Dunkelmann S, Endlicher D, Prillwitz A, Rudolph F, Groth P, Schümichen C
Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Rostock, Deutschland.
Nuklearmedizin. 1999;38(5):131-9.
The presented study prospectively evaluates the efficacy of optimized radioiodine therapy in patients (pts) with multifocal (MFA) and disseminated (DISA) autonomy. The target dose was related to the total thyroid volume and was increased in moderate and nonlinear increments from 150 to 300 Gy dependent on the pretherapeutic Tc-99m pertechnetate thyroid uptake under suppression (TcTUs). Patients with focal autonomy were treated with a target dose independent of TcTUs and were used as control group.
The data of 641 pts (518 women, 123 men) were evaluated, 466 pts with MFA or DISA and 175 pts with focal autonomy. In pts with MFA and DISA the target dose was increased in four steps: TcTUs < 3%: 150 Gy, > 3-6%: 200 Gy, > 6-12%: 250 Gy and > 12%: 300 Gy. In pts with focal autonomy a fixed target dose of 300 or 400 Gy was applied. The radioactivity to be administered was calculated using a modified Marinelli formula. The follow-up examination was performed at the earliest after four, on average after eight months. Normalization of TSH was the only criterion for successful therapy.
The success rate in pts with latent or manifest hyperthyroidism in focal autonomy was 91.5%, therapy was not successful in 5.1% and hypothyroidism occurred in 3.4%. The average success rate in pts with MFA and DISA was 91.5%, therapy failed in 7.5% and a very low rate of 1% with hypothyroidism was seen.
The presented optimized therapy concept with calculated, nonlinear increase of the target dose according to the TcTUs-level guaranteed even in MFA and DISA a high success rate comparable to that in focal autonomy along with a very low rate of hypothyroidism.
本研究前瞻性评估优化放射性碘治疗对多灶性（MFA）和弥漫性（DISA）自主性甲状腺疾病患者的疗效。目标剂量与甲状腺总体积相关，并根据抑制状态下的治疗前锝-99m高锝酸盐甲状腺摄取率（TcTUs），以中度和非线性增量从150 Gy增加至300 Gy。局灶性自主性甲状腺疾病患者接受与TcTUs无关的目标剂量治疗，并作为对照组。
评估了641例患者（518例女性，123例男性）的数据，其中466例为MFA或DISA患者，175例为局灶性自主性甲状腺疾病患者。对于MFA和DISA患者，目标剂量分四步增加：TcTUs<3%：150 Gy，>3 - 6%：200 Gy，>6 - 12%：250 Gy，>12%：300 Gy。对于局灶性自主性甲状腺疾病患者，应用300或400 Gy的固定目标剂量。使用改良的马林内利公式计算给药放射性活度。随访检查最早在4个月后进行，平均在8个月后进行。促甲状腺激素（TSH）正常化是治疗成功的唯一标准。
局灶性自主性甲状腺疾病患者潜在或明显甲亢的成功率为91.5%，治疗失败率为5.1%，甲状腺功能减退发生率为3.4%。MFA和DISA患者的平均成功率为91.5%，治疗失败率为7.5%，甲状腺功能减退发生率极低，为1%。
所提出的优化治疗方案，根据TcTUs水平计算目标剂量并呈非线性增加，即使在MFA和DISA患者中也能保证高成功率，与局灶性自主性甲状腺疾病相当，且甲状腺功能减退发生率极低。
