~(131)Ⅰ治疗Graves病合并眼病的疗效评价

Graves病中有13%～45%的患者合并Graves眼病,~(131)Ⅰ治疗对Graves病是较好的方法,但对Graves眼病的疗效仍有争议.作者对182例Graves病合并眼病的患者~(131)Ⅰ治疗效果进行了观察,现将结果报道如下.     

甲亢经~(131)Ⅰ治疗后暂时性甲状腺功能减退

10例甲状腺功能亢进患者,其中女性7例,中数年龄52(49～69)岁,男性3例,年龄为50、59和67岁。均未应用抗甲状腺药物,皆有弥漫性甲状腺肿。~(131)Ⅰ的治疗剂量为2.5～11.8mCi(中数4mCi),暂时性甲状腺功能减退(甲减)的诊断依据为血清甲状腺素(T_4)浓度降低。治疗前后均测定血清T_4、T_3(三碘甲腺原氨酸)和TSH(促甲状腺激素),当T_4浓度暂时性降低时,患者未发生临床上甲减。治疗后患者中数血清T_4(正常为4.7～10.9μg%)由16.4μg%(12.4～24.9μg%)降至3.0μg%(1.6～4.2μg%),以后又上升至7.1μg%(4.8～14.5μg%);中数血清T_3(正常为0.8～1.8ng/ml)由3.2ng/ml(2.0～4.9ng/ml)降至0.8ng/ml(0.7～1.2ng/ml),后恢复到1.3ng/ml(0.8～1.6ng/ml);中数血清     

抗甲状腺药物治疗Graves甲亢的预后判断

抗甲状腺药物治疗 Graves 甲亢的预后受多种因素的影响,本文分别详述判断其治疗的各种预后指标。     

甲亢治疗与Graves眼病进程的关系

观察了不同甲亢治疗方法对眼病发生发展的影响。对象与方法４４３例具有轻度或无眼病的Ｇｒａｖｅｓ甲亢随机分成三组。组１（１５０例）接受１３１Ｉ治疗（量为４．４～５．６ＭＢｑ）；组２（１４５例）接受１３１Ｉ和强的松治疗，于放疗后２～３ｄ开始用强的松０．４～...     

~(131)Ⅰ治疗甲状腺功能亢进症的进展

近年来国内外发表了一些~(131)Ⅰ治疗甲状腺功能亢进症(甲亢)的临床指南.这些指南表明了~(131)Ⅰ治疗甲亢在5方面的进展,包括:(1)~(131)Ⅰ治疗亚临床甲亢;(2)~(131)Ⅰ治疗Graves甲亢合并甲状腺摄碘率升高的慢性淋巴细胞性甲状腺炎;(3)~(131)Ⅰ治疗儿童和青少年甲亢;(4)~(131)Ⅰ治疗Graves眼病;(5)~(131)Ⅰ治疗难治性重度甲亢.本文简要介绍并评价有关内容.     

抗甲状腺药物对~(131)I治疗甲状腺功能亢进症疗效的影响

131I是治疗甲状腺功能亢进症(甲亢)的主要药物之一,治疗前应用硫氧嘧啶类药物如丙硫氧嘧啶可能会降低131I治疗甲亢的治愈率,咪唑类药物如甲巯咪唑则不会影响其疗效。131I治疗甲亢后应用丙硫氧嘧啶或甲巯咪唑对131I疗效的影响尚有争议之处。抗甲状腺药物影响131I疗效的机理可能在于改变了131I的有效半衰期和(或)甲状腺对131I的摄取率。     

不同抗甲状腺药物对^131Ⅰ治疗Graves病近期疗效的比较

目的探讨Graves病患者使用不同抗甲状腺药物后再行^131Ⅰ治疗的疗效比较。方法随访Graves病经抗甲状腺药物治疗后再行^131Ⅰ治疗的患者98例,按治疗前分别使用丙基硫氧嘧啶、他巴唑、碳酸锂分为3组,前两组在^131Ⅰ治疗前停用抗甲亢药物15天,碳酸锂组使用至治疗当日,采用个性化^131Ⅰ治疗后6个月复查并评价治疗效果。结果使用丙基硫氧嘧啶组在^131Ⅰ治疗6月后仍有38％患者甲状腺功能亢进,使用他巴唑组甲亢比例为23％,而碳酸锂组仅为9．6％,3组间比较均有显著性差异（α〈0．05）;3组间发生甲减例数比较无显著性差异（P〉0．05）。结论在^131Ⅰ治疗Graves病前使用丙基硫氧嘧啶会降低^131Ⅰ治疗甲亢的疗效,其影响高于他巴唑组及碳酸锂组,3组中碳酸锂组对^131Ⅰ治疗甲亢的疗效影响最小。     

甲状腺相关眼病药物治疗

甲状腺相关眼病(TAO) 是甲状腺功能亢进治疗的难点。药物、眶放射和手术是治疗TAO 的三大主要方式, 其中药物治疗是常用的治疗方法。目前糖皮质激素是应用最广泛、疗效最明确的药物,但是对于TAO 的复视和眼 球突出的治疗效果并不理想。新型的免疫抑制剂在抑制TAO 的炎症反应、成纤维细胞的脂肪化及免疫应答方面有 独到之处,有望成为TAO 治疗的新方向。     

~(131)I治疗儿童及青少年Graves病甲亢疗效评价

目的分析~(131)I治疗儿童及青少年甲亢的临床效果,探讨应用~(131)I治疗儿童及青少年甲亢的可行性。方法从确诊为甲亢并进行~(131)I治疗的468例儿童、青少年患者的临床资料中,抽取临床资料完整(包括随访资料、甲功、肝功、外周血常规等复查结果)的253例患者的病例资料进行分析。结果 253例患者中,1次治愈229例(90.51%)、好转21例(8.30%)、无效3例(1.19%),治疗总有效率为98.81%。2次治疗后,治愈14例(5.53%)。出现甲减37例(14.62%),综合甲减率为11.85%,复发9例(3.55%)。结论~(131)I治疗儿童青少年甲亢疗效肯定、相对安全,无明显近期和远期副作用,~(131)I可作为治疗儿童青少年甲亢的首选方案。     

131I与抗甲状腺药物治疗甲亢性心脏病临床疗效比较

目的: 比较131I与抗甲状腺药物（ATD）治疗甲亢性心脏病的临床疗效。方法: 对226例甲亢性心脏病患者分别采用131I（151例）及ATD（75例）治疗,比较两组病例的临床疗效、治疗前后甲状腺激素水平、心电图及超声心动图变化情况。结果: 131I组的总有效率显著高于ATD组（P<0.01);且心功能改善及心电图好转率均显著高于ATD组（均P<0.01)。超声心动图检查:131I组患者LVEF、LVEDD、LVESD、SV及CO治疗后较治疗前显著改善(P<0.01);ATD组治疗前后差异无统计学意义;治疗后两组指标相比差异有统计学意义（P<0.01)。两组治疗后甲状腺激素水平较治疗前均显著降低（P<0.01),但两组治疗后甲状腺激素水平相比无统计学意义。131I组甲状腺功能减退（甲减）发生率显著高于ATD组（17% vs. 0%,P<0.01）。结论: 131I治疗甲亢性心脏病综合疗效优于ATD,缺点是甲减发生率高。     

Hypothyroidism after iodine-131 or surgical therapy for Graves' disease hyperthyroidism

BACKGROUND: The aim of this work was to describe late permanent hypothyroidism after iodine-131 or surgery, and to seek predictive factors of hypothyroidism for the two treatments. MATERIAL: From 1979 to 1994, 462 patients with Graves' disease hyperthyroidism underwent definitive treatment. Three hundred and fifty-five patients were treated with low calculated doses of iodine-131, and 107 patients with subtotal thyroidectomy. Life-table analysis was performed and the cumulative incidence of hypothyroidism was calculated by Kaplan-Meier's method, and survival (euthyroidism) within the groups was compared by the Mantel-Cox method. RESULTS: Of the 355 patients treated with one dose of 6.6 1.9 mCi of iodine-131, 246 became euthyroid after one dose, and 109 needed 2 or more doses. Twenty-two patients received one or more doses higher than 10 mCi. The probability of euthyroidism at 145 months after low-dose was 10. 19% and age, sex, pretreatment with antithyroid drugs, previous subtotal surgery did not influence the final outcome. Of the 107 surgically treated patients the probability of euthyroidism at 144 months was 56.1%. Age, sex, duration of hyperthyroidism, duration of antithyroid treatment, weight of thyroid resected, did not influence the final outcome. The weight of the thyroid remnant was 5.4 1.5 g and the multivariate statistical model by conditional logistic regression showed that the weight of thyroid remnant was the only variable that influenced long-term thyroid function. CONCLUSIONS: There is no ideal dose of iodine-131 that would correct hyperthyroidism in Grave? disease without risk of hypothyroidism. Surgery is an alternative definitive treatment with a risk of hypothyroidism within the 2 first years, and a cumulative risk of hypothyroidism lower than with iodine-131.     

Transient hyperthyroidism after withdrawal of antithyroid drugs in patients with Graves' disease

The development of silent thyroiditis in patients with a history of Graves' disease is common, especially in the postpartum period. We describe herein patients with Graves' disease who developed transient hyperthyroidism but not silent thyroiditis after withdrawal of antithyroid drug (ATD). If such patients are diagnosed as recurrence of Graves' disease, they may receive ATD or radioiodine therapy unnecessarily. We investigated the characteristics of these patients to prevent unnecessary therapy. We retrospectively studied 22 patients with Graves' disease who showed transient thyrotoxicosis after withdrawal of ATD. Two of 22 patients were male and the mean ages (+/- SD) were 33.7 +/- 12.6 yr. We observed these patients for 28.5 +/- 12.8 (mean +/- SD; range 12-53) months after transient thyrotoxicosis, and measured TSH, FT4, and TSH binding inhibitor immunoglobulin in sera. Radioiodine uptake was measured in 6 of them. The radioiodine uptake in the 4 patients was not suppressed (27.5%, 28.0%, 32.7%, 38.1%). These uptake levels indicate that their thyrotoxicosis was not caused by silent thyroiditis. Most of the 22 patients became euthyroid within 6 months. This study suggests a new therapeutic option as follows: in the case of young patients with mild thyrotoxicosis after withdrawal of ATD, physicians should follow them up for one month without medication unless they have unbearable symptoms or complications.     

Three patients who spontaneously developed persistent hypothyroidism during or following treatment with antithyroid drugs for Graves' hyperthyroidism.

Three patients with Graves' disease who spontaneously developed hypothyroidism after treatment with antithyroid drugs are described herein. Patient 1 developed a painful tender thyroid enlargement with a fever and accelerated erythrocyte sedimentation rate when she was receiving maintenance therapy with methimazole, and she progressed to persistent hypothyroidism with increased titers of antithyroglobulin and antimicrosomal antibodies and marked reduction of goiter size within the subsequent 2 months. Thyroid-stimulating hormone-binding inhibitory immunoglobulins (TBIIs) and thyroid stimulation-blocking antibody (TSBAb) were absent when she was hypothyroid. Hypothyroidism probably resulted from autoimmune thyroid destruction due to subacute aggravation of Hashimoto's thyroiditis. During the clinical course of patient 2, accelerated erythrocyte sedimentation rate and later transient increases of antimicrosomal and antithyroglobulin antibody titers were observed repeatedly (four times), and she finally fell into overt hypothyroidism. She also had negative results of tests for TBII and TSBAb. Her hypothyroidism appeared to result from repeated thyroid destruction due to aggravation of Hashimoto's thyroiditis. Patient 3 fell into hypothyroidism when receiving a small dosage of methimazole. The TBII and TSBAb were strongly active when she developed hypothyroidism, which thus seemed to be due to blocking antibody. Patients with Graves' hyperthyroidism may eventually progress to hypothyroidism later by several different mechanisms. Severe and sudden or slowly repeated thyroid destruction due to aggravation of Hashimoto's thyroiditis is one mechanism. Another may be the appearance of a blocking antibody to the TSH receptor.     

药物治疗Graves病停药后复发的相关因素研究进展

Graves病是一种器官特异性自身免疫性甲状腺疾病.目前主要有抗甲状腺药物、放射性131Ⅰ和手术切除3种治疗方法.亚欧国家绝大多数医师首选抗甲状腺药物治疗,其方便、经济、安全,发生永久性甲状腺功能减退少见,但停药后复发率高.其复发与遗传易感基因、疾病自身特点、免疫及环境等多种因素相关.明确其复发相关因素,以便临床医师指导患者的个体化治疗.     

Graves病药物治疗停药复发相关因素分析

Objective To explore the value of thyroid-stimulating antibody(TSAb) and degree of goiter in predicting the outcome of Graves'disease after antithyroid drug treatment. Methods Seventy-one patients with Graves'disease were given antithyroid drugs for (2. 8±1. 4)years and then followed up for(22±6.0)months.Finally,age,gender,thyroid function,TSAb and goiter size at the time of drug withdrawal were compared between the relapsed and relieved groups. TSAb was measured in all patients by using HEK-hTSHR cells. Results Eleven of 71 patients relapsed during the follow-up after drug withdrawal. The relapse rate (42. 9% ,6/14)in patients with positive TSAb was significantly higher than that (8.8%, 5/57) in patient with negative TSAb (X2 = 9.97, P<0.01). The relapse rates in patients with normal size thyroid, Ⅰ degree goiter,Ⅱ degree goiter were 6.25%, 12.2%,35.7% respectively. TSAb activity, positive rate and goiter size of the relapsed patients at the time of drug withdrawal were significantly higher than those of relieved patients (P<0.05 or P<0. 01). Conclusion TSAb activity and goiter size at the time of drug withdrawal are two effective prognostic markers of relapse in Graves' disease treated with antithyroid drugs.     

Graves病药物治疗停药复发相关因素分析

Objective To explore the value of thyroid-stimulating antibody(TSAb) and degree of goiter in predicting the outcome of Graves'disease after antithyroid drug treatment. Methods Seventy-one patients with Graves'disease were given antithyroid drugs for (2. 8±1. 4)years and then followed up for(22±6.0)months.Finally,age,gender,thyroid function,TSAb and goiter size at the time of drug withdrawal were compared between the relapsed and relieved groups. TSAb was measured in all patients by using HEK-hTSHR cells. Results Eleven of 71 patients relapsed during the follow-up after drug withdrawal. The relapse rate (42. 9% ,6/14)in patients with positive TSAb was significantly higher than that (8.8%, 5/57) in patient with negative TSAb (X2 = 9.97, P<0.01). The relapse rates in patients with normal size thyroid, Ⅰ degree goiter,Ⅱ degree goiter were 6.25%, 12.2%,35.7% respectively. TSAb activity, positive rate and goiter size of the relapsed patients at the time of drug withdrawal were significantly higher than those of relieved patients (P<0.05 or P<0. 01). Conclusion TSAb activity and goiter size at the time of drug withdrawal are two effective prognostic markers of relapse in Graves' disease treated with antithyroid drugs.     

Graves病药物治疗停药复发相关因素分析

Objective To explore the value of thyroid-stimulating antibody(TSAb) and degree of goiter in predicting the outcome of Graves'disease after antithyroid drug treatment. Methods Seventy-one patients with Graves'disease were given antithyroid drugs for (2. 8±1. 4)years and then followed up for(22±6.0)months.Finally,age,gender,thyroid function,TSAb and goiter size at the time of drug withdrawal were compared between the relapsed and relieved groups. TSAb was measured in all patients by using HEK-hTSHR cells. Results Eleven of 71 patients relapsed during the follow-up after drug withdrawal. The relapse rate (42. 9% ,6/14)in patients with positive TSAb was significantly higher than that (8.8%, 5/57) in patient with negative TSAb (X2 = 9.97, P<0.01). The relapse rates in patients with normal size thyroid, Ⅰ degree goiter,Ⅱ degree goiter were 6.25%, 12.2%,35.7% respectively. TSAb activity, positive rate and goiter size of the relapsed patients at the time of drug withdrawal were significantly higher than those of relieved patients (P<0.05 or P<0. 01). Conclusion TSAb activity and goiter size at the time of drug withdrawal are two effective prognostic markers of relapse in Graves' disease treated with antithyroid drugs.