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グレヴス 病 の 管理: レビュー
Henry B Burch1, David S Cooper2
1Endocrinology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland2Uniformed Services University of Health Sciences, Bethesda, Maryland.
JAMA
|December 17, 2015
まとめ
グラブス 病 の 治療 に は,抗甲状腺 薬,放射性 ヨウ素,または 手術 が 含ま れ ます. 甲状腺機能過剰症の最良の治療法は 患者の個別の要因と好みに左右されます
科学分野:
- 内分泌学
- 内科 医学
背景:
- グレイヴス病は成人における 持続性甲状腺機能過剰症の 最も一般的な原因です
- 約3%の女性と0.5%の男性に影響する.
研究 の 目的:
- グレイブズ病の治療方法を 検討する
- 治療方法の効果とリスクを比較する.
主な方法:
- PubMedとCochraneのデータベースからの英語研究の体系的レビュー (2015年6月〜10月).
- 13件のランダム化臨床試験,5件のシステマティックレビュー/メタ解析,52件の観察研究を含む.
主要な成果:
- 抗甲状腺薬は ~50%で寛解をもたらすが,希少なリスク (アグラヌロサイトーシス,肝毒性) を伴う.
- 放射性ヨウ素 (RAI) と手術は生涯レボチロキシン補充につながり,RAIは甲状腺の眼疾患を悪化させる可能性があります.
- 手術は,疑わしい結節,副甲状腺症,大きな,または重度の眼疾患,副甲状腺症および声帯麻痺の危険性がある場合に好ましい.
結論:
- 治療の選択 (抗甲状腺薬,RAI,手術) は患者の好みと臨床的要因に依存する.
- 医師 は 患者 の カウンセリング を 導く ため に,各 治療 の 利点 と 欠点 を 考慮 し て ください.
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