如何才可使THYROID斷根

慢郎中

我喜欢读NEJM,对于里头的article我都奉为圭臬，并以此这为准绳。

我看了你的writing,大概是有些医学背景的，不妨参考里头的几篇review article,我附上目录方便你去查询。如果你没有途径可以access,寄来你的电邮地址，我会下载打包去给你读。


(1)        Graves' Disease Anthony P. Weetman, M.D., D.Sc.
Volume 343:1236-1248, October 26, 2000, Number 17

Approximately 30 to 40 percent of patients who are treated with an antithyroid drug remain euthyroid 10 years after the discontinuation of antithyroid drug therapy, which means that the Graves' disease has remitted. Whether the remission is entirely spontaneous or is due to amelioration of hyperthyroidism or to an immunomodulatory action of these drugs is unclear.4 If hyperthyroidism recurs after treatment with an antithyroid drug, there is little chance that a second course of treatment will result in permanent remission.
Repeated attempts to predict the outcome after drug therapy is stopped have failed to identify reliable markers, although young patients and those with large goiters, ophthalmopathy, or high serum concentrations of thyrotropin-receptor antibody at the time of diagnosis are unlikely to have permanent remissions.62 With respect to regimens of antithyroid drugs, prospective, randomized trials have established that prolonging treatment beyond 18 months confers no benefit when the titration regimen is used (Table 2),63 whereas treatment for more than 6 months confers no benefit with the "block–replace" regimen.64 I prefer the block–replace regimen because it involves fewer visits to the clinic and because euthyroidism seems easier to maintain. Thyroxine is added to the antithyroid drug in the block–replace regimen to avert hypothyroidism, but an additional role of thyroxine — namely, to suppress the secretion of thyrotropin and thereby possibly prevent the release of thyroid antigens — was suggested by the finding of a very low rate of recurrent hyperthyroidism in one study of patients given thyroxine during and after a course of methimazole.65 These results were not reproduced in several other studies for reasons that are unclear.66


(2) Antithyroid Drugs ,David S. Cooper, M.D. Volume 352:905-917, March 3, 2005, Number 9

Given these results, treatment with antithyroid drugs for 12 to 18 months is the usual practice, as recommended in a recent systematic, evidence-based review.63 Some patients opt for long-term antithyroid drug treatment (i.e., years or even decades), and there is no theoretical reason why a patient whose disease is well controlled with a small dose of antithyroid drug could not continue antithyroid-drug therapy indefinitely.64 Finally, a Japanese study showed that a combination of an antithyroid drug plus thyroxine for one year, followed by thyroxine alone for three years, decreased the relapse rate significantly.65 However, subsequent attempts to replicate this study have failed.66,67,68

Discontinuation of Drug Treatment

With the exception of children and adolescents, who are often treated with antithyroid drugs for many years, antithyroid drugs are usually stopped or tapered after 12 to 18 months of therapy. The likelihood of relapse is increased in patients with normal serum levels of free thyroxine and triiodothyronine but suppressed serum thyrotropin levels.69 Relapse usually occurs within the first three to six months after medication is stopped.47 Thereafter, the rate of recurrence decreases and plateaus after one to two years, for an overall recurrence rate of approximately 50 to 60 percent.48,70,71 About 75 percent of women in remission who become pregnant will have a postpartum relapse of Graves' disease or the development of postpartum thyroiditis.72 Lifelong follow-up is required for patients in remission, since spontaneous hypothyroidism may develop decades later in some of them.73

(3 )The Management of Hyperthyroidism, Jayne A. Franklyn
Volume 330:1731-1738, June 16, 1994, Number 24
There are conflicting results regarding the likelihood of a long-term remission of Graves' hyperthyroidism during antithyroid-drug therapy, with the reported rates ranging from 10 to 75 percent24,25,26. Clinical findings associated (weakly) with remission are a small goiter and recent onset of the hyperthyroidism. There are no reliable tests for predicting relapse at the time that therapy is discontinued26,27,28,29,30,31,32.
One factor that affects the likelihood of such remission is the duration of treatment28. In one study, the rate of remission one year after treatment was stopped was 31 percent among patients treated for six months and 82 percent among patients treated for two years33. Despite evidence in favor of longer treatment,34 therapy is usually continued for one to two years, after which the patient must be reevaluated regularly. I do not favor longer courses, because of the need for monitoring and poor compliance. Relapse is most likely within the first six months after withdrawal of therapy but may occur years later. If patients relapse and wish to avoid ablative treatment, antithyroid-drug therapy may be resumed; very-long-term therapy appears to be safe.

华侨

通过气功修练，阴阳调和，五脏功能正常就可改善。

不必吃药，不必担心毒素与副作用。

伤凤、感冒、咳嗽也难犯。我只练了2个星期，不再生病了。190LBS ---> 180LBS，肚腩也缩小了，精神充沛！

[ 本帖最后由 华侨 于 27-10-2006 10:57 AM 编辑 ]