Sankar R, Sripathy G
Institute of Nuclear Medicine and Allied Sciences, Lucknow Road, Timarpur, Delhi 110054, India.
Natl Med J India. 2000 Sep-Oct;13(5):246-51.
Graves' disease is a common condition encountered in clinical practice. The available modes of therapy for Graves' disease are antithyroid drugs, radioiodine and surgery. Radioiodine therapy is indicated in patients with nearly all causes of hyperthyroidism and is considered the treatment of choice for most patients with Graves' hyperthyroidism who are beyond the adolescent years. Pregnancy and breast-feeding are absolute contraindications. Although there are many ways of calculating the dose of radioiodine, fixed dose regimens are gaining acceptance. Hypothyroidism follows sooner or later in nearly all patients treated with radioiodine. Available evidence suggest that patients are best treated by a single thyroablative dose, the aim being elimination of hyperthyroidism, with larger doses accomplishing it with more certainty, and the inevitable hypothyroidism develops under physician control. Radioiodine therapy can lead to exacerbation of infiltrative ophthalmopathy and this can be prevented by the concomitant administration of corticosteroids. Radioiodine therapy for Graves' hyperthyroidism has no adverse effects on the health of the offspring of treated patients. There are no definitive data that provide evidence for increased rates of thyroid cancer, leukaemia, infertility or neonatal abnormality in patients treated with radioiodine. Radioiodine therapy is safe, definitive and cost-effective.
格雷夫斯病是临床实践中常见的病症。格雷夫斯病现有的治疗方式包括抗甲状腺药物、放射性碘和手术。放射性碘治疗适用于几乎所有病因导致的甲状腺功能亢进患者，并且被认为是大多数青春期后的格雷夫斯甲亢患者的首选治疗方法。怀孕和哺乳期是绝对禁忌证。尽管计算放射性碘剂量有多种方法，但固定剂量方案正逐渐被接受。几乎所有接受放射性碘治疗的患者迟早都会出现甲状腺功能减退。现有证据表明，患者采用单次甲状腺消融剂量治疗效果最佳，目的是消除甲状腺功能亢进，剂量越大实现这一目标的确定性越高，且不可避免的甲状腺功能减退在医生控制下发生。放射性碘治疗可导致浸润性眼病加重，这可通过同时给予皮质类固醇来预防。格雷夫斯甲亢的放射性碘治疗对接受治疗患者的后代健康没有不良影响。没有确凿数据表明接受放射性碘治疗的患者甲状腺癌、白血病、不孕或新生儿异常的发生率增加。放射性碘治疗安全、有效且具有成本效益。
