Long-Term Antithyroid Drug Therapy in Smoldering or Fluctuating-Type Graves' Hyperthyroidism with Potassium Iodide.

IF 3.9 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrinology and Metabolism Pub Date : 2024-10-16 DOI:10.3803/EnM.2024.2079
Ken Okamura
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Abstract

Graves' hyperthyroidism is characterized by stimulation of the thyroid gland by thyroid-stimulating hormone receptor antibodies (TRAbs). Antithyroid drug (ATD) continuation is recommended as long as the thyroid gland is stimulated. Goiter size, thyroidal 123I uptake, serum thyroglobulin level, and TRAb positivity are reliable markers of thyroid stimulation. Attention must also be paid to the responsiveness of the thyroid gland due to the high prevalence of painless thyroiditis and spontaneous hypothyroidism during treatment. TRAbs disappeared at <5 years entering remission in 36.6% of patients (smooth-type), while re-elevation of TRAb activity occurred in 37.7% (fluctuating-type) and remained positive for >5 years in 21.1% (smoldering-type). Seven percent of patients remained positive for TRAbs for >30 years, requiring life-long ATD treatment. Remission occurred after median 6.8 years (interquartile range, 4.0 to 10.9) of ATD treatment in 55% of patients. However, late relapse may occur after stressful events (dormant type). In apparently intractable Graves' disease (GD) with a large goiter (>40 g), 131I therapy should be considered. For initial and long-term ATD treatment, we must choose effective, safe, and economical drugs such as 100 mg potassium iodide (KI), although KI sensitivity varies in patients with GD. Thionamide, which has notorious side effects, is added only during the KI-resistant period.

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用碘化钾长期抗甲状腺药物治疗燃烧型或波动型巴塞杜氏甲状腺功能亢进症
巴塞杜氏甲状腺功能亢进症的特点是甲状腺受到促甲状腺激素受体抗体(TRAbs)的刺激。只要甲状腺受到刺激,就建议继续服用抗甲状腺药物(ATD)。甲状腺肿大、甲状腺 123I 摄取、血清甲状腺球蛋白水平和 TRAb 阳性是甲状腺刺激的可靠标志。由于治疗期间无痛性甲状腺炎和自发性甲状腺功能减退症的发病率很高,因此还必须注意甲状腺的反应性。21.1%的患者(烟熏型)在5年后TRAbs消失。7%的患者在超过30年的时间里TRAbs仍呈阳性,需要终生接受ATD治疗。55%的患者在接受 ATD 治疗中位数为 6.8 年(四分位数间距为 4.0 至 10.9)后病情得到缓解。然而,晚期复发也可能发生在应激事件之后(休眠型)。对于甲状腺肿大(大于40克)且明显难治的巴塞杜氏病(GD)患者,应考虑采用131I治疗。对于初始和长期的ATD治疗,我们必须选择有效、安全和经济的药物,如100毫克碘化钾(KI),尽管GD患者对KI的敏感性各不相同。只有在 KI 耐药期才会添加副作用显著的硫酰胺。
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来源期刊
Endocrinology and Metabolism
Endocrinology and Metabolism Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.60
自引率
5.90%
发文量
145
审稿时长
24 weeks
期刊介绍: The aim of this journal is to set high standards of medical care by providing a forum for discussion for basic, clinical, and translational researchers and clinicians on new findings in the fields of endocrinology and metabolism. Endocrinology and Metabolism reports new findings and developments in all aspects of endocrinology and metabolism. The topics covered by this journal include bone and mineral metabolism, cytokines, developmental endocrinology, diagnostic endocrinology, endocrine research, dyslipidemia, endocrine regulation, genetic endocrinology, growth factors, hormone receptors, hormone action and regulation, management of endocrine diseases, clinical trials, epidemiology, molecular endocrinology, neuroendocrinology, neuropeptides, neurotransmitters, obesity, pediatric endocrinology, reproductive endocrinology, signal transduction, the anatomy and physiology of endocrine organs (i.e., the pituitary, thyroid, parathyroid, and adrenal glands, and the gonads), and endocrine diseases (diabetes, nutrition, osteoporosis, etc.).
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