The Effect Of Methimazole Or Prednisone On Therapeutic Effect And TRAb Level After ¹³¹â…  Therapy In Graves' Disease

Objective:To evaluate the effect of Methimazole or Prednisone on the therapeutic effect and serum TRAb level after 131I therapy in Graves'disease.Methods:228 patients (73 males and 155 females, ratio of 1:2.1, aged from 14 to 69 years old, average age 40.32±11.77) who were diagnosed as Graves'disease in our department and treated with 131I therapy between March 2008 and February 2009 were collected as our samples. Cases with history of Thyroid Surgery or 131I treatment as well as other diseases as immune diseases, heavy heart disease or poor functionality of liver or kidney were excluded. Patients were divided into three groups randomly. GroupⅠincludes 103 Patients who were treated with 131I therapy alone. GroupⅡincludes 61 patients who were treated with 131I therapy plus Methimazole (15mg qd, for 45 days) 4 days after the beginning of 131I therapy. GroupⅢincludes 64 patients who received 131I therapy and took Prednisone (10 mg tid for 20 days, drug capacity were gradually reduced, for a period of two and a half months) right after the 131I treatment. Symptoms and vital signs of the patients were carefully examined, recorded and evaluated before and one month after the 131I treatment. Levels of the serum FT3,FT4,TSH and TRAb were collected one month, three months, six months and nine months after 131I therapy to evaluate the therapeutic effect and serum TRAb level. All the data were analyzed by the statistical software SPSS (version 11.0). All the data were arranged in x±s form, comparisons between groups of data adopted t method or variance method, rare cases which did not comply with normal distribution were analyzed by rank sum test, and rate comparison adoptedχ2 method.Results:1. Symptoms, vital signs and serum FT3, FT4, TSH levels of patients in GroupⅠshowed no obvious change (P>0.05) one month after the treatment. In GroupⅡ, symptoms and vital signs of the patients showed significant clinical improvement (t=7.05, P<0.001),serum FT3, FT4 levels decreased obviously, these differences had statistical significance (t1=3.05, P<0.05; t2=4.02, P<0.05). In GroupⅢ, symptoms and vital signs of the patients showed significant clinical improvement,which had statistical significance (t=8.48, P<0.05), while serum FT3, FT4 levels showed no obvious change, which also meant no statistical significance (P>0.05)2. Nine month after the 131I therapy,18 patients received their second 131I therapy, among which 8 cases (8/103,7.8%)in GroupⅠ,6 cases(6/61,9.8%)in GroupⅡ, and 4 cases(4/64,6.3%) in GroupⅢ. Data comparison of those who did not receive a second treatment 3 months,6 months and 9 months after the 131I treatment had no statistical significance (P>0.05).3. Three months after the 131I therapy, significant differences in Graves' ophthalmopathy were witnessed among the three groups (χ2=63.32, P<0.001). GroupⅢwas much better than those of GroupⅠor GroupⅡ.4. After 131I therapy, serum TRAb level of the patients rose dramatically in all three groups. The level came to a peak after 3 months, and decreased gradually 6 months later. Three months after the treatment, there were significant differences in TRAb level among the three groups (F=3.20, P<0.05). Significant differences of TRAb level were witnessed between GroupⅢand GroupⅠ(P=0.017<0.05). Differences in TRAb level between GroupⅢand GroupⅡhad statistical significance (P=0.049<0.05). Difference between GroupⅠand GroupⅡhad no statistical significance (P>0.05). Six months or nine months after the therapy, differences among three groups had no statistical significance (P>0.05)Conclusions:1.131I therapy plus Methimazole can soon improve their high supersession symptoms, reduce thyroid hormones concentrations in peripheral blood apparently, has no effect on the cure rate of 131I treatment.2.131I therapy plus Prednisone could avoid Graves' ophthalmopathy or reduce its symptom effectively, improve patients'high supersession symptoms rapidly, and has no effect on the cure rate of the 131I treatment.3. In aspect of immunological function disorder, no immunosuppression activity of Methimazole is shown. Compared to 131I therapy, there is no difference in serum TRAb level after three months of treatment. While 131I therapy plus Prednisone can effectively improve and stabilize patients' immunologic function, make up for the defect of 131I treatment in curing immunological functioning disorder.