抗甲状腺药物治疗——Graves病治疗的首选

Anti-thyroid drugs—first choice for Graves' disease

Graves病是甲亢中最常见的类型,是一种与自身抗体(TRAb)相关的自身免疫性疾病。其具体机制还不十分明确。Graves病治疗有抗甲状腺药物(ATD)、放射性碘(RAI)和手术3种传统的治疗方法。惟有ATD治疗是针对免疫因素,最终使TRAb转阴而治愈甲亢。中外文献反复强调ATD治疗是所有Graves甲亢的基础治疗,也是世界各地(除美国外)治疗甲亢的首选药物,其不破坏甲状腺滤泡结构,安全有效,药物作用可逆,不会造成永久性甲减。ATD治疗不仅能单选首选,还可作为手术和同位素治疗前的优选方案。美国ATA主席Cooper教授(NEJM,2005)提出了Graves甲亢的治疗路径可以给予我们一些临床指导。

Graves＇ disease, the most common disorder of hyperthyroidism, is an autoimmune disease related with autoantibody （ TRAb ） , with the specific mechanism remaining incompletely understood. The therapies for Graves disease include three conventional methods： anti-thyroid drugs, radioiodine and surgery. Only treatment with anti-thyroid drugs is aimed at the immune factor; they can eliminate TRAb and lead to recovery ultimately. Literatures have drumed in that treatment with anti-thyroid drugs was a basic therapy for Graves＇ diseases, and they were the first choice to cure hyperthyroidism all over the world （ except for the U. S. A）. The drugs do not destroy the structure of thyroid follicle ,and are safe and efficient;moreover, their effect is reversible and therefore do not cause permanent damage to the thyroid. Anti-thyroid drugs not only can be used alone, it also can be used before radioiodine or surgery. ATA chairman professor Cooper（ NEJM ,2005 ） propounded a therapy path for Graves＇ disease,which is helpful for clinical practice.