Clinical Analysis On 323 Patients Diagnosed With Graves Disease

Aim:To investigate the clinical characteristics,symptoms and signs, concomitant circumstances,recurrence,efficacy and adverse events of anti-thyroid drug(ATDs) in the patients diagnosed with Graves disease (GD).To investigate the treatment status of the patients diagnosed with GD.To optimize the diagnosis and treatment of GD.Population and Methods:241 patients diagnosed with GD and treated with ATDs were retrospectively analyzed,and these patients were all recruited in Endocrinology Clinic of two three-level hospitals in Shanghai during 2006.1.1-2007.6.30.The general information,symptoms and signs, concomitant circumstances,recurrence and treatment status of these patients was retrospectively investigated by questionnaire.A prospective study including 74 primary GD patients was conducted during 2006.1.1-2008.6.30,and we focused on the treatment status and adverse events of ATDs in these patients.Results:1.GD could be observed in different age group.The incidence of GD in female was 2.47 times greater than those in male.10%GD patients had GD family history.2.Palpitations,sweating and weight loss were the most common symptoms,78.0%,68.7%and 67.5%respectively.I degree goiter and soft swelling of thyroid were the most common signs,and no goiter of thyroid was also the common sign.11.1%of the patients had simple exophthalmos, and 6.5%of the patients had infiltrative exophthalmos.3.Cardiac arrhythmia occurred in 143 patients(44.3%),of which 132 patients(92.3%) with sinus tachycardia,7 patients(4.9%) with atrial fibrillation and the rest of the patients with APC,VPC and supraventricular tachycardia.Elevated liver transaminase emerged in 78 patients(35.3%).Liver transaminase was partly or completely recovered after ATDs treatment in 36 patients(46.2%).Elevated liver transaminase newly occurred in 9 patients(12%) during ATDs treatment.Decrease of white blood cell occurred in 16 patients(5.4%),and recovered in 68.8% of these patients after anti-thyroid treatment.Decrease of white blood cell newly occurred in 12 patients during ATDs treatment.ANCA-related vasculitis emerged in 1 patient during treatment course.4.The mean recovery time of FT3 and FT4 was 3 months(95%CI:1, 10.45),and the mean recovery time of TSH was 5 months(95%CI:1,11.80) by the prospective study.The recovery time of TSH was 1 month(95% CI:-2.63,8.88) later than that of FT3 and FT4.No significance of recovery time of FT3,FT4 and TSH was revealed between the MMI and PTU treatment subgroups.Recovery time of FT3,FT4 and TSH was also not correlated with ATDs category and combined drug treatment(ATD with LT4).The recovery time of TSH was not correlated with ATDs category(p＞0.05).5.GD recurrence rate was 29%,and was not correlated with age by retrospective analysis.Single recurrence was the common GD recurrence(71.4%),and 15.7%of the patients had three times or more recurrence.42%of GD patients recurred within 2 years after ATD withdrawal,and 29.5%of GD patients recurred after ATD withdrawal for more than 10 years.The latest recurrence of GD appeared in ATD withdrawal for 62 years.The interval time of GD recurrence varied from 2 month to 32 years among the patients with three times or more recurrence.6.Among 32 patients of MMI treatment group,gastrointestinal side effects occurred in 1 patient(3.1%),allergic epispasis in 1 patient (3.1%),decrease of white blood cell in 3 patients(9.4%),and liver impairment in 1 patient(3.1%).Among 42 patients of PTU treatment group, no gastrointestinal side effects occurred,allergic epispasis in 4 patient(9.5%),decrease of white blood cell in 2 patients(4.8%),and liver impairment in 1 patient(2.4%).Conclusion:1.There was a significant female predilection with diffuse toxic goiter(GD).2.Palpitations,sweating and weight loss were the most common symptoms.No or mild goiter and soft swelling of thyroid were the most common signs.Simple exophthalmos was common in the patients with exophthalmos.3.GD patients had a high incidence of cardiac arrhythmia,most with sinus tachycardia and atrial fibrillation,so thyroid function should be screened among these patients with sinus tachycardia and atrial fibrillation.Many GD patients had liver impairment and decreased white blood cell,and these abnormalities could be recovery followed with normalized thyroid function.Liver impairment seemed to be associated with thyroid function and decreased white blood cell might be associated with autoimmune disorders.4.The recovery time of thyroid function was not correlated with ATD category and combined drug treatment(ATD with LT4).The recovery time of TSH was longer than that of FT3 and FT4 for 1 month.The difference of recovery time of TSH and FT3,FT4 was not associated with ATD category.5.GD recurrence was not correlated with age.Single recurrence was the common 6D recurrence,and three times or more GD recurrence was not rare.Most GD patients recurred within 2 years after ATD withdrawal,while the recurrent GD patients still emerged after ATD withdrawal for more than 10 years.6.Gastrointestinal side effects and decrease of white blood cell in the patients with MMI treatment were greater than those in the patients with PTU treatment,however,allergic epispasis in the patients with MMI treatment were fewer than those in the patients with PTU treatment.Liver impairment in the patients with PTU treatment was similar with that in the patients with MMI treatment.