Objective To evaluate the safety and effectiveness of interventional therapy for hyperthyroidism. Methods From 1995 to 2000, 38 cases underwent bilateral super-selective superior thyroid arteries embolization with brown-algae microballs.Results There was no misembolization and mortality. Hyperthyroidism crisis developed in 2 cases. Thirty eight cases were followed-up for 0.5～5 years (the median time was 2.2 years). Medications were needed only in one patient because of relapse and the others were cured. Conclusion This procedure features miniinvasive trauma, less complications and quick recovery. It may be a safe and rational treatment for hyperthyroidism.
42 cases of hyperthyroidism had been operated from 1990-1993.In the preoperative treatment,antithyroid drugs were used togather with thyroxine.Some advantages have been observed,which are better than drugs were used togather with thyroxine.Some advantages have been observed,which are better than thoes of the usual preoperative preparaton.①Patient can be prepared to a complete euthyroid state.②The vascularity of the gland can be reduced to a least degree so that the operative risk of bleeding is will small.③The serum thyroid hormone will not be raised,therefore no thyroid crisis occurs.
Thirty patients with heperthyroidism were investigated for triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), thyromicrosome antibody (TMA), thyroglobulin antibody (TGA) and hydrocortisone before and after operation. The levels of serum T3, T4, TGA, TMA were markedly decreased after operation, and the level of hydrocortisone farther decreased from the preoperative low level. But only a little decrease in TSH level was found as compared with that before operation. The assay of these hormones and antibodies has very important clinical significance for judgement of the effect of operation and prevention of crisis of hyperthyroidism.
Objective To explore the methods of evidence-based individualized treatment for a patient with Graves’ disease. Method We searched The Cochrane Library (Issue 3, 2006), SUMSEARCH (Jan.1980 to Mar. 2006), PubMed (1980 to Mar.2006), CNKI (Jan.1980 to Mar. 2006) and VIP (Jan.1980 to Mar.2006) to identify the best evidence for antithyroid drugs, iodine radioisotopes and thyroidectomy for patients with Graves’ hyperthyroidism and evaluate the quality of available evidence. Results We identified 1 clinical guideline, 1 Cochrane systematic review, 1 meta-analysis and 15 randomized controlled trials. There was no significant difference between the titration regimen and the block-replace regimen in the relapse of hyperthyroidism, while the block-replace regimen was associated with more adverse effects. Prescribing replacement thyroxine, either with or after the anti-thyroid drug treatment, had no significant effect on relapse. Methimazole was more effective than propylthiouracil in the induction of euthyroidism. There was no significant difference in the quality of life between the drugs, 131I and the thyroidectomy therapy, and the relapse was lower with thyroidectomy therapy but the cost was higher. Given the current evidence together with our clinical experience and considering the patient and her family’s values and preferences, methimazole (10 mg tid) was administered to her and then gradually reduced. No obvious adverse effects occurred within 4 months’ follow-up. Conclusion Drugs, radioactive iodine and thyroidectomy are all effective in the treatment of Graves’ hyperthyroidism. Methimazole is an effective and well tolerated drug for the treatment of Graves’ hyperthyroidism and further research into side effect are needed. Prescribing replacement thyroxine has no significant effect on relapse.