Drug discontinuation after treatment with minimum maintenance dose of an antithyroid drug in Graves' disease: a retrospective study on effects of treatment duration with minimum maintenance dose on lasting remission
Drug discontinuation after treatment with minimum maintenance dose of an antithyroid drug in Graves' disease: a retrospective study on effects of treatment duration with minimum maintenance dose on lasting remission
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DOI：
10.1507/endocrj.k10e-262
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发表时间：
2011-02-01
影响因子：
2
通讯作者：
Hamada, Noboru
中科院分区：
文献类型：
--
作者：
Konishi, Toshiaki;Okamoto, Yasuyuki;Hamada, Noboru
根据日本甲状腺协会2006年发布的Graves病治疗指南，每隔一天服用一片AID片治疗后，当血清游离甲状腺素（FT4）和促甲状腺激素（TSH）浓度维持在参考范围内一定时间后，建议停止抗甲状腺药物（ATD）治疗（最低维持剂量治疗，MMDT）。在这项回顾性研究中，调查了 MMDT 持续时间和缓解率之间的关系。参与者是连续 107 名按照指南停止 ATD 治疗的格雷夫斯病患者。停止 ATD 时以及此后每 3 个月测量一次血清 FT4、TSH 和 TSH 受体抗体 (TRAb) 水平。停药后 6 个月、1 年和 2 年缓解患者的比例分别为 86.9%、73.8% 和 68.2%。缓解率随着 MMDT 持续时间的增加而增加，MMDT 持续时间为 19 个月或以上的患者显着高于 M MDT 持续时间为 6 个月或以下的患者。在MMDT持续时间为6个月或以下的患者中，TRAb阳性患者在停药时的缓解率显着低于TRAb阴性患者；然而，在 MMDT 持续时间为 7 个月或更长的患者中没有观察到这一点。这些结果表明，在一定 MMDT 持续时间后停止 ATD 的患者中，缓解率随着 MMDT 持续时间的增加而增加，并且 MMDT 持续时间为 6 个月或更短的 TRAb 阳性患者不应停止 ATD。
According to the guideline issued by the Japan Thyroid Association in 2006 for treatment of Graves' disease, discontinuing antithyroid drug (ATD) therapy is recommended when serum free thyroxine (FT4) and thyroid stimulating hormone (TSH) concentrations have been maintained within the reference range for a certain period after treatment with one AID tablet every other day (minimum maintenance dose therapy, MMDT). In this retrospective study, the relationship between MMDT duration and remission rate was investigated. The participants were 107 consecutive patients with Graves' disease whose ATD therapy was stopped according to the guideline. Serum FT4, TSH, and TSH receptor antibody (TRAb) levels were measured when ATD was discontinued and every 3 months thereafter. The percentage of patients in remission was 86.9% at 6 months, 73.8% at I year, and 68.2% at 2 years after ATD discontinuation. The remission rate increased with MMDT duration, being significantly higher in patients with MMDT durations of 19 months or more than those with M MDT durations of 6 months or less. In patients with MMDT durations of 6 months or less, the remission rate was significantly lower in TRAb-positive patients than in TRAb-negative patients at the time of withdrawal of ATD; however, this was not observed in patients with MMDT durations of 7 months or more. These findings suggest that in patients who discontinue ATD after a certain MMDT duration, the remission rate increases as the MMDT duration increases, and ATD should not be discontinued in TRAb-positive patients with MMDT durations of 6 months or less.