目的 探讨促甲状腺激素受体抗体（TRAb）滴度动态变化联合甲状腺超声弹性成像参数对Graves病（GD）复发风险的预警价值。 方法 选取2019年1月至2021年11月收治的306例GD患者，所有病例按规范接受抗甲状腺药物治疗并对纳入患者进行随访。监测治疗过程中TRAb滴度动态变化，并根据变化趋势分为持续降低组和动态升高组。采用超声弹性成像技术测量甲状腺体积、弹性评分、相对应变值平均值（MEAN）及蓝色面积比例（%AREA）。通过多因素logistic回归分析GD复发的影响因素，并采用受试者工作特征（ROC）曲线评估各指标的预测效能。 结果 共丢失随访14例，最终纳入292例患者完成随访，其中动态升高组103例，持续降低组189例。从治疗12个月开始，两组TRAb水平出现显著变化，持续降低组保持下降趋势，至随访结束时维持在较低水平；动态升高组则缓慢下降，在治疗18个月时最低，之后出现上升趋势，随访期间呈持续升高趋势。至随访终点共87例患者复发，复发率为29.79%。动态升高组复发率为66.02%（68/103），显著高于持续降低组的10.05%（19/189）（χ² = 99.831，P < 0.05）。多因素logistic回归分析显示，TRAb滴度动态升高、弹性评分（3 ~ 4）、%AREA升高及甲状腺体积增大均为GD复发的独立危险因素（P < 0.05）。ROC曲线分析显示，TRAb滴度动态升高、弹性评分（3 ~ 4）、%AREA升高及甲状腺体积增大的曲线下面积（AUC）分别为0.823、0.652、0.801、0.724；超声联合模型AUC为0.888，四指标联合模型AUC为0.913，预测效能最佳。 结论 TRAb动态升高和超声弹性成像参数是预测GD复发的独立影响因素，其联合应用可提高复发风险预测的准确性。

Objective To investigate the predictive value of dynamic changes in thyrotropin receptor antibody （TRAb） titers combined with ultrasound elastography parameters for predicting recurrence risk in Graves' disease （GD）. Methods A total of 306 patients with GD admitted between January 2019 and November 2021 were enrolled. All patients received standard antithyroid drug treatment and were followed up. Dynamic changes in TRAb titers during treatment were monitored and the patients were divided into a continuously decreasing group and a dynamically increasing group based on the trend of change. Ultrasound elastography was used to measure thyroid volume， elasticity score， mean strain value （MEAN）， and blue area percentage （%AREA）. Independent risk factors for GD recurrence were identified via multivariate logistic regression analysis， and the predictive performance of indicators was evaluated using receiver operating characteristic （ROC） curves. Results A total of 14 cases were lost to follow-up， and 292 cases were eventually included to complete follow-up， including 103 cases in the dynamic increase group and 189 cases in the continuous decrease group. TRAb levels diverged significantly between groups starting at 12 months of treatment. The persistent-decrease group maintained a downward trend， remaining low at follow-up termination. In contrast， the dynamic-increase group showed a slow decline， reaching a nadir at 18 months before rising again， with sustained elevation during follow-up. By the end of follow-up， 87 patients （29.79%） experienced recurrence. The recurrence rate was significantly higher in the dynamic-increase group （66.02%， 68/103） than in the persistent-decrease group （10.05%， 19/189； χ² =99.831， P < 0.05）. Multivariate logistic regression identified TRAb titer elevation， elasticity score （3 ? 4）， elevated %AREA， and increased thyroid volume as independent risk factors for recurrence （P < 0.05）. ROC analysis showed area under the curve （AUC） values of 0.823 for TRAb dynamic elevation， 0.652 for elasticity score （3 ? 4）， 0.801 for %AREA elevation， and 0.724 for thyroid volume enlargement. The ultrasound-combined model achieved an AUC of 0.888， while the four-indicator combined model demonstrated the highest predictive accuracy （AUC = 0.913）. Conclusions Dynamic TRAb elevation and ultrasound elastography parameters are independent predictors of GD recurrence. Their combination enhances the accuracy of recurrence risk prediction.