Translated Abstract
Objective：Antithyroid drug is the first choice in our treatment of Graves‘ hyperthyroidism. This study is to analyze the patients’ change before and after antithyroid drug treatment, understand the long-term remission or relapse rate of patients receiving antithyroid drug, judge the personal trait and clinical character relating to prognosis, compare the impact of different means to the outcome of disease, find a rational individual therapy method to reduce the relapse risk after antithyroid drug treatment.Patients and Methods：Clinical datas of Graves‘ hyperthyroidism outpatients in our hospital from Feb. 2002 to Feb. 2005 were collected. All 133 patients were given methylthiouracil for treatment with initial dosage of 30mg per day. The thyroid function test was done every one or two months. Methylthiouracil dosage was gradually reduced to 1.25mg-5.0mg per day after normalization of thyroid function. The total course was continued for 6-7 months, and follow-up period after drug cessation was at least 1 year for each patient. If the patients relapsed for hyperthyroidism during follow-up，new therapy plan was made. Up to the ending of follow-up, patients still with normal laboratory results was considered as remission. All patients’ history, symptom, sign, laboratory results and regimen were detailedly collected every time he saw the doctor. At the ending of follow-up, we compare the personal trait and clinical character between remission group and relapse group and judge whether different regimen had impact on Graves‘ hyperthyroidism patient’ prognosis. The SPSS 12.0 software package was used. Values are given as means + standard error of the mean, and their difference were compared by student t test. Differences in frequencies were compared by χ2 test. Analysis of predictive factors that had been used for stratification of patients relied on the logistic regression. P value ＜ 0.05 were considered significant. Results：The patients are from 10 years old to 71 years old, with an average value 33.8 +12.5 years old. The peak onset age phase is from 20 years old to 50 years old, which occupy 77.4% of all patients. In this study group, women (80.5%) are more than men (19.5%).The follow-up period after drug cessation was 1 year to 3 year for every patient. During which, 118 cases (88.7%) kept in remission and 15 cases (11.3%) relapsed. 12 cases relapsed in the first year after drug cessation, and 3 cases relapsed in the second year. Previous hyperthyroidism history, continuous obvious goiter, positive TSAb and TSH before drug cessation are all independent risk factors of relapse( OR value is separately5.68、20.61、9.83、6.21). But age, sex, initial goiter, exophthalmos, T3 and T4 level before therapy, the time TSH normalization taking, TGA and TMA level before drug cessation are not obviously relevant to the prognosis. To combine first attack, obviously decreased goiter, negative TSAb and TSH before drug cessation together to predict remission, the positive predict value and negative predict value is 96.4% and 24% respectively.85 cases were given a minimal MMI maintenance dosage of 2.5mg or 1.25mg per day, of which 6 cases (7.1%) relapsed. 48 cases were given a minimal MMI maintenance dosage of 5mg per day, of which 9 cases (18.8%) relapsed. The latter is with a significantly higher relapse rate than the former (p＜0.05).Conclusions:1. Regular and individual antithyroid drug treatment can achieve 88.7% remission rate in selected Graves‘ hyperthyroidism patients with mild and moderate goiter.2. Previous hyperthyroidism history, continuous obvious goiter, positive TSAb and TSH before drug cessation are all risk factors of relapse。3. To combine first attack, obviously decreased goiter, negative TSAb and TSH before drug cessation together to predict remission, the positive predict value and negative predict value is 96.4% and 24% respectively.4. Patients with a minimal MMI maintenance dosage of 2.5mg or 1.25mg per day have lower relapse rate than patients with a minimal MMI maintenance dosage of 5mg per day, which suggest that gradually reducing the MMI dosage to no more than 2.5mg per day may reduce the relapse risk.
Corresponding authors email
