Clinical Feasibility Analysis Of Antithyroid Drugs Graded Treatment Based On Hyperthyroidism

Object:In order to provide a basis for more reasonable clinical medication,the author try to classify patients according to their FT3 and FT4 levels,select three different doses of mebendazole(MMI)for initial treatment,and then compare their efficacy on hyperthyroidism and the occurrence of adverse reactions.Methods: Collect 139 cases of hyperthyroidism patients who were regularly treated in our outpatient department of endocrinology from April 2016 to October 2019,and divide the hyperthyroidism into three groups according to the serum FT3 and FT4 levels before treatment.MMI-1(n = 46),MMI-2(n = 26),MMI-3(n = 67),the initial treatment was given daily oral methimazole 15mg(day service),20mg(day service),30mg(Take three times),and then monitor the condition changes according to the standard diagnosis and treatment of hyperthyroidism.After the thyroid function is normal,gradually reduce the amount until maintenance treatment.The observation time is not less than 12 weeks.Collect the general data,thyroid function indexes,liver function and blood routine biochemical indexes of patients before and after treatment.Results:1.Changes in thyroid function after the treatment1.1 Before the treatment,the levels of FT3 and FT4 of the patients were all like this: severe group>moderate group>mild group(all p<0.05);4 weeks after the treatment,the FT3 and FT4 of the severe group and the moderate group were still higher than the mild group(all P <0.05),but the difference between the severe group and the moderate group was no longer statistically significant(P>0.05);with the passage of treatment time,by the 8th week(FT3,FT4)and the12 th week(FT3),the comparison between the three groups has no statistical significance(P> 0.05),but the 12 th week is mild Although the FT4 level of most patients in the group has dropped to the normal range,it still appears relatively higher than the severe group(P <0.05)1.2 The decline of FT3 and FT4 in the 4th,8th,and 12 th weeks after the treatment were all like this: severe group> moderate group> mild group(all p<0.05).1.3 In the 4th week after the treatment,the proportion of thyroid function recovery was higher in the light group than in the middle group and the severe group,but there was no difference in the rate of normal thyroid function between the groups at 8 and 12 weeks after the treatment(all p> 0.05).1.4 At 4 weeks,8 weeks,and 12 weeks after the treatment,the increase of TSH of each group was not statistically significant(all p> 0.05).2.Comparison of blood routine related indexes of each group after the treatment2.1 Before the treatment,the neutrophil count critical group was less than the mild group(p <0.05),and the hemoglobin concentration severe group was less than the mild and moderate group(all p <0.05).But these changes are within the normal range.2.2 Before the treatment,the neutrophil count in the severe group was less than that in the mild group,and compared with baseline,the neutrophil count increased at 4 weeks,8 weeks,and 12 weeks after the treatment.After 8 weeks and 12 weeks of the treatment,the white blood cell count increased than the baseline,and the differences were statistically significant(all p <0.05).The same results were not observed in the mild and moderate disease groups.None of the patiensts’ leukocytes and neutrophils levels were lower than the lower limit of normal reference value,no matter before or after the treatment.2.3 Changes in hemoglobin after the treatment.Compared with before treatment’s data,at the 4th and 8th week after the treatment,the hemoglobin concentration in the severe group increased and was higher than the baseline value(all p <0.05),and the 8th week it was also greater than the 4th week’s,but after that it becomed stable.At the same time,in the light group,the author also observed that the 4th and 8th weeks after the treatment the hemoglobin concentration in the severe group were higher than the baseline,and then gradually stabilized.There was no similar change in the treatment of the middle group.It can be seen that hyperthyroidism itself,especially in severely ill patients,may cause the tendency of peripheral blood cells to decline,including the total number of white blood cells,neutrophils and hemoglobin may be affected,but as the disease control and thyroid function return to normal,these changes are gradually restore.3.Changes in liver function ALT and AST after the treatmentAfter the treatment,1 case of 139 patients suffered from drug-induced liver injury,mainly with elevated ALT(ALT> 3 × ULN),which occurred at the 12 th week of medication.This patient’s liver function returned to normal after MMI was stopped and proper liver protection treatment was given.Conclusions:1.According to the level of FT3 and FT4 blood levels,the condition of newly diagnosed hyperthyroidism patients is divided into three levels: mild,moderate and severe.Based on this,small,medium and large doses of antithyroid drugs are selected for initial hyperthyroidism.Treatment,the three groups of patients can obtain similar curative effect in the same observation period,which is clinically feasible.The thyroid grading treatment has no serious adverse effects on peripheral blood cells and liver function.The selection of the above treatment methods can reduce the possible side effects of drugs while ensuring the efficacy,which will have potential clinical benefits for patients and is clinically necessary.2.Hyperthyroidism itself,especially patients with severe hyperthyroidism,may be accompanied by peripheral blood cells tending to be lower.After treatment with antithyroid drugs,as the condition of hyperthyroidism gradually controls,the above "abnormalities" will tend to be normal.