疗方式。按照此标准，87.5%结果为阳性的患者实现了长期甲状腺功能正常。治疗前的预测指标为甲状腺肿大小、T4水平和24小时¹³¹I摄取率。
由于¹³¹I使超过2/3的患者发生甲状腺功能减退，且手术除成本外还存在严重并发症，我们主张将PTU作为一线治疗方法；联合治疗（PTU+T4）似乎很有前景。如果PTU治疗6个月后TRAb或抑制试验未改善，我们建议采用¹³¹I或手术治疗。
