甲状腺素在抗甲状腺药物治疗格雷夫斯病复发中的作用

目的：探讨格雷夫斯病（Graves，diseaes)经抗甲状腺药物（ATD）治疗后用甲状腺素减少复发的效果。方法：对新确立诊断的60例Graves病患者，在他巴唑治疗0．5年后，随机分为3组：A组：给予小剂量他巴唑加左旋甲状腺素（L－T4）50μg/d;B组：单纯小剂量他巴唑治疗；C组：同A组。治疗24个月后，A组停他巴唑，单用L－T4 50μg/d；B组继续以他巴唑维持量，C组他巴唑维持量加L－T4 50μg/d，半年后停药随访。结果A、C组TSAb；B组继续以他巴唑维持量，C组他巴唑维持量加L－T450μg/d，半年后停药随访。结果A、C组TSAb滴度较B组低，但3组停药1年内复发率差异无显著意义，分别为4／20，20％、5．20，25％和4／20，20％，结论他巴唑加用甲状腺素以及延长甲腺素的治疗，较单用巴唑治疗Graves病并不能更好地降低复发率，促甲状腺素受体抗体水平尚不足Graves病复发的惟一因素。

Effect of thyroxine upon prevention of recurrence of Graves'disease treated with antithyroid drugs

OBJECTIVE: To investigate the effect of thyroxine upon the prevention of recurrence of Graves disease after treatment by antithyroid drugs. METHODS: Sixty patients newly diagnosed as Graves disease were treated with methimazole for 6 months and then randomly distributed into three groups. Patient in group A and group C received small dose of methimazole plus L-T(4) 50 microgram/d, and patients in group B were treated with methimazole in small dose only. Twenty four months later, only L-T(4) 50 microgram/d, without methimazole, was administered to the patients of group A; methimazole in maintenance dose was administered continuously to the patients of group B, and patients in group C were treated with methimazole in maintenance dose plus L-T(4) 50 microgram/d. Such treatments lasted 6 months. Post-treatment follow-up survey was conducted to the three groups. RESULTS: The titers of thyroid-stimulating Ab (TSAb) in groups A and C were lower than that in group B. However, the recurrence rates among the three groups (4/20, 20%; 4/20, 25%; and 4/20, 20% respectively) were not significantly different. CONCLUSION: Both treatment of Graves' disease with methimazole plus L-T4 and treatment with prolonged use of methimazole cannot reduce the recurrence rate more effectively than treatment with only methimazole. The level of TSAb is not the only factor that influences the recurrence of Graves disease.