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目的 研究抗甲状腺药物 (ATD)或甲状腺次全切除术、加碘盐 (AIS)和甲状腺自身抗体对Graves病(GD)的影响。方法 每 3个月观察接受ATD或手术治疗的GD病人复发率、甲状腺自身抗体 ,第 1次复发病例的甲状腺激素和再次ATD治疗的缓解需时及维持ATD用量等 ;比较手术治疗和ATD治疗、AIS饮食或无碘盐(NIS)饮食、自身抗体 (TM -Ab和TG -Ab)增高和自身抗体正常病人的甲亢症状缓解需时、复发率、维持ATD用量、甲状腺激素和甲状腺大小等。结果 手术治疗组病人的TM -Ab水平、甲减发生率、第 1次复发后再次接受ATD治疗缓解后TSH水平明显高于ATD治疗组 (P均 <0 0 5 ) ;而 5年复发率、第 1次复发后的FT3 和FT4 及再次接受ATD治疗的缓解需时和维持ATD用量则明显低于ATD治疗组 (P均 <0 0 5 )。AIS饮食的ATD治疗病人的甲亢缓解需时、1年和 5年复发率、维持ATD用量和FT4 及甲状腺重量明显高于NIS饮食者 (P均 <0 0 5 ) ;而缓解期TSH则明显低于NIS饮食者 (P <0 0 5 )。自身抗体升高病人的 1年和 5年复发率、维持ATD用量和甲减发生率明显高于自身抗体正常者 (P <0 0 5 ) ;而TSH则明显低于自身抗体正常者 (P <0 0 5 )。结论 手术治疗甲亢症的缓解率较高 ,复发时病情较轻 ,再次ATD治疗较易 ;AIS饮食可增加GD病人的ATD治?
Objective To study the effects of anti-thyroid drugs (ATD) or subtotal thyroidectomy, iodized salt (AIS) and thyroid autoantibodies on Graves disease (GD). Methods The relapse rate of thyroid autoantibodies, thyroid hormones in the first relapse and the remission of ATD and the maintenance of ATD dosage were observed every 3 months in patients with GD or ATD. Compared with surgical treatment and ATD treatment, AIS diet or no-iodized salt (NIS) diet, increased autoantibodies (TM -Ab and TG -Ab) and patients with normal autoantibodies required for remission of hyperthyroidism, relapse rate, maintenance of ATD dosage, thyroid hormone and thyroid size. Results The levels of TM-Ab and the incidence of hypothyroidism in the surgical treatment group were significantly higher than those in the ATD-treated group (P <0.05) after the first relapse and ATD treatment. The 5-year recurrence rate, After the first relapse of FT3 and FT4 and re-ATD treatment remission time and maintenance of ATD was significantly lower than ATD treatment group (P all <0.05). Attenuation of hyperthyroidism in ATD-treated patients with AIS diet took 1, 5 and 5 years of relapse, maintenance of ATD dosage, and FT4 and thyroid weights were significantly higher than those of NIS diet (all P <0.05), while TSH was significantly lower in remission In NIS diets (P <0 05). The autoantibodies increased the recurrence rates of patients at one year and five years, and the incidence of ATD and hypothyroidism were significantly higher than those with normal autoantibodies (P <0.05), while TSH was significantly lower than that with autoantibodies (P < 0 0 5). Conclusions Surgical treatment of hyperthyroidism has a high remission rate and a mild relapse. It is easier to treat with ATD again. Does AIS diet increase ATD in patients with GD?