放射性碘治疗甲状腺功能亢进症。成功率及抗甲状腺药物的影响。

Radioiodine treatment of hyperthyroidism. Success rate and influence of thyrostatic medication.

作者信息

Ghadban Wisam K, Zirie Mahmoud A, Al-Khateeb Daoud A, Jayyousi Amin A, Mobayedh Hassan M, El-Aloosy Ahmed S

机构信息

Department of Endocrinology/Metabolism and Internal Medicine, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.

出版信息

Saudi Med J. 2003 Apr;24(4):347-51.

PMID:12754531

Abstract

OBJECTIVE

The aim of this study is to evaluate the response rate of hyperthyroidism to radioactive iodine (RAI) treatment, optimum effective dose, effect of pretreatment with thyrostatic medications, etiology, ophthalmopathy, mortality and cancer incidence post RAI treatment.

METHODS

Retrospective study analysis of 360 patients records who received RAI treatment (dose 5-15 mCi) for hyperthyroidism in Hamad Medical Corporation, Qatar between 1984-1999, treated and analyzed. Follow-up data was available in 215 patients, with a follow-up range of 2-10 years, of these 84 were males and 131 were females, with an age range of 12-74 years. Eighty percent were toxic diffuse goiter, 13.5% were toxic multinodular goiter and 6.5% were toxic single nodule. Eighty-seven percent had been pre-treated with anti-thyroid medications. Free thyroxine4, and thyroid stimulating hormone were recorded at diagnosis; 6 months, one year and yearly post RAI treatment.

RESULTS

The incidence of hypothyroidism was 55.8% at 6 months and 67.9% at one year. There was no significant difference in the response rate to different doses of RAI treatment groups (50-59%, p=0.46). The response rate was significantly higher in the group without pre-treatment with anti-thyroid medications (95% versus 80.9%, p<0.0001) and 27.4% of our patients had ophthalmopathy. There was no significant worsening or new development of ophthalmopathy post RAI treatment. Three of our patients developed cancer: one with colonic, one with breast and one with acute leukemia. The mortality rate according to the age group was linear in the positive direction of age and the highest was 74-year-old (10.5 per 10,0000 population).

CONCLUSION

Radioactive iodine treatment is an effective modality for definitive treatment of hyperthyroidism with long-term cure approaching 80%. Response rate was not related to gender, etiology or RAI dosage. Pre-treatment with anti-thyroid medication reduces the response rate. Radioactive iodine treatment has no significant influence on ophthalmopathy, mortality or thyroid cancer.

摘要

目的

本研究旨在评估甲状腺功能亢进症对放射性碘（RAI）治疗的反应率、最佳有效剂量、甲状腺抑制药物预处理的效果、病因、眼病、放射性碘治疗后的死亡率和癌症发病率。

方法

对1984年至1999年期间在卡塔尔哈马德医疗公司接受放射性碘治疗（剂量5 - 15毫居里）的360例甲状腺功能亢进症患者的记录进行回顾性研究分析。215例患者有随访数据，随访时间为2至10年，其中男性84例，女性131例，年龄范围为12至74岁。80%为毒性弥漫性甲状腺肿，13.5%为毒性多结节性甲状腺肿，6.5%为毒性单结节。87%的患者曾接受抗甲状腺药物预处理。在诊断时、放射性碘治疗后6个月、1年及每年记录游离甲状腺素4和促甲状腺激素。

结果

6个月时甲状腺功能减退症的发生率为55.8%，1年时为67.9%。不同剂量放射性碘治疗组的反应率无显著差异（50 - 59%，p = 0.46）。未接受抗甲状腺药物预处理的组反应率显著更高（95%对80.9%，p < 0.0001），27.4%的患者患有眼病。放射性碘治疗后眼病无显著恶化或新发病例。我们的3例患者患了癌症：1例结肠癌，1例乳腺癌，1例急性白血病。按年龄组划分的死亡率在年龄正方向呈线性，最高的是74岁组（每100000人口10.5例）。