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格雷夫斯病的管理:一篇综述
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
概括
格雷夫斯病的治疗包括抗甲状腺药物,放射性或手术. 甲状腺功能过高的最佳治疗方法取决于个体的因素和偏好.
科学领域:
- 内分泌学
- 内部医学
背景情况:
- 格雷夫斯病是成年人持续性甲状腺功能障碍的最常见原因.
- 影响约3%的女性和0.5%的男性.
研究的目的:
- 审查格雷夫斯病的治疗方案.
- 为了比较不同治疗方式的疗效和风险.
主要方法:
- 来自PubMed和Cochrane数据库的英语研究的系统审查 (2000年6月至2015年10月).
- 包括13项随机临床试验,5项系统性审查/元分析和52项观察性研究.
主要成果:
- 抗甲状腺药物在50%的患者中提供缓解,但具有罕见的风险 (腺细胞瘤,肝毒性).
- 放射性 (RAI) 和手术导致终身激素替代;RAI可能会恶化甲状腺眼病.
- 对于可疑的结节,甲状腺功能过高,大或严重的眼睛疾病,有甲状腺功能下降和声带的风险,最好进行手术.
结论:
- 治疗选择 (抗甲状腺药物,RAI,手术) 取决于患者的偏好和临床因素.
- 医生必须权衡每种疗法的优缺点来指导患者的咨询.
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