Clinical Study On The Risk Factors And TCM Syndromes Of Recurrence In Patients With Graves' Disease After The Antithyroid Drug Therapy

ObjectivesExploring the risk factors of the recurrence in patients with Graves' disease after the antithyroid drug therapy.On this basis,establishing a preliminary predictive model of recurrence in order to provide reference for the GD patients to choose the best therapy.MethodsFrom September 2012 to October 2018,the GD patients who met the inclusion criteria were enrolled in the study.All patients were from Nanjing University of Chinese Medicine Affiliated Hospital of Integrated Traditional Chinese and Western Medicine and given the antithyroid drug therapy.The clinical data and the TCM symptoms and syndrome of the patients were recorded before and af'ter therapy.According to the state of recurrence after ATD withdrawal for one year or more,the patients were divided into recurrence group and remission group.By comparing the baseline data of two groups,we plan to explore the risk factors affecting the recurrence of patients with Graves'disease,and to find the relevance between the recurrence and initial TCM symptoms and syndromes.Finally,by using the logistic regression analysis,we established a predictive model for recurrence after the antithyroid drug therapy with Graves' disease.Results1 CompletionFrom September 2012 to October 2018,323 patients were enrolled in the study.77 patients have completed the observation,while 172 were still in follow-up.12 patients received the radiation iodine or surgical therapy.62 cases lost to follow up,the rate of'which was 19.20%.In the patients who have completed the study,40 patients had remission and 37 had recurrence(recurrence rate:48.05%)2 Risk factiors for Graves' disease recurrence after antithyroid drug therapyAccording to the statistical analysis,there were significant differences in gender,combined with Graves' ophthalmopathy or not,goiter,serum FT4 and PT3 level,serum TRAb and thyroid volume between the two groups(f<0.05,OR>1).The recurrence of patients with pre-cervical swelling,eye swelling and tearing,irritability,bad breath,hot and sweaty was higher.There were statistical differences between the two groups in TCM syndromes.The recurrence rate of the yin deficiency yang excess syndrome was higher than that of the heart-liver fire-excess syndrome(73.3%v.s.35.0%,P<0.05).Age,smoking,genetic history,serum TSH,TPOAb and TGAb levels,and blood flow of superior thyroid artery were not significantly different between two groups.Logistic multivariate regression analysis f'ound that large goiter and high levels of serum TRAb were the independent risk factors tor the recurrence of Graves' disease.3 Establishment of logistic regression modelThe" clinical features factors,thyroid-related factors and TCM symptoms","clinical features factors,thyroid-related factors,not included in TCM symptoms”two forms of logistic regression model were esrtablished.Model 1,which was consisted of clinical features factors,thyroid-related factors and TCM symptoms,included the goiter and TRAb factors,and the equation was P(Y)1?1/(1+e^-(-3.417+0.115xTRAB+1.125xgoiter)).Model 2,not including the TCM symptoms,was also composed by goiter and TRAb factors,and the equation was P(Y)2=1/(l+e^-(-2.910+0.102 ×TRAB+1.280 × goiter))(Note:the variables can be directly brought into the values of TRAb and goiter degree.).The threshold value of P(Y)1 was 0.258,and of P(Y)2 was 0.369.The AUC value of both was 0.885,the sensitivity was 0.865,and the specificity was 0.775.This model provided the reference for predicting the recurrence of Graves' disease to some extent.Conclusion1 Female,combined with Graves ophthalmopathy,goiter(?° or larger),high levels of serum FT4(?62.39 pmol/L),FT3(?18.07 pmol/L)and TRAb(14.04?U/L)and larger thyroid volume(?28.21 cm3)were correlated with the recurrence of Graves'disease.Patients with pre-cervical swelling,eye swelling and tearing,irritability,bad breath,hot and sweaty were easy to relapse.There were statistical differences between the two groups in TCM syndromes.2 Logistic multivariate analysis showed that high serum TRAb levels and large goiter were independent risk factors for recurrence of Graves'disease.3 This study preliminarily established a risk model for predicting the recurrence of Graves' disease after antithyroid drug therapy,which provided the reference for the follow-up study.