Alström syndrome with a novel mutation of ALMS1 and Graves’hyperthyroidism:A case report and review of the literature

BACKGROUND Alström syndrome(AS,OMIM ID 203800)is a rare disease involving multiple organs in children and is mostly reported in non-Chinese patients.In the Chinese population,there are few reports on the clinical manifestations and pathogenesis of AS.This is the first report on the association between AS and Graves’hyperthyroidism.CASE SUMMARY An 8-year-old Chinese girl was diagnosed with AS.Two years later,Graves’hyperthyroidism developed with progressive liver dysfunction.The patient’s clinical data were collected;DNA from peripheral blood of the proband,parents and sibling was collected for gene mutation detection using the second-generation sequencing method and gene panel for diabetes.The association between the patient’s genotype and clinical phenotype was analyzed.She carried the pathogenic compound heterozygous mutation of ALMS1(c.2296_2299del4 and c.11460C>A).These stop-gain mutations likely caused truncation of the ALMS1 protein.CONCLUSION The manifestation of hyperthyroidism may suggest rapid progression of AS.

Influence of serum levels of TSH receptor antibody in pregnant women with Graves disease on neonatal hyperthyroidism

Objective:To investigate the clinical significance of serum thyroid stimulating hormone(TSH) receptor antibody(TRAb) levels in pregnant women with Graves'disease,on neonatal hyperthyroidism. Methods:The clinical data of 68 pregnant women with Graves' disease and their newborns were retrospectively analyzed.Testing indicators included thyroid function tests and TRAb levels during pregnancy,at delivery,and within 2 weeks after birth.The serum TRAb and T_3,T_4,Free T_3,Free T_4,TSH levels were detected by radio receptor assay(RRA) and electrical chemiluminescence immunoassay(ECLIA),respectively. Results:The results showed that serum TRAb levels of the third trimester of pregnancy was positively correlated with that of the umbilical vein(n = 68,r= 0.8494,P<0.01),and that of the newborns(n = 68, r=0.8286,P<0.01).The incidence of neonatal hyperthyroidism was 11.8%(8/68).The serum TRAb levels in the 8 neonates with hyperthyroidism within 2 weeks after birth were 3 times higher than those in the normal neonates.Of these 8 neonates,2 had 15 times higher serum TRAb levels than those of normal neonates within 2 weeks after birth.The thyroid function and TRAb levels of these 2 neonates were still abnormal 6 months later. Conclusions:The risk of hyperthyroidism in newborn whose mother's TRAb levels were high in the third trimester of pregnancy was increased.This study suggests a significant correlation between TRAb levels in pregnant women with Graves' disease and the severity of neonatal hyperthyroidism.

Lithium carbonate plus ¹³¹I in the treatment of Graves’ hyperthyroidism

Aims: Effectiveness of radioiodine for Graves’ hyperthyroidism (GD) depends on its intrathyroidal persistence, which could be enhanced by lithium by blocking the release of organic iodine and thyroid hormone from the thyroid gland. The present aim focused on the effect of the addition of lithium carbonate to 131I therapy in patients with GD. Methods: 100 consecutive patients with GD were randomly assigned to two groups: group (A) patients treated with 131I and group (B) patients treated with 131I plus lithium carbonate. Patients in B group were treated with a dose of 0.5 g per day (2 × 0.25 g) of lithium carbonate for half a month before and after the administration of 131I. Thyroid weight was estimated by ultrasonography and careful palpation of the thyroid. Radiation absorbed dose rate in the front of the neck was measured on days 1530 and 45 after the administration of 131I. Serum concentrations of thyroidstimulation hormone (TSH), fee tri-iodothyrosine (T3) and free thyroxine (T4) were tested on days 30, 45, 90, 180 before and after treatment. Results: After RIT, radiation absorbed dose rate in the front of neck gradually decreased as time went on (p 0.05), free T3 and free T4 values in both groups rose significantly one month after treatment (all p 0.05). Cure rate of hyperthyroidism was achieved in 36 of the 50 patients (72%) treated with 131I alone and in 38 of the 50 patients (76%) treated with 131I plus lithium. Conclusion: We suggest that for patients withdrawing of ATD and those with short effective half-time, as well as those intolerant or invalid, the short term addition of lithium to 131I allows for a better control of thyrotoxia and the completeness of treatment.

Selective Pituitary Resistance to Thyroid Hormone: Clinical Hyperthyroidism with High TSH on Levothyroxine Administration in I-131 Ablated “Graves Disease”

Resistance to Thyroid Hormone (RTH) is a rare form of hormone resistance secondary to changes in the genes encoding thyroid hormone receptors. The two subtypes, Pituitary RTH (PRTH) and Generalized RTH (GRTH), cause clinically distinguishable patient presentations. In PRTH, typically only the pituitary gland is resistant to thyroid hormone (TH) while the rest of the body maintains sensitivity. Selective pituitary resistance to thyroid hormone results in dysregulation of thyroid hormone homeostasis with clinical presentation as either euthyroid or hyperthyroidism. PRTH is characterized by elevated thyroid hormone levels with an elevated or inappropriately normal TSH concentration. Herein we describe a case report of a 70-year-old woman who complained of weight loss of over 35 lbs., palpitations, jitters, hair loss, diarrhea, fatigue, muscle weakness, etc. over 6 months, thus, indicating the presence of iatrogenic hyperthyroidism while receiving levothyroxine 175 ug daily prescribed by her primary care provider because of a reported history of “Graves disease” treated by radioactive iodine ablation of the thyroid several years ago. The daily dose of levothyroxine had been increased gradually at an interval of 3 months over a year because of persistent elevation of serum TSH level. Laboratory tests revealed markedly elevated Free T4, Free T3 and TSH levels, along with low concentrations of all lipid fractions, serum creatinine and urea nitrogen levels, indicating TSH induced hyperthyroidism or PRTH. Further testing documented a mutation of thyroid hormone receptor beta gene 2 confirming presence of PRTH. We believe that the initial diagnosis of Graves Disease was erroneous and I-131 ablation further confounded and missed the diagnosis of PRTH. Thus, the purpose of this report is to report a patient with PRTH and describe potential pitfalls in diagnosis and management of this rare disorder.

Alternating Hyperthyroidism and Hypothyroidism in Graves’ Disease: A Case Report and Literature Review

Background: Alternating thyroid function between hypo- and hyperthyroidism is a very rare phenomenon attributed to the switch between the types of thyroid stimulating hormone receptor autoantibodies;thyroid stimulating antibody and thyroid stimulating hormone blocking antibody. Case Presentation: We report an 18 years old male who presented with hyperthyroidism attributed to Graves’ disease. He was treated with antithyroid medication. During follow up, his thyroid function was switching between hyper- and hypothyroidism which was difficult to treat with antithyroid medication. His laboratory investigations revealed high thyroid stimulating immunoglobulin and TSH binding inhibitory immunoglobulin. Due to the difficultly of managing him with antithyroid medication, he was offered a definitive management for his Graves’ disease. Conclusion: This case demonstrates a rare challenging presentation of Graves’ disease. Patients presenting with fluctuation in thyroid function between hyper-and hypothyroidism need a definitive management for Graves’ disease.

剪切波弹性成像评估甲巯咪唑治疗初诊Graves病疗效的应用价值

目的 探讨超声剪切波弹性成像(shear wave elastography, SWE)技术评估甲巯咪唑治疗初诊Graves病疗效的临床应用价值。方法 收集60例经滨州医学院附属医院初诊确诊为Graves病的患者,给予服用甲巯咪唑进行治疗,检测治疗前及治疗2月后患者血清甲状腺功能指标包括血清促甲状腺激素(thyrotropin, TSH)、血清游离三碘甲状腺原氨酸(free triiodothyronine, FT3)和血清游离甲状腺素(free thyroxine, FT4),以及甲状腺自身免疫性炎症指标促甲状腺激素受体抗体(TRAb)。同时应用SWE技术分别测量患者治疗前及治疗2月后甲状腺组织的杨氏模量最大值、最小值和平均值,应用配对t检验对治疗前后的结果进行分析比较。结果 比较治疗前及治疗2月后结果显示,所测血清甲状腺功能指标(TSH、FT3、FT4)显著改善(P<0.01),TRAb显著好转(P<0.05);应用SWE技术测得患者甲状腺组织的各项杨氏模量值也有显著变化(P<0.01)。结论 SWE技术测得甲状腺组织杨氏模量值的变化与患者甲状腺功能指标变化的临床意义一致,说明SWE实时、定量且客观获取的患者甲状腺组织的硬度变化信息,可为临床医师准确评估Graves病治疗效果及调整用药剂量提供重要的量化参考依据,具有较高的临床应用价值。

Correlation between ^99mTcO₄<sup style="margin-left:-7px;">-</sup>Thyroid Scintigraphy and Blood Test in Primary Hyperthyroidism

Background: The 99mTcO4- thyroid scintigraphy is commonly used for hyperthyroidism diagnosis. Uptake value of 99mTcO4- on thyroid scintigraphy is an indicator of hyperthyroidism activity. Although, the correlation between free T3 value and free T4 value is not necessary clear in primary hyperthyroidism. Introduction: This study investigated the correlation between results of blood test and uptake of 99mTcO4- on thyroid scintigraphy in primary hyperthyroidism. Methodlogy: In this retrspective study, uptake was calculated in patients diagnosed with primary hyperthyroidism (Graves’ disease/Basedow’s disease) based on clinical findings, blood tests, thyroid ultrasound, and 99mTcO4- thyroid scintigraphy (uptake ≥3%) at St. Marianna University School of Medicine Hospital between 1 January 2010 and 31 December 2019. This uptake of 99mTcO4- was compared with results of blood tests. Results: Fifty-four consecutively arriving patients at the hospital (12 men, 42 women;mean age 43.0 ± 14.0 years) were selected. Free T3 (n = 54) was 14.6 ± 6.8 pg/mL, free T4 (n = 53) was 5.0 ± 2.3 ng/mL, and uptake on thyroid scintigraphy was 10.0% ± 7.1%. The correlation coefficients were 0.60 (p < 0.01) between free T4 (all case), 0.39 (p < 0.01) between free T4 (under 7 ng/mL), 0.12 (p = 0.70) between free T4 (above 7 ng/mL) and 99mTcO4- thyroid scintigraphy uptake. Conclusion: In primary hyperthyroidism (Graves’ disease), there is a correlation between free T4 value and 99mTcO4- thyroid scintigraphy uptake, but there is no correlation in patients with high free T4 level.

Graves甲亢患者^(131)I治疗3个月后甲状腺激素和TSH水平对患者预后的评估作用

目的探讨Graves甲亢患者131I治疗后3个月时疗效判断对治疗结果的预测及指导治疗的临床意义。方法将临床诊断为Graves甲亢,接受131I治疗并完成3个月和6个月或更长时间随访的258例患者按3个月时检测的甲状腺激素和TSH水平分为好转组、临床痊愈组、甲减Ⅰ组(FT4减低,TSH≤10 mIU/L)、甲减Ⅱ组(FT4减低,TSH>10 mIU/L)和无效组,分析各组间6个月后甲减、临床痊愈及甲亢复发发生率的差异,同时分析甲减Ⅰ组和Ⅱ组一过性甲减的发生率(3个月时诊断甲减,6个月后临床痊愈或复发)的差异。结果好转组6个月后临床痊愈率为43%,甲减率为18%;临床痊愈组6个月后复发率为10.6%,甲减率56%,临床痊愈率33.3%;甲减Ⅰ组复发率26.9%,临床痊愈11.5%,一过性甲减发生率为38.46%;甲减Ⅱ组复发率9.5%,临床痊愈9.5%,一过性甲减发生率为18.92%;无效组6个月后临床痊愈率5%,甲减率15%。5组间的6个月甲减发生率差异具有统计学意义(χ2=69.14,P=0.000)。临床痊愈组和甲减I组、甲减II组间6个月后复发率无统计学差异(χ2=5.690,P=0.058)。两组间差异分析,好转组与无效组和治愈组与甲减I组间的6个月甲减发生率无统计学意义(U=698,P=0.751;U=707,P=0.130),其他组间均具有统计学意义。甲减I组与甲减Ⅱ组间一过性甲减的发生率具有统计学差异(U=774,P=0.046)。结论对Graves甲亢131I治疗后3个月诊断临床痊愈的患者要积极缩短随后的随访时间,以便及早发现甲减,及时给予治疗。对于3个月时FT4减低,TSH>10 mIU/L的患者应尽早进行甲状腺激素的替代治疗,其一过性甲减的可能性很低。对于3个月时虽然FT4减低,但TSH≤10 mIU/L的患者,要注意密切复查,其一过性甲减的发生率近40%。对于3个月无效的患者,应及时进行第二疗程的治疗或采用其他方法积极治疗,其治愈的可能性很低。

^(131)I治疗巨大与非巨大甲状腺肿性Graves甲亢疗效对比

目的通过与非巨大性甲状腺肿组的对比,探讨131I治疗巨大性甲状腺肿性Graves甲亢的临床疗效。方法选取经过131I治疗的甲状腺质量>70 g的甲亢患者128例作为研究组,同期经过131I治疗的甲状腺质量<70 g的甲亢患者318例作为对照组,对比131I治疗后两组患者一次治愈率、总治愈率及甲状腺功能减退发生情况。结果 131I治疗巨大甲状腺肿性Graves甲亢的总治愈率95.3%,一次治愈率46.9%,早发甲减发生率4.7%;对照组总治愈率90.9%,一次治愈率65.7%,早发甲减发生率9.1%。两组一次治愈率有统计学差异(P=0.000);两组总治愈率、早发甲减发生率无统计学差异(P=0.115)。结论 131I治疗巨大甲状腺肿性Graves甲亢安全有效,无一例发生气管压迫、喉头水肿、甲亢危象等不良反应,总治愈率与早发甲减的发生率与非巨大性甲状腺肿性Graves甲亢相近。

Graves眼病的治疗

Graves眼病又叫甲状腺相关性眼病 ,浸润性突眼 ,与甲状腺自身免疫有关 ,尤其是与 Graves甲亢有关 ,发病率占甲亢的 5 %～ 10 % ,男性多于女性。严重 Graves眼病的治疗是一个临床难题 ,因此人们不断研究新的治疗方法 ,企图攻克 Graves眼病这一课题。在此 ,将 Graves眼病的治疗作一简要的介绍 ,并展望 Graves眼病治疗的发展趋势。

^(131)I治疗Graves甲亢前长时间应用抗甲状腺药物对其疗效的影响

目的探讨131I治疗Graves甲亢前长时间应用抗甲状腺药物(ATD)对Graves甲亢治愈率的影响。方法临床诊断为Graves甲亢患者176例,其中87例为ATD治疗至少6个月后甲亢未愈患者,89例为未进行系统ATD治疗患者。所有患者均常规行个体计量法131I治疗,且治疗前停用ATD(咪唑类至少3 d、硫脲类至少2周)。131I治疗6个月后进行随访及疗效评价,痊愈或甲减为治疗成功,好转或无效为治疗失败。两组患者131I治愈率差异比较行χ2检验,并用t检验比较其他临床或实验资料的差异。结果 131I治疗后6个月两组患者的治愈率分别为47.1%和76.4%,两组比较差异有统计学意义(P=0.000);两组患者24h最高摄碘率分别为(58.74±14.74)%和(65.98±14.63)%,差异有统计学意义(P=0.001)。结论 131I治疗前长时间应用ATD将会降低131I治疗Graves甲亢患者的治愈率,长时间应用ATD患者24 h最高摄碘率降低。

灵芝多糖在Graves病小鼠模型中对甲亢及甲亢肝脏功能损伤的影响

目的探讨灵芝多糖对Graves病(GD)模型小鼠甲状腺功能亢进症(甲亢)及其所致肝脏功能损伤的影响。方法利用促甲状腺素受体A亚单位(TSHR-A)免疫BALB/c小鼠获得GD动物模型,检测小鼠血清甲状腺素(T4)、促甲状腺素受体抗体(TRAb)和肝功能指标并分析相关性。在建模过程中,分别给予纯水、低剂量灵芝多糖(100 mg.kg-1.d-1)和高剂量灵芝多糖(400 mg.kg-1.d-1)灌胃,观察小鼠血清T4、TRAb和肝功能指标谷丙转氨酶(ALT)、谷草转氨酶(AST)和碱性磷酸酶(ALP)的变化。结果与模型组未发生甲亢和对照组小鼠比较,模型组发生甲亢小鼠的血清ALT、AST和ALP水平均显著升高(P<0.05),血清AST、ALP与T4水平呈显著正相关(r值分别为0.585和0.744,P<0.05),与TRAb水平无相关性(P>0.05)。灵芝多糖干预后,模型小鼠血清T4和TRAb无显著变化(P>0.05)。经低剂量灵芝多糖干预的模型组发生甲亢小鼠的肝功能指标(血清ALT和ALP)均显著优于纯水组(P<0.05)。结论灵芝多糖对GD模型小鼠的甲亢状态无明显影响,但对甲亢引起的肝脏功能损伤具有改善作用。

高活性促甲状腺素受体抗体的Graves病患者甲亢复发情况研究

目的分析不同活性促甲状腺素受体抗体(TRAb)的Graves病患者抗甲状腺药物治疗(ATD)后甲亢复发率差异。方法从2009年1月至2009年12月在佛山市南海区第二人民医院治疗的191例Graves病患者,收集患者甲状腺功能指标、TRAb、抗甲状腺球蛋白抗体(TG-Ab)、抗甲状腺过氧化物酶抗体(TPO-Ab),根据最初TRAb滴度不同分为3组:高活性组(22例),中活性组(67例),低活性组(102例)。ATD治疗,待TRAb阴转后,停药观察3年,比较三组的甲亢复发率。结果高活性组TRAb(3.40±1.15)U/L明显高于中活性组(1.09±0.30)U/L及低活性组(0.72±0.18)U/L;中活性组也明显高于低活性组,差异具有统计学意义(均P<0.01)。高活性组甲亢复发率为31.81%,明显高于中活性组11.94%及低活性组9.80%,差异具有统计学意义(均P<0.01)。结论 TRAb是监测Graves病控制情况和是否复发的重要指标;高活性TRAb的Graves病患者ATD治疗后甲亢复发率明显增高,对于这些患者可适当延长ATD疗程。

^(131)Ⅰ治疗Graves甲亢中动态监测血清TRAb的临床价值

目的探讨^(131)I 治疗 Graves 甲状腺功能亢进症(简称甲亢)中动态监测血清促甲状腺激素受体抗体(TRAb)水平变化的临床价值。方法 130例 Graves 甲亢患者和50名健康对照者分别于^(131)I 治疗前及治疗后3,6,12和24个月采用放射受体分析法(RRA)测定其血清 TRAb 水平。数据用 x^-±s表示,组间差异用方差分析与 t 检验。结果 130例 Graves 甲亢患者在^(131)I 治疗前血清 TRAb水平[(92.93±68.99)U/L]高于健康对照组(P<0.01)。在^(131)I 治疗后3个月血清 TRAb 水平[(139.04±77.19)U/L]明显高于治疗前(P<0.01),治疗后6个月患者血清 TRAb 水平[(65.87±54.86)U/L]开始降低,但与对照组比较差异仍有统计学意义(P<0.01),在^(131)I 治疗12个月后血清TRAb 水平[(14.16±12.35)U/L]明显降低(P<0.01),到24个月患者血清 TRAb 水平[(12.99±5.52)U/L]与对照组比较差异无统计学意义(P>0.05)。结论在^(131)I 治疗前检测血清 TRAb 水平可指导^(131)I 的用量;在^(131)I 治疗后检测 Graves 甲亢患者的 TRAb 水平有助于随访监测及疗效评价,还可了解治疗后的免疫反应状态。

^(131)I治疗Graves甲亢近期疗效评价

目的 评价放射性碘 (13 1I)治疗毒性弥漫性甲状腺肿 (Graves病 )的近期临床疗效。方法 对接受13 1I治疗的 2 78例Graves甲亢患者随访 1年。所有病人于治疗后 3、6、12个月复诊。治疗结果包括治愈 (包括治疗后甲状腺功能恢复正常与发生甲低 )和未愈 (甲亢 )。结果 治疗后 3个月 ,有 179例 (6 4 3%)患者甲状腺功能恢复正常 ,35例 (12 6 %)发生甲低 ,6 4例(2 3 1%)仍处于甲亢 ,治愈率为 76 9%。治疗后半年与一年的治愈率相似 (84 6 %vs 88 8%) ,均显著性高于 3个月 ,分别有193例 (6 9 5 %)和 196例 (70 5 %)甲状腺功能恢复正常 ,42例 (15 1%)和 5 1例 (18 3%)发生甲低。结论 13 1I能迅速治愈甲亢 ,疗效显著 ,简便安全 ,是成人Graves甲亢的首选治疗方法。

^(131)I治疗前抗甲状腺药物对Graves甲状腺功能亢进的影响

目的探讨运用131I治疗Graves甲状腺功能亢进(甲亢)前先较长时间服用抗甲状腺的药物对Graves甲亢治愈率的影响。方法将临床明确诊断为Graves甲亢的100例患者按是否经过抗甲状腺药物(ATD)治疗,分为对照组和治疗组,对照组为用ATD治疗最少半年而未愈的患者,治疗组为未经ATD治疗的患者,两组患者同时采用131I治疗。结果对照组的治愈率为72%,治疗组的治愈率为98%,治疗组明显高于对照组;两组治疗后的甲状腺功能比较,治疗组的治疗结果也显著优于对照组,差异有统计学意义(P<0.05)。结论 131I治疗Graves甲亢前较长时间的应用ATD能够降低131I对Graves甲亢的治愈率,从而影响其疗效。

^(131)I治疗巨大甲状腺肿性Graves病104例临床分析

目的评价131I治疗巨大甲状腺肿性Graves病的治疗效果和131I使用剂量的最优化。方法经过131I治疗104例巨大甲状腺肿性Graves病患者,依据SPECT甲状腺断层显像确定甲状腺质量为70～200g,平均(93.2±27.5)g,根据患者个体因素确定个体化的每克甲状腺组织131I剂量,一般每克甲状腺131I剂量范围为3.7～7.77MBq,给予的131I治疗剂量范围为518～1369MBq。结果一次131I治疗后,60例(57.7%)甲状腺功能恢复正常,30例(28.9%)大部分缓解,8例(7.7%)部分缓解,4例(3.8%)甲减,仅2例(1.9%)无效,且无效的2例患者经第2次131I治疗后都明显缓解。结论 131I治疗巨大甲状腺肿性Graves病是一种安全有效的方法;依据甲状腺断层显像确定甲状腺质量和根据患者个体情况确定个体化的每克甲状腺组织131I剂量可以优化131I治疗效果。

Grave's病再次^(131)I治疗时间的选择

目的探讨Grave’s病患者再次131碘治疗时间。方法回顾2007年2月1日～2010年4月30日期间接受131I治疗、且随访近1年左右的48例G rave’s甲亢患者,记录患者年龄、性别及4次随访结果(FT3、FT4、TSH),以评估患者疗效及转归。结果 4次随访时间分别为(103.6±21.9)、(188.2±46.3)、(300.1±80.9)、(476±142.9)d。治疗半年后治愈和甲减患者数量相对稳定,分别维持在27%和66%左右。末次随访时患者治愈率93.7%,甲状腺功能减退发生率62.5%,复发率6.3%,甲状腺功能正常者占31.3%。第1次随访的复发、治愈和甲减患者均可在病程中出现复发、治愈和甲减,其中第1、2次随访时患者病情变化较大,第3、4次随访病情则较平稳。结论单次小剂量131I治疗6个月后,患者整体复发率、治愈率和甲减率均较稳定,且个体甲状腺激素水平也趋于稳定,应于此时给予第二次131I治疗。

甲状腺动脉栓塞治疗Graves病对甲状腺自身抗体的影响

目的探讨甲状腺动脉栓塞治疗Graves病对甲状腺自身抗体的影响。方法对临床确诊的41例Graves病进行甲状腺动脉栓塞治疗。术前测定甲状腺自身抗体水平，术后随访3～61个月，依据患者症状、体征、甲状腺功能等观察疗效，并定期检测甲状腺自身抗体的滴度／活性和阳性率。结果Graves病时TRAb、TGAb、TMAb滴度／活性和阳性率高于正常水平，以TRAb更为显著。介入治疗6个月后有效组TRAb活性和阳性率降至正常水平，而复发组则仍保持较高水平。TGAb、TMAb滴度和阳性率于治疗前、后无明显变化。结论栓塞治疗可以间接地纠正Graves病免疫功能的紊乱，降低某些自身抗体的产生。栓塞治疗有效者术后6个月TRAb多降至正常水平，高于正常水平者提示复发可能，TRAb可作为判断手术疗效的指标之一；TGAb和TMAb对于判断手术疗效意义不大。

不同起始剂量甲巯咪唑治疗Graves病的疗效

目的探讨甲巯咪唑最佳的起始剂量治疗方案。方法病例选自在武警辽宁总队医院门诊就诊的Graves病初诊或复发患者,随机分为两组,A组135例(甲巯咪唑15mg,1次/d)和B组110例(甲巯咪唑10 mg,3次/d),随访12周,比较两组的疗效及不良反应发生率。结果 (1)A组患者依从性达到91.9%,明显好于B组(80.9%);(2)治疗4周、8周及12周后甲状腺激素降至正常的比率在A组分别为62.1%、83.6%和89.7%,B组分别为65.9%,84.4%和88.3%,无统计学差异;(3)药物不良反应发生率在A组为5.9%,B组为10.9%;(4)甲状腺肿大达Ⅲ度(OR=12.529)或FT4显著升高达正常值的4倍以上(OR=9.117)的患者采用甲巯咪唑小剂量每日一次顿服法疗效欠佳。结论初始治疗采用甲巯咪唑小剂量15 mg日一次顿服法对大多数Graves病患者安全有效,但对于甲状腺Ⅲ度肿大或甲状腺激素水平显著升高者起始治疗量10 mg每日3次方法更为适合。