Nygaard B, Hegedüs L, Nielsen K G, Ulriksen P, Hansen J M
Department of Endocrinology, Herlev Hospital, University of Copenhagen, Denmark.
Clin Endocrinol (Oxf). 1999 Feb;50(2):197-202. doi: 10.1046/j.1365-2265.1999.00635.x.
To investigate the long-term effects of radioiodine (131I) on thyroid function and size in patients with a solitary toxic thyroid nodule.
Prospective study of patients treated for a solitary autonomous toxic nodule, followed by evaluation of thyroid volume and function.
Sixty-two consecutive patients followed for a minimum of 12 months (range 12-168, median 60). Seventeen patients received antithyroid drug treatment before 131I.
Standard thyroid function variables and ultrasonically determined thyroid volume before as well as 0.75, 1.5, 3, 6 and 12 months after treatment, and then once a year were investigated.
131I treatment (3.7 MBq/g thyroid tissue corrected to a 100% 24-h 131I uptake) was given as a single dose in 53 patients; six needed two doses and another three were given 3-5 131I treatments. The median initial dose was 310 MBq (140-666) and the median total dose was 332 MBq (148-1576). In patients receiving one 131I treatment (n = 53) the total thyroid volume decreased significantly from a median of 40 ml (range 19-77) to 24 ml (8-50) within 3 months. This represented a median reduction of 35%. A further significant decrease was seen after 24 months to a total reduction of 45%. In patients given more than one dose the thyroid volume was reduced from a median of 45 ml (19-104) before treatment to 30 ml (14-50) after a follow-up of 60 months (9-132) after the last 131I treatment. Patients without antithyroid pretreatment, receiving one 131I treatment (n = 39) became euthyroid after a median of 1.5 months (0.75-9) after treatment. Seventy-five per cent were euthyroid within 3 months. In patients pretreated with antithyroid drugs and treated with one dose of 131I (n = 14) euthyroidism was achieved after a median of 12 months (0.75-24) after 131I treatment. Hypothyroidism developed in five patients (8%) after a median of 36 months (6-60) after 131I treatment.
A cure-rate of 75% within 3 months is seen when treating autonomous solitary toxic thyroid nodules with 131I. The thyroid volume is reduced by 35% within 3 months and 45% after 2 years. Side-effects are few and consist of hypothyroidism in less than 10% with a median follow-up of 5 years. This treatment should be regarded as the standard treatment for this condition until prospective comparisons with surgery and ethanol injection therapy have been performed.
探讨放射性碘（¹³¹I）对孤立性毒性甲状腺结节患者甲状腺功能及大小的长期影响。
对接受孤立性自主性毒性结节治疗的患者进行前瞻性研究，随后评估甲状腺体积和功能。
62例连续患者，随访至少12个月（范围12 - 168个月，中位数60个月）。17例患者在¹³¹I治疗前接受了抗甲状腺药物治疗。
在治疗前以及治疗后0.75、1.5、3、6和12个月，然后每年一次，对标准甲状腺功能变量以及超声测定的甲状腺体积进行研究。
53例患者接受单次¹³¹I治疗（根据24小时¹³¹I摄取率100%校正为3.7 MBq/g甲状腺组织）；6例需要两剂，另外3例接受3 - 5次¹³¹I治疗。初始剂量中位数为310 MBq（140 - 666），总剂量中位数为332 MBq（148 - 1576）。接受单次¹³¹I治疗的患者（n = 53），甲状腺总体积在3个月内从中位数40 ml（范围19 - 77）显著降至24 ml（8 - 50）。这代表中位数减少35%。24个月后进一步显著下降，总体减少45%。接受多剂治疗的患者，甲状腺体积从治疗前中位数45 ml（19 - 104）在最后一次¹³¹I治疗后随访60个月（9 - 132）后降至30 ml（14 - 50）。未接受抗甲状腺预处理的患者，接受单次¹³¹I治疗（n = 39），治疗后中位数1.5个月（0.75 - 9）变为甲状腺功能正常。75%的患者在3个月内甲状腺功能正常。接受抗甲状腺药物预处理并接受单次¹³¹I治疗的患者（n = 14），¹³¹I治疗后中位数12个月（0.75 - 24）实现甲状腺功能正常。5例患者（8%）在¹³¹I治疗后中位数36个月（6 - 60）出现甲状腺功能减退。
用¹³¹I治疗自主性孤立性毒性甲状腺结节，3个月内治愈率达75%。甲状腺体积在3个月内减少35%，2年后减少45%。副作用较少且在中位随访5年时甲状腺功能减退发生率低于10%。在与手术和乙醇注射疗法进行前瞻性比较之前，这种治疗应被视为这种疾病的标准治疗方法。
