Al-Kaabi Juma M, Hussein Samir S, Bukheit Charles S, Woodhouse Nicholas J, Elshafie Omiema T, Bererhi Haddia
Department of Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.
Saudi Med J. 2002 Sep;23(9):1049-53.
This study was performed to evaluate the efficacy of radioactive iodine 131I therapy of Graves' hyperthyroidism at Sultan Qaboos University Hospital, Oman and to determine the optimal dose of 131I needed to achieve the euthyroid or hypothyroid status.
The medical records of 366 patients with Graves hyperthyroidism who received a single dose of 131I at Sultan Qaboos University Hospital, Oman between 1991 and 1999 were reviewed. The diagnosis was based on clinical, biochemical grounds and 99mTc thyroid scintigraphy. The patients were followed up for a minimum period of 12 months. For the analysis, the patients were divided into 6 groups according to the 131I dose administered: Dose one (350-399), dose 2 (400-449), dose 3 (450-499), dose 4 (500-549), dose 5 (550-599) and dose 6 (> or = 600) MBq.
Fifty-eight percent of all the patients were hypothyroid after 3 months. Three hundred and twenty two patients (88%) were treated by a single dose of 131I in 12 months (85.5% hypothyroid and 2.5% euthyroid). Forty-one patients (11.2%) required a 2nd 131I dose and only 3 patients required 3 doses of 131I. The best cure rate (93%) was observed in group dose 5 (574.0 +/- 16.4 MBq) which however, was not significantly different from other dosage levels. The female to male ratio was 2:1 and the cure rates were not gender or age related.
Treatment of Graves' hyperthyroidism from a single 131I dose is our aim, rather than avoidance of hypothyroidism. Our results indicate that cure rates are higher with larger doses of 131I except in group dose 6 (special category of patients). In the future, fixed doses would be adopted in our radioactive iodine treatment practice guidelines. As the majority of our patients were hypothyroid at 3 months regular monthly follow-up is essential. Whenever appropriate, physicians are encouraged to consider early referral of Graves' hyperthyroidism patients for radioactive iodine treatment as it is cheap, effective, easy to administer and free from serious side effects.
本研究旨在评估阿曼苏丹卡布斯大学医院采用放射性碘131I治疗格雷夫斯甲亢的疗效，并确定实现甲状腺功能正常或甲状腺功能减退状态所需的131I最佳剂量。
回顾了1991年至1999年间在阿曼苏丹卡布斯大学医院接受单剂量131I治疗的366例格雷夫斯甲亢患者的病历。诊断基于临床、生化依据及99mTc甲状腺闪烁扫描。对患者进行了至少12个月的随访。为进行分析，根据给予的131I剂量将患者分为6组：剂量一组（350 - 399）、剂量二组（400 - 449）、剂量三组（450 - 499）、剂量四组（500 - 549）、剂量五组（550 - 599）和剂量六组（≥600）MBq。
3个月后所有患者中有58%出现甲状腺功能减退。322例患者（88%）在12个月内接受了单剂量131I治疗（85.5%甲状腺功能减退，2.5%甲状腺功能正常）。41例患者（11.2%）需要第二次131I剂量，仅3例患者需要3次131I剂量。在剂量五组（574.0±16.4 MBq）中观察到最佳治愈率（93%），然而，这与其他剂量水平无显著差异。男女比例为2:1，治愈率与性别或年龄无关。
我们的目标是采用单剂量131I治疗格雷夫斯甲亢，而非避免甲状腺功能减退。我们的结果表明，除剂量六组（特殊类别患者）外，较大剂量的131I治愈率更高。未来，我们的放射性碘治疗实践指南中将采用固定剂量。由于我们的大多数患者在3个月时出现甲状腺功能减退，因此定期每月随访至关重要。只要合适，鼓励医生尽早将格雷夫斯甲亢患者转诊接受放射性碘治疗，因为它价格便宜、有效、易于给药且无严重副作用。
