Custro N, Ganci A, Scafidi V
Institute of Internal Medicine and Geriatrics, University of Palermo, Italy.
J Endocrinol Invest. 2003 Feb;26(2):106-10. doi: 10.1007/BF03345136.
Relapses of hyperthyroidism after treatment with radioiodine for uni- or multi-nodular goiter may be accompanied by the appearance of TSAb. However, this phenomenon has only emerged from one retrospective study on Northern European patients, in which it was not possible to determine whether TSAb also appeared in treated patients who did not relapse. The present study aimed to assess the appearance, immunogenic nature and clinical characteristics of hyperthyroidism relapse after treatment with 131I for nodular toxic goiter in patients from the Mediterranean area. A retrospective study was performed on 76 consecutive patients, born and resident in Sicily and aged 56-80 yr at diagnosis, who were treated with radioiodine. Serum aliquots obtained from the patients before 131I treatment and during a follow-up of 36-144 months were assayed for TSAb and TPOAb. The clinical charts of the patients were also re-examined. Twenty-six out of 76 patients (36.8%) had a hyperthyroidism relapse after a first treatment with 131I. Eight of the 26 (30.7%) also relapsed after the second treatment. Three out of 26 (11.5%) relapsed after a third treatment. The 50 patients who required only one treatment and the 18 who relapsed only once were all TSAb-negative at baseline, while 3/8 (37.5%) who relapsed also after the second treatment were already TSAb-positive at baseline. TSAb became positive in 3/18 patients (16.7%) who relapsed once, and in 4/8 (50.0%) of those who relapsed after a second treatment. One of these 7 TSAb-positive relapsers was also already TPOAb-positive at baseline and another became TPOAb-positive after treatment. The presence of circulating TSAb in 3/76 (3.9%) patients before treatment for toxic goiter more probably points to a diagnosis of Marine-Lenhart's syndrome. In contrast, the de novo appearance of TSAb in the presence of hyperthyroidism relapse in 4/76 (5.3%) patients suggests the development of a Graves'-like disease after radioiodine treatment. This occurrence does not seem to have precise ethnic grounds, since the incidence we observed in Mediterranean patients was similar to that previously reported in Northern European patients.
放射性碘治疗单结节或多结节性甲状腺肿后甲状腺功能亢进复发可能伴有TSAb的出现。然而，这一现象仅在一项针对北欧患者的回顾性研究中出现，在该研究中无法确定TSAb是否也出现在未复发的接受治疗患者中。本研究旨在评估地中海地区患者经131I治疗结节性毒性甲状腺肿后甲状腺功能亢进复发的出现情况、免疫原性本质及临床特征。对76例连续患者进行了回顾性研究，这些患者出生并居住在西西里岛，诊断时年龄为56 - 80岁，均接受了放射性碘治疗。在131I治疗前及36 - 144个月的随访期间采集患者血清样本，检测TSAb和TPOAb。还重新检查了患者的临床病历。76例患者中有26例（36.8%）在首次接受131I治疗后出现甲状腺功能亢进复发。26例中的8例（30.7%）在第二次治疗后也复发。26例中的3例（11.5%）在第三次治疗后复发。仅需一次治疗的50例患者和仅复发一次的18例患者在基线时TSAb均为阴性，而第二次治疗后也复发的8例中的3例（37.5%）在基线时TSAb已呈阳性。18例复发一次的患者中有3例（16.7%）TSAb转为阳性，第二次治疗后复发的8例中有4例（50.0%）TSAb转为阳性。这7例TSAb阳性复发患者中有1例在基线时TPOAb也呈阳性，另1例在治疗后TPOAb转为阳性。3/76（3.9%）毒性甲状腺肿治疗前患者中循环TSAb的存在更可能提示诊断为Marine-Lenhart综合征。相反，4/76（5.3%）甲状腺功能亢进复发患者中TSAb的新发出现提示放射性碘治疗后发生了类似格雷夫斯病的疾病。这种情况似乎没有确切的种族依据，因为我们在地中海患者中观察到的发病率与先前在北欧患者中报道的相似。
