- 期刊
Long-Term Antithyroid Drugs in Graves' Disease: A Review of the Literature
長期抗甲狀腺藥物在葛瑞夫茲氏病的治療：文獻回顧
摘要
Graves' disease (GD), the leading cause of persistent hyperthyroidism in adults, is an autoimmune disease that primarily affects the thyroid gland and also may affect multiple other organs, including the heart, eyes, and skin. Among the currently available treatment modalities for GD are antithyroid drugs (ATDs), radioiodine ablation (RIA), and thyroidectomy. However, these treatment modalities have certain limitations. For example, ATDs are associated with a high risk of hyperthyroidism relapse, and definitive therapy, either RIA or thyroidectomy, is associated with permanent hypothyroidism, requiring lifelong thyroid hormone replacement therapy. So far, no consensus has been reached regarding the optimal treatment modality for GD. Currently, ATDs are regarded as the most preferred first-line treatment worldwide. According to the traditional standard of care, patients with GD should be treated with ATDs for 12 to 18 months. However, the relapse rate following ATD therapy is usually high (approximately 50%), and many patients require additional treatment. Therefore, whether long-term ATD (LTATD) treatment (60 months or more), relative to standard treatment for 12 to 18 months, reduces the frequency of relapse in patients with GD remains unclear. In addition, the predictive factors of remission or relapse for GD remain a matter of debate. The current paper summarizes the evidence available on LTATD treatment, focusing both on its efficacy and safety in patients with GD and on its effect on the remission rate of hyperthyroidism. The paper also presents a review of the current knowledge available regarding the predictors of GD relapse following ATD treatment.
並列摘要
葛瑞夫茲氏病（Graves' disease）是導致成年人持續性甲狀腺機能亢進的主要原因，它是一種自體免疫性疾病，主要影響甲狀腺，也可能影響多個其它器官，包括心臟、眼睛和皮膚等等。目前主要治療葛瑞夫茲氏病的方式包括有抗甲狀腺藥物、放射碘消融術和甲狀腺切除術。然而，這些治療方式都各存有某些的局限性。例如，抗甲狀腺藥物的治療存有高度甲狀腺機能亢進復發的風險，而決定性的治療（definitive therapy），無論是放射碘消融術還是甲狀腺切除術，容易造成永久性甲狀腺功能低下，需要終身接受甲狀腺素補充的治療。到目前為止，關於葛瑞夫茲氏病的最佳治療方式尚未達成共識。目前，抗甲狀腺藥物被認為是全球最受歡迎的首選治療方式。根據傳統的治療標準，甲狀腺機能亢進患者應該接受抗甲狀腺藥物治療12至18個月。然而，抗甲狀腺藥物治療後的復發率通常很高（約略50%），許多患者需要接受額外的治療。因此，長期服用抗甲狀腺藥物（60個月或以上）治療相對於標準治療12至18個月是否能減少甲狀腺機能亢進患者的復發頻率仍不清楚。此外，對於葛瑞夫茲氏病的緩解或復發的預測因子仍存在有爭議。本文綜論有關長期服用抗甲狀腺藥物治療來治療葛瑞夫茲氏病，主要舉證該治療方式在患者之中是有其有效性和安全性，以及其對甲狀腺機能亢進緩解率的影響。此外，本文也針對目前抗甲狀腺藥物治療後關於葛瑞夫茲氏病復發預測因子做進一步文獻探討。