Lind Peter
Department of Nuclear Medicine and Endocrinology, PET Center Klagenfurt, LKH Klagenfurt, St Veiterstrasse 47, 9020 Klagenfurt, Austria.
Eur J Nucl Med Mol Imaging. 2002 Aug;29 Suppl 2:S453-7. doi: 10.1007/s00259-002-0831-4. Epub 2002 Jun 25.
Several therapeutic options are available for the treatment of Graves' disease (GD), including long-term antithyroid drug medication (ATD), near-total resection (NTR) and radioiodine therapy (RIT). These treatments are used with different frequencies depending on geographical location, size of the goitre, age of the patient and experience of the physician. It should be noted that RIT is still being applied more frequently in the United States than in Europe. Despite the fact that RIT was introduced as long ago as 1941, several questions are still the subject of debate: Should a fixed dose or a calculated dose be used. If the dose is calculated, how many Grays (Gy) should be delivered to the thyroid? What is the goal of RIT in GD? Which factors, including ATD, influence the outcome of RIT? Is RIT appropriate in GD with Graves' ophthalmopathy (GO)? Although not all these questions have been answered yet, conclusions can be derived regarding a general strategy for use of RIT in GD. As with surgery, the goal of RIT in GD is euthyroidism with or without L-thyroxine medication. There is a clear advantage of dose calculation over use of a fixed dose because the only factor influencing the outcome is the dose delivered to a certain thyroid volume. To minimise recurrent hyperthyroidism, an ablative approach using a delivered dose of 250 Gy is widely accepted. Beside pretherapeutic T(3) levels, thyroid volume and 24-h thyroid uptake, ATD may influence the outcome of RIT. Today it is accepted by most thyroidologists that, if ATD medication is necessary in overt hyperthyroidism, it should be withdrawn at least 2 days before RIT. In patients with GD and GO, RIT may worsen GO. If RIT is performed in GO it should be done under a 3-month steroid medication regimen. In conclusion, RIT can be considered an appropriate and cost-effective therapy in GD, although the decision regarding treatment should be taken on an individual basis, paying due respect to the course and severity of disease, the presence of GO and, last but not least, the wishes of the patient.
目前有多种治疗方案可用于治疗格雷夫斯病（GD），包括长期抗甲状腺药物治疗（ATD）、近全切除术（NTR）和放射性碘治疗（RIT）。这些治疗方法的使用频率因地理位置、甲状腺肿大小、患者年龄和医生经验而异。应当指出，RIT在美国的应用频率仍然高于欧洲。尽管RIT早在1941年就已被引入，但仍有几个问题存在争议：应该使用固定剂量还是计算剂量？如果计算剂量，应该向甲状腺输送多少戈瑞（Gy）？GD中RIT的目标是什么？哪些因素（包括ATD）会影响RIT的效果？RIT在伴有格雷夫斯眼病（GO）的GD中是否适用？尽管并非所有这些问题都已得到解答，但关于GD中使用RIT的总体策略仍可得出结论。与手术一样，GD中RIT的目标是实现甲状腺功能正常，无论是否使用L-甲状腺素药物。与使用固定剂量相比，剂量计算具有明显优势，因为影响结果的唯一因素是输送到特定甲状腺体积的剂量。为了将复发性甲状腺功能亢进降至最低，采用250 Gy的消融剂量的方法已被广泛接受。除了治疗前的T(3)水平、甲状腺体积和24小时甲状腺摄取量外，ATD可能会影响RIT的效果。如今，大多数甲状腺学家都认为，如果在显性甲状腺功能亢进中需要使用ATD药物，应在RIT前至少2天停药。在患有GD和GO的患者中，RIT可能会使GO恶化。如果在GO患者中进行RIT，应在3个月的类固醇药物治疗方案下进行。总之，RIT可被视为GD中一种合适且具有成本效益的治疗方法，尽管治疗决策应根据个体情况做出，充分考虑疾病的病程和严重程度、GO的存在情况，以及最后但同样重要的患者意愿。
