A Systematic Review Of Drug Therapy For Gravese’ Hyperthyroidism

Background and Objective:Graves’s disease is a most common autoimmune thyroid disease.Researches in recent years have a more clear understanding about the effects of TSH receptor antibody in the pathogenesis of GD.Studies have shown that TSH receptor stimulating antibody is not only the main reason for the development of Graves’ disease,but also an important factor for the disease recurrence.It was thought that some thyroid stimuli such as TSH and TSAb can promote the continuous release of thyroid auto-antigens after antithyroid drug therapy,resulting in the relapse of GD.Therefore, combining thyroxine with ATD in curing GD may inhibit the release of thyroid auto-antigens, so as to prevent the relapse of GD.But the conclusion was in controversy.The meta-analysis focused on this issue with the purpose to provide therapy choices for the clinicians.Method:Articles compared relapse rate between combined therapy group and ATD alone group available on Pubmed and Wanfang medicine online were collected into the study, supplemented by hand-searching.Selection of researches depends on the inclusion and exclusion criteria, and the relevent references were also checked as the supplement. RevMan5.1software was used to run statistical calculation,results are referred to the risk ratio of relapse rate and95%confidence interval; subgroup analysis was carried out according to the different duration of follow-up and similarities and differences in experimental design. Sensitivity analysis was actualized to estimate the stability of the results;funnel plot method and fail-safe number method were used to assess publication bias.Results228essays were obtained through computer, only8researches included in the study finally. A total of1003patients with primary GD were included, which with589from combined treatment group and414from ATD alone group.Results:the overall effect of RR(per protocol analysis):M-H method.random effect model:RR=0.89,95%CI [0.671.17],P=0.40; subgroup analysis (per protocol analysis):similar in experiment design:M-H method, random effect model:RR=0.60,95%CI[0.251.43], P=0.25; subgroup analysis (per protocol analysis):duration of follow-up:1-2years group,M-H method.random effect model:RR=0.84,95%CI [0.681.05],P=0.13,duration of follow-up:beyond2years group, M-H method,random effects model: RR=0.90,95%CI[0.491.65],P=0.72; sensitivity analysis (intention-to-treat analysis):M-H method.random effect model:RR=0.91,95%CI [0.751.11],P=0.37; all P values>0.05which yielded no significant difference in the relapse rate between two groups.Conclusion:Current clinical researches showed no benefit from comparing combined thyroxine therapy and anti-thyroid drugs alone therapy.but due to the design defects in the past experiments so a good large multicenter clinical test need to be carried out.