Clinical diagnosis and treatment of refractory hyperthyroidism / 中国实用内科杂志

Graves' disease(GD) is the most common cause of endogenous thyrotoxicosis, and current therapeutic options for GD include antithyroid drugs(ATD), radioactive iodine and thyroidectomy. Refractory hyperthyroidism is a rare condition in which hy¬perthyroidism fails to respond to the conventional therapy of anti-thyroidal med¬ications. Enlarged goiter size, high titers of thyrotropin receptor antibodies(TRAb) at diagnosis and/or at the end of the treatment, TSH suppression after drug withdrawal and compliance to the treatment have all been proposed as risk factors that predict the relapse of GD. we propose that a patient-centered professionalism should be consistently followed, and that refractory hyperthyroidism because of unsuitable therapeutic strategies should be strictly avoided in the clinical practice. For the patients with refractory hyperthyroidism, radical treatment is recommended, however,continued long-term low-dose ATD can be considered.

Clinical characteristics of patients with early hypothyroidism after 131I therapy and patients with refractory hyperthyroidism / 第二军医大学学报

Objective To analyze the clinical characteristics of patients with early hypothyroidism after 131I therapy and patients with refractory hyperthyroidism. Methods The clinical data of patients with early hypothyroidism after receiving 131I treatment in three months and patients with refractory hyperthyroidism were retrospectively analyzed in the present study, and the clinical data of them were compared with the patients in the control group. Results A total of 246 patients of hyperthyroidism were included. The thyroid peroxidase antibody (TPOAb) level of the early hypothyroidism group was significantly higher than that of the control group (P<0.05). Patients in the refractory hyperthyroidism group had significantly longer disease course and significantly higher levels of free triiodothyronine (FT3), free thyroxine (FT4), thyrotrophin receptor antibody (TRAb), 3 h iodine uptake, and 131I dose compared with the control group (P<0.05 or 0.01); while thyroid stimulating hormone (TSH) and TPOAb levels of the refractory hyperthyroidism group were significantly lower than those of the control group (P<0.05 or 0.01). Conclusion TPOAb level is closely related to patients with early hypothyroidism after receiving 131I treatment. Patients with refractory hyperthyroidism have longer disease course and higher levels of FT3, FT4 and TRAb.