Graves病不应“谈碘色变”
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摘要
富碘中药用于治疗瘿病超过2 000年,碘能通过减少甲状腺激素分泌和抑制碘的有机化迅速降低激素水平。碘脱逸与碘缺乏地区结节性甲状腺肿患者碘致甲状腺功能亢进症的报道使临床医生治疗Graves病"谈碘色变"。新近的临床研究结果显示碘治疗Graves病具有潜在优势,富碘中药是治疗Graves病可行的选择。
Iodine-rich Chinese herbs have been used for treating goiter over 2 000 years. Iodine acutely lowers thyroid hormone concentrations by reducing hormone secretion, and inhibits its own organification. However, reports of escape from these beneficial effects of iodine as well as reports of iodine-induced hyperthyroidism in patients with nodular goiter discouraged the use of iodine in Graves′ disease. Recent studies have suggested a potential role for iodine in Graves′ disease patients, Iodine-rich Chinese herbs could be an alternative choice for Graves′ disease.
Iodine-rich Chinese herbs have been used for treating goiter over 2 000 years. Iodine acutely lowers thyroid hormone concentrations by reducing hormone secretion, and inhibits its own organification. However, reports of escape from these beneficial effects of iodine as well as reports of iodine-induced hyperthyroidism in patients with nodular goiter discouraged the use of iodine in Graves′ disease. Recent studies have suggested a potential role for iodine in Graves′ disease patients, Iodine-rich Chinese herbs could be an alternative choice for Graves′ disease.
引文
[1] 方药中, 邓铁涛, 李克光, 等主编. 实用中医内科学[M]. 上海: 上海科学技术出版社, 1997: 493.
[2] 崔鹏, 高天舒. 常用软坚散结中药及复方碘含量的测定[J]. 中华中医药学刊, 2007, 25(7): 1396-1398.
[3] 郑曲, 高天舒. 富碘中药碘含量的测定及影响因素分析[J]. 中国生化药物杂志, 2014, 34(7): 171-173, 176.
[4] 崔鹏, 高天舒, 李贺. 富碘中药治疗瘿病的研究进展[J]. 中华中医药学刊, 2007, 25(10): 2090-2092.
[5] 李品. 从中医古籍中探寻治疗瘿病的组方规律[D]. 沈阳: 辽宁中医药大学, 2012.
[6] 王彤瑞, 高天舒. 古代治瘿方剂用药规律探究及古今用药异同初探[J]. 中医药导报, 2017, 23(7): 49-50, 56.
[7] 胡方林, 陈大舜. 古代文献治疗瘿病方剂的用药规律[J]. 中医药学刊, 2006, 24(7): 1270-1272.
[8] 叶子. 古代治疗瘿病方剂规律的剖析及其在现代临床的运用分析[D]. 武汉: 湖北中医药大学, 2014.
[9] 周玉, 吕萌, 王芷乔, 等. 基于中医传承辅助系统探讨瘿病方剂组方规律[J]. 中医学报, 2016, 31(11): 1758-1762.
[10] 王焘. 外台秘要方[M]. 北京: 华夏出版社, 1993: 354.
[11] 赵佶. 圣济总录[M]. 北京: 人民卫生出版社, 1982: 2110.
[12] 朱震亨. 丹溪心法[M]. 沈阳: 辽宁科学技术出版社, 1997: 92.
[13] 潘文奎. 如何正确使用含碘中药治疗甲状腺机能亢进?[J]. 中医杂志, 1994, 35(12): 752.
[14] 高洪春. 甲亢勿用海藻类药物[J]. 四川中医, 1988, 7(7): 54.
[15] 李常度, 李培丽. 含碘中药治疗甲状腺机能亢进症的利弊[J]. 北京中医, 1991, 10(3): 46-47.
[16] 王旭. 略论含碘中药在治疗“甲亢”中的运用[J]. 江苏中医, 2000, 21(4): 35-36.
[17] 徐蓉娟. 临床应用含碘中药治疗甲状腺疾病的思考[J]. 上海中医药大学学报, 2009, 23(6): 1-3.
[18] 瞿忠灿. 藻药散加味治疗甲亢36例疗效观察[J]. 云南中医中药杂志, 2002, 23(3): 13.
[19] 张振榆, 张伟. 消瘿汤治疗甲状腺机能亢进100例[J]. 陕西中医, 2008, 29(3): 307-308.
[20] 黄江荣, 黄蔚, 黄文惠. 黄祥武治疗甲状腺功能亢进症经验介绍[J]. 中国中医药信息杂志, 2008, 15(10): 80-81.
[21] 刘丽娟, 黄仰模. 黄仰模教授中医治疗甲亢的经验[J]. 中国中医药现代远程教育, 2008, 6(10): 1158-1159.
[22] 王家元. 含碘中药治疗甲状腺功能亢进症的可行性探讨[J]. 中医杂志, 1992, 33(9): 51.
[23] 张宜默, 宋立群. 甲状腺功能亢进辨治验案[J]. 中医药学报, 2006, 34(1): 42-43.
[24] 柳长凤, 刘洪毓, 苗晶囡, 等. 国家已公开专利中治疗甲亢的中药用药规律探讨[J]. 中医药信息, 2013, 30(2): 61-64.
[25] Plummer HS, Boothby WM. Glandular therapy: the administration of thyroid preparations[J]. JAMA, 1924, 83(17): 1333-1335.
[26] Thompson WO, Thompson PK, Brailey AG, et al. Prolonged treatment of exophthalmic goiter by iodine alone[J]. Arc Intern Med, 1930, (4): 481-502.
[27] Wolff J, Chaikoff IL. The inhibitory action of iodide upon organic binding of iodine by the normal thyroid gland[J]. J Biol Chem, 1948, 172(2): 855-856.
[28] Okamura K, Sato K, Fujishima M. Reversible or irreversible thyroid dysfunction in Hashimoto thyroiditis[M]. Amsterdam, The Netherlands: Elsevier Science Publishers, 1993: 149-154.
[29] Stewart RD, Murray IP. Effect of small doses of carrier iodide upon the organic binding of radioactive iodine by the human thyroidgland[J]. J Clin Endocrinol Metab, 1967, 27(4): 500-508.
[30] Astwood EB. Thyroid and antithyroid drugs[M]. 3rd ed. New York: The Macmillan Company, 1965: 1466-1503.
[31] Vagenakis AG, Wang CA, Burger A, et al. Iodide-induced thyrotoxicosis in Boston[J]. N Engl J Med, 1972, 287(11): 523.
[32] Stanbury JB, Ermans AE, Bourdoux P, et al. Iodine-induced hyperthyroidism: occurrence and epidemiology[J]. Thyroid, 1998, 8(1): 83.
[33] Okamura K, Sato K, Fujikawa M, et al. Remission after potassium iodide therapy in patients with Graves′ hyperthyroidism exhibiting thionamide-associated side effects[J]. J Clin Endocrinol Metab, 2014, 99(11): 3995-4002.
[34] Uchida T, Goto H, Kasai T, et al. Therapeutic effectiveness of potassium iodine in drug-na?ve patients with Graves′ disease: a single-center experience[J]. Endocrine, 2014, 47(2): 506-511.
[35] Sato S, Noh JY, Sato S, et al. Comparison of efficacy and adverse effects between methimazole 15 mg + inorganic iodine 38 mg/day and methimazole 30 mg/day as initial therapy for Graves′ disease patients with moderate to severe hyperthyroidism[J]. Thyroid, 2015, 25(1): 43-50.
[36] Yoshihara A, Noh JY, Watanabe N, et al. Substituting potassium iodide for methimazole as the treatment for Graves′ disease during the first trimester may reduce the incidence of congenital anomalies: a retrospective study at a single medical institution in Japan[J]. Thyroid, 2015, 25(10): 1155.
[37] Park SM, Cho YY, Joung JY, et al. Excessive iodine intake does not increase the recurrence rate of graves′ disease after withdrawal of the antithyroid drug in an iodine-replete area[J]. Eur Thyroid J, 2015, 4(1): 36-42.
[38] Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis[J]. Thyroid, 2016, 26(10): 1343.
[39] Nagataki S. Effect of excess quantities of iodide[M]. Washington DC: American Physiological Society, 1974: 329-344.
[40] Taurog AM. Thyroid hormone synthesis: thyroid iodine metabolism[M]. 8th ed. Philadelphia: Lippincott Williams, Wilkins, 2000: 61-85.
[41] Many MC, Mestdagh C, van den Hove MF, et al. In vitro study of acute toxic effects of high iodide doses in human thyroid follicles[J]. Endocrinology, 1992, 131(2): 621.
[42] 曲金桥. 富碘中药与碘过量对碘缺乏NOD. H-2～(h4)小鼠甲状腺氧化应激的比较[D]. 沈阳: 辽宁中医药大学, 2014.
[43] 齐腾澈. 碘过量与海藻玉壶汤对碘缺乏机体甲状腺内氧化应激的比较研究[D]. 沈阳: 辽宁中医药大学, 2012.
[44] 郑曲. 富碘复方瘿宁合剂治疗结节性甲状腺肿临床经验总结及实验研究[D]. 沈阳: 辽宁中医药大学, 2015.
[45] 时杨, 高天舒, 杨柳. 富碘中药复方对甲亢大鼠甲状腺功能和形态的影响[J]. 辽宁中医药大学学报, 2009,11(9): 186-188.
[2] 崔鹏, 高天舒. 常用软坚散结中药及复方碘含量的测定[J]. 中华中医药学刊, 2007, 25(7): 1396-1398.
[3] 郑曲, 高天舒. 富碘中药碘含量的测定及影响因素分析[J]. 中国生化药物杂志, 2014, 34(7): 171-173, 176.
[4] 崔鹏, 高天舒, 李贺. 富碘中药治疗瘿病的研究进展[J]. 中华中医药学刊, 2007, 25(10): 2090-2092.
[5] 李品. 从中医古籍中探寻治疗瘿病的组方规律[D]. 沈阳: 辽宁中医药大学, 2012.
[6] 王彤瑞, 高天舒. 古代治瘿方剂用药规律探究及古今用药异同初探[J]. 中医药导报, 2017, 23(7): 49-50, 56.
[7] 胡方林, 陈大舜. 古代文献治疗瘿病方剂的用药规律[J]. 中医药学刊, 2006, 24(7): 1270-1272.
[8] 叶子. 古代治疗瘿病方剂规律的剖析及其在现代临床的运用分析[D]. 武汉: 湖北中医药大学, 2014.
[9] 周玉, 吕萌, 王芷乔, 等. 基于中医传承辅助系统探讨瘿病方剂组方规律[J]. 中医学报, 2016, 31(11): 1758-1762.
[10] 王焘. 外台秘要方[M]. 北京: 华夏出版社, 1993: 354.
[11] 赵佶. 圣济总录[M]. 北京: 人民卫生出版社, 1982: 2110.
[12] 朱震亨. 丹溪心法[M]. 沈阳: 辽宁科学技术出版社, 1997: 92.
[13] 潘文奎. 如何正确使用含碘中药治疗甲状腺机能亢进?[J]. 中医杂志, 1994, 35(12): 752.
[14] 高洪春. 甲亢勿用海藻类药物[J]. 四川中医, 1988, 7(7): 54.
[15] 李常度, 李培丽. 含碘中药治疗甲状腺机能亢进症的利弊[J]. 北京中医, 1991, 10(3): 46-47.
[16] 王旭. 略论含碘中药在治疗“甲亢”中的运用[J]. 江苏中医, 2000, 21(4): 35-36.
[17] 徐蓉娟. 临床应用含碘中药治疗甲状腺疾病的思考[J]. 上海中医药大学学报, 2009, 23(6): 1-3.
[18] 瞿忠灿. 藻药散加味治疗甲亢36例疗效观察[J]. 云南中医中药杂志, 2002, 23(3): 13.
[19] 张振榆, 张伟. 消瘿汤治疗甲状腺机能亢进100例[J]. 陕西中医, 2008, 29(3): 307-308.
[20] 黄江荣, 黄蔚, 黄文惠. 黄祥武治疗甲状腺功能亢进症经验介绍[J]. 中国中医药信息杂志, 2008, 15(10): 80-81.
[21] 刘丽娟, 黄仰模. 黄仰模教授中医治疗甲亢的经验[J]. 中国中医药现代远程教育, 2008, 6(10): 1158-1159.
[22] 王家元. 含碘中药治疗甲状腺功能亢进症的可行性探讨[J]. 中医杂志, 1992, 33(9): 51.
[23] 张宜默, 宋立群. 甲状腺功能亢进辨治验案[J]. 中医药学报, 2006, 34(1): 42-43.
[24] 柳长凤, 刘洪毓, 苗晶囡, 等. 国家已公开专利中治疗甲亢的中药用药规律探讨[J]. 中医药信息, 2013, 30(2): 61-64.
[25] Plummer HS, Boothby WM. Glandular therapy: the administration of thyroid preparations[J]. JAMA, 1924, 83(17): 1333-1335.
[26] Thompson WO, Thompson PK, Brailey AG, et al. Prolonged treatment of exophthalmic goiter by iodine alone[J]. Arc Intern Med, 1930, (4): 481-502.
[27] Wolff J, Chaikoff IL. The inhibitory action of iodide upon organic binding of iodine by the normal thyroid gland[J]. J Biol Chem, 1948, 172(2): 855-856.
[28] Okamura K, Sato K, Fujishima M. Reversible or irreversible thyroid dysfunction in Hashimoto thyroiditis[M]. Amsterdam, The Netherlands: Elsevier Science Publishers, 1993: 149-154.
[29] Stewart RD, Murray IP. Effect of small doses of carrier iodide upon the organic binding of radioactive iodine by the human thyroidgland[J]. J Clin Endocrinol Metab, 1967, 27(4): 500-508.
[30] Astwood EB. Thyroid and antithyroid drugs[M]. 3rd ed. New York: The Macmillan Company, 1965: 1466-1503.
[31] Vagenakis AG, Wang CA, Burger A, et al. Iodide-induced thyrotoxicosis in Boston[J]. N Engl J Med, 1972, 287(11): 523.
[32] Stanbury JB, Ermans AE, Bourdoux P, et al. Iodine-induced hyperthyroidism: occurrence and epidemiology[J]. Thyroid, 1998, 8(1): 83.
[33] Okamura K, Sato K, Fujikawa M, et al. Remission after potassium iodide therapy in patients with Graves′ hyperthyroidism exhibiting thionamide-associated side effects[J]. J Clin Endocrinol Metab, 2014, 99(11): 3995-4002.
[34] Uchida T, Goto H, Kasai T, et al. Therapeutic effectiveness of potassium iodine in drug-na?ve patients with Graves′ disease: a single-center experience[J]. Endocrine, 2014, 47(2): 506-511.
[35] Sato S, Noh JY, Sato S, et al. Comparison of efficacy and adverse effects between methimazole 15 mg + inorganic iodine 38 mg/day and methimazole 30 mg/day as initial therapy for Graves′ disease patients with moderate to severe hyperthyroidism[J]. Thyroid, 2015, 25(1): 43-50.
[36] Yoshihara A, Noh JY, Watanabe N, et al. Substituting potassium iodide for methimazole as the treatment for Graves′ disease during the first trimester may reduce the incidence of congenital anomalies: a retrospective study at a single medical institution in Japan[J]. Thyroid, 2015, 25(10): 1155.
[37] Park SM, Cho YY, Joung JY, et al. Excessive iodine intake does not increase the recurrence rate of graves′ disease after withdrawal of the antithyroid drug in an iodine-replete area[J]. Eur Thyroid J, 2015, 4(1): 36-42.
[38] Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis[J]. Thyroid, 2016, 26(10): 1343.
[39] Nagataki S. Effect of excess quantities of iodide[M]. Washington DC: American Physiological Society, 1974: 329-344.
[40] Taurog AM. Thyroid hormone synthesis: thyroid iodine metabolism[M]. 8th ed. Philadelphia: Lippincott Williams, Wilkins, 2000: 61-85.
[41] Many MC, Mestdagh C, van den Hove MF, et al. In vitro study of acute toxic effects of high iodide doses in human thyroid follicles[J]. Endocrinology, 1992, 131(2): 621.
[42] 曲金桥. 富碘中药与碘过量对碘缺乏NOD. H-2～(h4)小鼠甲状腺氧化应激的比较[D]. 沈阳: 辽宁中医药大学, 2014.
[43] 齐腾澈. 碘过量与海藻玉壶汤对碘缺乏机体甲状腺内氧化应激的比较研究[D]. 沈阳: 辽宁中医药大学, 2012.
[44] 郑曲. 富碘复方瘿宁合剂治疗结节性甲状腺肿临床经验总结及实验研究[D]. 沈阳: 辽宁中医药大学, 2015.
[45] 时杨, 高天舒, 杨柳. 富碘中药复方对甲亢大鼠甲状腺功能和形态的影响[J]. 辽宁中医药大学学报, 2009,11(9): 186-188.