背景:Graves病(GD)是一种自身免疫性疾病,其特征是由于促甲状腺激素受体抗体(TRAb)增加导致的甲状腺功能亢进。GD的治疗通常包括放射性碘治疗,抗甲状腺药物(ATD),或者甲状腺切除术.由于很少有研究收集沙特阿拉伯ATD治疗后缓解率的数据,本研究旨在评估使用ATD治疗GD长期缓解的疗效和临床预测因素.
方法:我们对2015年7月至2022年12月期间在利雅得阿卜杜勒阿齐兹国王医疗城的内分泌诊所接受ATD治疗的189例GD患者进行了回顾性图表回顾研究。所有GD患者,成年人,以及在研究期间接受ATD治疗且至少随访18个月的14岁及以上青少年纳入研究.随访不足的患者以及接受放射性碘(RAI)治疗或甲状腺切除术作为GD一线治疗的患者被排除在研究之外。
结果:研究样本包括189名患者,其中72%是女性。患者的中位年龄为38岁(33,49)。共有103例患者(54.5%)获得缓解。患者的中位随访期为22.0个月(9,36)。与未获得缓解的患者相比,获得缓解的患者平均游离T4水平较低(25.8pmol/l±8.93和28.8pmol/l±10.82)(P值=0.038),TRAb滴度中位数较低(5.1IU/l(2.9,10.7))(10.5IU/l(4.2,22.5))(P值=0.001)。103例缓解患者中有35例(34%)在ATD停药后复发。与未复发的患者相比,复发的患者在99mTc-高tech酸扫描中显示出更高的甲状腺摄取中位数:10.3%(5.19,16.81)对6.0%(3.09,12.38),P值为0.03。他们还收到了更长时间的ATD,40.0个月(29.00,58.00)与25.0个月(19.00,32.50),P值<0.0001。
结论:大约一半接受ATD治疗的患者实现了GD的缓解;然而,大约三分之一的人复发了。诊断时较低的游离T4和TRAb水平与缓解有关。ATD停药后使用时间延长和甲状腺摄取增加与ATD停药后复发有关。未来的研究有必要确定GD患者ATD成功的预测因素。
BACKGROUND: Graves\' disease (GD) is an autoimmune disorder characterized by hyperthyroidism due to increased thyroid-stimulating hormone receptor antibodies (TRAb).The treatment of GD often consists of radioactive iodine therapy, anti-thyroid drugs (ATD), or thyroidectomy. Since few studies have collected data on remission rates after treatment with ATD in Saudi Arabia, our study aimed to assess the efficacy and the clinical predictors of GD long-term remission with ATD use.
METHODS: We conducted a retrospective chart review study of 189 patients with GD treated with ATD between July 2015 and December 2022 at the endocrine clinics in King Abdulaziz Medical City in Riyadh. All GD patients, adults, and adolescents aged 14 years and older who were treated with ATD during the study period and had at least 18 months of follow-up were included in the study. Patients with insufficient follow-up and those who underwent radioactive iodine (RAI) therapy or thyroidectomy as first-line therapy for GD were excluded from the study.
RESULTS: The study sample consisted of 189 patients, 72% of whom were female. The patients\' median age was 38years (33, 49). A total of 103 patients (54.5%) achieved remission. The median follow-up period for the patients was 22.0 months (9, 36). Patients who achieved remission had lower mean free T4 levels (25.8pmol/l ± 8.93 versus 28.8pmol/l ± 10.82) (P value = 0.038) and lower median TRAb titer (5.1IU/l (2.9, 10.7)) versus (10.5IU/l (4.2, 22.5)) (P value = 0.001) than patients who did not achieve remission. Thirty-five out of 103 patients who achieved remission (34%) relapsed after ATD discontinuation. The patients who relapsed showed higher median thyroid uptake on 99mTc-pertechnetate scan than patients who did not relapse: 10.3% (5.19, 16.81) versus 6.0% (3.09, 12.38), with a P value of 0.03. They also received ATD for a longer period, 40.0 months (29.00, 58.00) versus 25.0 months (19.00, 32.50), with a P value of < 0.0001.
CONCLUSIONS: The remission of GD was achieved in approximately half of the patients treated with ATD; however, approximately one-third of them relapsed. Lower Free T4 and TRAb levels at diagnosis were associated with remission. Longer ATD use and higher thyroid uptake upon diagnosis were associated with relapse after ATD discontinuation. Future studies are necessary to ascertain the predictors of ATD success in patients with GD.