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題名 | Outcome of Graves' Thyrotoxicosis after Antithyroid Drug Treatment=葛瑞夫氏甲狀腺機能亢進症藥物治療之預後 |
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作者 | 邱世欽; 黃鴻碩; 李麒麟; 張延彰; 盧成皆; 孫瑞鴻; 黃禹堯; 許瑞旭; 林仁德; 黃碧玉; 黃妙珠; | 書刊名 | 長庚醫學 |
卷期 | 18:4 1995.12[民84.12] |
頁次 | 頁305-314 |
分類號 | 415.931 |
關鍵詞 | 葛瑞夫氏甲狀腺機能亢進症; 抗甲狀腺藥物; 復發率; Graves' thyrotoxicosis; Antithyroid drug; Relapse rate; |
語文 | 英文(English) |
中文摘要 | 庚醫院臺北及林口院區一項頭究,收集1981年10月至1990年3月葛瑞夫氏甲狀腺機能亢進,未接受手術或放射碘治療而接受完整藥物療程之病例,分析藥物治療與影響預後之因素。 如此共81例接受分析,男女的比例為22:59,平均發病年齡為33.1±10.5歲(15-60歲)。接受抗甲狀腺藥物治療的期間平均為28.1±9.8月(11-63月),停藥後繼續追蹤53.6±25.2(5-108)月。結果痊癒組有40例(49.4%)。其餘41例於停藥後復發(50.6%),其中34例(829%)在兩年內復發而只有一例於停藥三年後才復發。 病人的甲狀腺較大者(grade I-III)有較高的復發率[29/46 vs. 12/35; 單變項分析?2=6.576,p=0.010;多變項析(LR) p=0.015]。同樣的,療程在23個月以內也比23個月以上(含)者有較高的復發率[15/20 vs. 26/61;?2=6.316,p=0.012;p=0.020,LR]病人發病時之T3≧300 ng/dl比T3<300 ng/dl在單變數分析時有較高的復發率[30/50 vs. 11/31;?2=4.601,p=0.032]但在多變數分析則無差異(p=0.094)。其它因素如年齡、性別、過去病史、家庭病史,發病時之T4,T3/T4比,甲狀腺抗體的濃度,如:TBII、AMA、ATA、眼睛病變,治療結束時之TBII、TRH試驗結果及是否併用甲狀腺素等皆與預後無關。 結論:(1)病人具有較大的甲狀腺(grade II-III)有較高之復發病。(2)復發的病人大都在停藥後兩年內發病。(3)甲狀腺機能亢進的療程至少23個月。(4)停藥後病人至少需追蹤檢查三年。 |
英文摘要 | To investiagzat the outcome of Graves’ thyrotoxicosis after antityroid drug management, data from 81 patients, treated in Chang Gung Memorial Hospital at Taipei and Linkou from October 1981 to March 1990, were analyzed. The gender ratio of female to male was 59:22. The mean age of onset was 33.1±10.5 (15-60) year-old. All the patients were treated with antitythyroid drug (Thionamide group) for a duration of 11 to 63 months (mean±SD=28.1±9.8 months). Forty of 81 patients (49.4%) were remained remission after up to 2 years of follow-up. Those patients relapse usually occurred within 2 years after discontinuation of treatment (34/41), and only one exceptional case relapsed after 3 years. Three conditions affected and relapse rate. Patients with larger goiter (grade II-III) and shorter duration of treatment (<23 months) had a higher relapse rate than those with smaller goiter (grade O-I) [29/46 vs. 12/35; ?2=6.576, p=0.010; p=0.015 in stepwise logistic regression (LR)] and longer duration of treatment (≧ 23 months) (15/20 vs. 26/61; ?2=6.316, p=0.012l; p=0.020 in LR). Patients with higher pre-treated serum triiodothyronine (T3 ≧300 ng/dl) had a higher relapse rate than those with lower T3 level (T3<300 ng/dl) in univariate anlaysis (30/50 vs. 11/31, ?2=4.601, p=0.032), but no significant difference by LR (P=0.094). Other clinical parameters including age, sex, past history, family history, thyroxine (T4) level, T3/T4 ratio, thyroid autoantibodies, staging of ophthalmospathy, responsiveness to thyrotropin-releasing hormone stimulation test at the end of treatment, and whether combined treatment with thyroxine had no significant difference betweent he relapse and remission groups. These data suggest: (a) patients with larger goiter (grade II-III had higher relapse rate; (b) most of the recurrent thyrotoxicosis patints relapsed within two years after drug withdrawal; (c) continuing treatment for more than twenty-three months produces better outcome; (d) patients with Graves’ thyrotoxicosis should be followed up for at least three years after withdrawal of antithyorid drug. @@g@ |
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