Takáts K I, Szabolcs I, Földes J, Földes I, Ferencz A, Rimanóczy E, Góth M, Dohán O, Kovács L, Szilágyi G
1st Department of Medicine, Haynal University of Health Sciences, Budapest, Hungary.
Exp Clin Endocrinol Diabetes. 1999;107(1):70-4. doi: 10.1055/s-0029-1212076.
The objective of the study was to investigate the efficacy of long term thyrostatic versus radioiodine treatment of hyperthyroidism in old age. Our study is a retrospective analysis of the therapeutical outcome in 66 patients over 60 years of age with toxic nodular goitre. The patients were divided in two groups: Group A: 28 patients on methimazole treatment: starting dose 5-30, median (M) 10 mg, maintenance dose 2.5-15 (M = 5) mg, follow up 6 to 240 months (M = 23.5 months). Group B: 38 patients treated by either 100-300 MBq (N = 14, subgroup B1) or 325-1000 MBq (N = 24, subgroup B2) 131I, follow up: 18 to 156 months (M = 48 months). The efficacy of the different therapeutical approaches were compared by calculating the occurrence rate of persisting and relapsing thyroid dysfunctions and associated side effects. The 28 patients on methimazole treatment became euthyroid after 1-16 (M = 5) months but numerous relapses occurred in the follow up: hyperthyroidism, clinical: 5, subclinical 13, (relapse duration: M = 8 months; associated symptoms: hypertension in 4, cardiac arrhythmia in 3, cerebral embolism in 1, angina pectoris in 2, weight loss in 2 cases). Poor patient's compliance (9/28) or dose reduction by the physician (5/28) were the main causes of the relapses. Transient clinical (3 cases) or subclinical (6 cases) hypothyroidism also occurred (duration: 1-3 M = 2 months, no clinical symptoms). In 7 out of 14 (50%) patients receiving 100-300 MBq 131I (Group B1) hyperthyroidism persisted (versus 4/24 -16.7%- in Group B2 following 325-1000 MBq 131I; chi2(1) = 4.78 P = 0.028), methimazole treatment had to be continued in 9/14 patients (64.3%) (versus 5/24 -20.8%)- in Group B2., chi2(1) = 7.18 P = 0.0074) and in 5/14 (35.7%) the radiotherapy had to be repeated (versus 5/24 -020.8%- in Group B2, not sign.). Our conclusions are: 1) long term thyrostatic treatment is not safe in elderly patients with toxic nodular hyperthyroidism, mainly because of poor compliance or dose reduction by the physician; 2) radioiodine treatment as the first choice should be recommended for these patients and higher doses should be preferred.
本研究的目的是调查长期使用抗甲状腺药物与放射性碘治疗老年甲亢的疗效。我们的研究是对66例60岁以上毒性结节性甲状腺肿患者的治疗结果进行回顾性分析。患者分为两组：A组：28例接受甲巯咪唑治疗，起始剂量5 - 30mg，中位数（M）为10mg，维持剂量2.5 - 15mg（M = 5mg），随访6至240个月（M = 23.5个月）。B组：38例接受100 - 300MBq（n = 14，B1亚组）或325 - 1000MBq（n = 24，B2亚组）的131I治疗，随访18至156个月（M = 48个月）。通过计算持续性和复发性甲状腺功能障碍的发生率以及相关副作用，比较不同治疗方法的疗效。28例接受甲巯咪唑治疗的患者在1 - 16个月（M = 5个月）后甲状腺功能恢复正常，但随访期间出现大量复发：临床甲亢5例，亚临床甲亢13例（复发持续时间：M = 8个月；相关症状：高血压4例，心律失常3例，脑栓塞1例，心绞痛2例，体重减轻2例）。患者依从性差（9/28）或医生减少剂量（5/28）是复发的主要原因。还出现了短暂性临床甲减（3例）或亚临床甲减（6例）（持续时间：1 - 3个月，M = 2个月，无临床症状）。接受100 - 300MBq 131I治疗的14例患者中有7例（50%）甲亢持续存在（而接受325 - 1000MBq 131I治疗的B2组为4/24 - 16.7%；卡方检验（1）= 4.78，P = 0.028），B1组9/14例患者（64.3%）不得不继续接受甲巯咪唑治疗（而B2组为5/24 - 20.8%，卡方检验（1）= 7.18，P = 0.0074），B1组5/14例患者（35.7%）不得不重复放疗（而B2组为5/24 - 20.8%，无统计学意义）。我们的结论是：1）长期使用抗甲状腺药物治疗老年毒性结节性甲亢不安全，主要原因是患者依从性差或医生减少剂量；2）对于这些患者，应推荐放射性碘治疗作为首选，且应首选较高剂量。
