Sabri O, Zimny M, Schreckenberger M, Reinartz P, Ostwald E, Buell U
Department of Nuclear Medicine, Aachen University of Technology, Germany.
Thyroid. 1999 Dec;9(12):1181-8. doi: 10.1089/thy.1999.9.1181.
We sought to ascertain how high the success rates of radioiodine therapy are for Graves' disease patients with large diffuse goiters when aiming for a constant absorbed dose of 250 Gy. Thirty-six patients with a thyroid volume of 50-110 mL were evaluated for changes in thyroid function and appearance 3, 6, and 12 months after radioiodine therapy. Success was defined as definitive elimination of hyperthyroidism following therapy (hypothyroidism corrected with thyroxine on diagnosis); failure as persistent/recurrent hyperthyroidism after 12 months. Overall success rate was 50%. However, a subgroup of 20 patients without simultaneous carbimazole (carbimazole-off) showed a highly significantly larger success rate (85%) than the 16 patients with simultaneous carbimazole (carbimazole-on) at the time of radioiodine therapy (6.3%, p < 0.000005). Successful cases showed a significantly higher volume reduction after radioiodine than failures (75.5% vs. 35.4%, p < 0.00005). Stepwise logistic regression showed that therapy failure was related to administration of carbimazole during radioiodine therapy (p < 0.0250 and absorbed dose (p < 0.05), but not thyroid function (free triiodothyronine [FT3] and free thyroxine [FT4]), initial thyroid volume or thyrotropin-receptor antibody (TRAb) value. However, a significant correlation of therapy success to absorbed dose (r = 0.69, p < 0.005) could be shown only for carbimazole-off patients, but not for the others. Finally, multivariate factor analysis consistently showed that therapy success was correlated only to absorbed dose and antithyroid drugs, not to initial thyroid volume, TRAb value, or thyroid function. Thyroid volume per se is not responsible for the lower success rate in Graves' disease patients with large goiters because even a comparable group of 32 Graves' disease patients with small thyroid glands (< or =20 mL) and without simultaneous carbimazole showed a success rate of 87.5%. The high failure rate in the carbimazole-on patients (absorbed dose comparable to carbimazole-off) is due to the simultaneous administration of carbimazole. Therefore, if clinically feasible, we recommend discontinuing carbimazole at least one day before beginning radioiodine therapy.
我们试图确定，对于患有大型弥漫性甲状腺肿的格雷夫斯病患者，当目标是恒定吸收剂量为250戈瑞时，放射性碘治疗的成功率有多高。对36例甲状腺体积为50 - 110毫升的患者在放射性碘治疗后3、6和12个月评估甲状腺功能和外观变化。成功定义为治疗后甲亢得到彻底消除（诊断时用甲状腺素纠正的甲状腺功能减退）；失败定义为12个月后持续/复发甲亢。总体成功率为50%。然而，20例在放射性碘治疗时未同时服用卡比马唑（停用卡比马唑）的患者亚组显示出的成功率（85%）比16例在放射性碘治疗时同时服用卡比马唑（服用卡比马唑）的患者显著更高（6.3%，p < 0.000005）。成功病例在放射性碘治疗后的体积缩小明显高于失败病例（75.5%对35.4%，p < 0.00005）。逐步逻辑回归显示，治疗失败与放射性碘治疗期间卡比马唑的使用（p < 0.0250）和吸收剂量（p < 0.05）有关，但与甲状腺功能（游离三碘甲状腺原氨酸[FT3]和游离甲状腺素[FT4]）、初始甲状腺体积或促甲状腺素受体抗体（TRAb）值无关。然而，仅在停用卡比马唑的患者中显示出治疗成功与吸收剂量有显著相关性（r = 0.69，p < 0.005），其他患者则不然。最后，多因素分析一致表明，治疗成功仅与吸收剂量和抗甲状腺药物相关，与初始甲状腺体积、TRAb值或甲状腺功能无关。甲状腺体积本身并非患有大型甲状腺肿的格雷夫斯病患者成功率较低的原因，因为即使是32例甲状腺较小（≤20毫升）且未同时服用卡比马唑的格雷夫斯病患者的可比组，成功率也为87.5%。服用卡比马唑的患者（吸收剂量与停用卡比马唑的患者相当）失败率高是由于同时服用了卡比马唑。因此，如果临床可行，我们建议在开始放射性碘治疗前至少一天停用卡比马唑。
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