Prediction of Relapse After Antithyroid Drugs Withdrawal: A Narrative Review

IF 2.1 Q3 ENDOCRINOLOGY & METABOLISM International Journal of Endocrinology and Metabolism Pub Date : 2020-06-29 DOI:10.5812/ijem.102346
Pei-Wen Wang
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引用次数: 3

Abstract

Context: Antithyroid drugs (ATD) are the first-line treatment for Graves’ disease (GD); however, relapse following treatment is approximately 30% - 40% in the first year, and 50% - 60% in the long term. Identification of risk factors that predict relapse, after discontinuing ATD, plays an important role in guiding therapeutic options. Evidence Acquisition: PubMed was used to search for studies published in English between 1995 and 2019. The following search terms were used: Graves’ disease, antithyroid drugs, relapse, recurrence, and outcome. The reference lists from review articles were also included in the search in order to find older journals. Results: Factors associated with a high recurrence rate, as reported in most studies, were divided into phenotype and genotype predictors. Phenotype factors included large goiter size, persistence of high TSH receptor antibody (TRAb), severe hyperthyroidism, smoking, younger age, male sex, and prior history of recurrence. Genotype factors included human leukocyte antigen (HLA), CD40, CTLA-4, PTPN22, Tg, and TSHR genes. In a subgroup analysis by age, genetic factors were better predictors in the younger group, while clinical signs were more useful in the older group. The reliability of using individual baseline risk factors to predict subsequent relapse is poor; however, predictive scores calculated by grouping single risk factors might help to predict future outcomes. Conclusions: Longer normalization time of TRAb, the persistence of a palpable goiter, and harboring genetic risk factors in younger patients are associated with high recurrence rate of GD. Multi-marker prediction models have been proposed and validated to improve the predictive value of relapse after ATD withdrawal.
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抗甲状腺药物停药后复发的预测:一个叙述性的回顾
背景:抗甲状腺药物(ATD)是Graves病(GD)的一线治疗药物;然而,治疗后的复发率在第一年约为30%-40%,在长期约为50%-60%。在停用ATD后,识别预测复发的风险因素在指导治疗选择方面发挥着重要作用。证据获取:PubMed用于搜索1995年至2019年间以英语发表的研究。使用了以下搜索术语:Graves病、抗甲状腺药物、复发、复发和结果。评论文章的参考文献列表也被包括在搜索中,以查找较旧的期刊。结果:如大多数研究所报道的,与高复发率相关的因素分为表型和基因型预测因素。表型因素包括甲状腺肿大、TSH受体抗体(TRAb)持续高、严重甲状腺功能亢进、吸烟、年龄较小、男性和既往复发史。基因型因素包括人类白细胞抗原(HLA)、CD40、CTLA-4、PTPN22、Tg和TSHR基因。在按年龄进行的亚组分析中,遗传因素在年轻组中是更好的预测因素,而临床体征在老年组中更有用。使用个体基线风险因素预测后续复发的可靠性较差;然而,通过对单个风险因素进行分组计算的预测得分可能有助于预测未来的结果。结论:TRAb正常化时间较长、可触及甲状腺肿持续存在以及年轻患者携带遗传危险因素与GD的高复发率有关。已经提出并验证了多标记预测模型,以提高ATD停药后复发的预测价值。
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来源期刊
CiteScore
3.10
自引率
4.80%
发文量
0
期刊介绍: The aim of the International Journal of Endocrinology and Metabolism (IJEM) is to increase knowledge, stimulate research in the field of endocrinology, and promote better management of patients with endocrinological disorders. To achieve this goal, the journal publishes original research papers on human, animal and cell culture studies relevant to endocrinology.
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