Erem Cihangir, Kandemir Nurten, Hacihasanoglu Arif, Ersöz Halil Onder, Ukinc Kubilay, Kocak Mustafa
Department of Internal Medicine, Division of Endocrinology and Metabolism, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
Endocrine. 2004 Oct;25(1):55-60. doi: 10.1385/endo:25:1:55.
To assess the effectiveness of radioactive iodine (RAI) treatment in patients with hyperthyroidism and to evaluate prognostic factors affecting outcome.
Our cohort comprised 115 consecutive patients with hyperthyroidism treated with RAI at the Endocrinology Clinic at the Farabi Hospital, Trabzon, between 1994 and 2002. Data were retrieved from the endocrinology clinic database. Patients were categorized into three diagnostic groups: Graves' disease (GD), toxic multinodular (TMN) hyperthyroidism, and toxic adenoma. Our policy, over the period of the study, was to offer a single fixed first dose (10 mCi) 131I to all patients with toxic nodular goiter (TNG) for the first time and to all patients with relapsed GD.
There was no significant difference in the cure rate between GD and TNG, but Graves' patients had a significantly higher incidence of hypothyroidism (p < 0.001). In contrast, incidence of euthyroidism was significantly increased in TNG than those of the patients with GD (p < 0.05). The incidences of hyperthyroidism, euthyroidism, cure rate, and persistent hyperthyroidism did not vary significantly between females and males. Age at onset of hyperthyroidism at diagnosis was not associated with outcome of RAI therapy. The incidence of hypothyroidism in patients who had nonpalpable goiter was higher than those in patients who had medium or large goiter (p < 0.05). The means of serum FT3 and TT4 at presentation were correlated with the development of hypothyroidism after RAI therapy. Logistic regression analysis showed serum FT3 concentration at presentation to be significant contributing factor to failure to respond to a single dose of RAI. Patients who had higher FT3 concentrations at diagnosis were more likely to fail to respond to RAI therapy.
The results of the present study of a cohort of patients with hyperthyroidism demonstrate that a single fixed dose of 10 mCi of RAI is highly effective in curing GD as well as toxic nodular hyperthyroidism. Therefore, treatment protocols for these groups should be identical. The most important factors that determine efficacy of RAI treatment are serum FT3 concentrations at diagnosis before the initiation of treatment and goiter size. Therefore, these factors should be taken into consideration when planning treatment. If such factors are present, the initial dose of RAI should be increased.
评估放射性碘（RAI）治疗甲状腺功能亢进症患者的有效性，并评估影响治疗结果的预后因素。
我们的队列包括1994年至2002年期间在特拉布宗法拉比医院内分泌诊所接受RAI治疗的115例连续甲状腺功能亢进症患者。数据从内分泌诊所数据库中获取。患者被分为三个诊断组：格雷夫斯病（GD）、毒性多结节性（TMN）甲状腺功能亢进症和毒性腺瘤。在研究期间，我们的策略是首次向所有毒性结节性甲状腺肿（TNG）患者和所有复发的GD患者提供单一固定的首剂（10毫居里）131I。
GD和TNG之间的治愈率无显著差异，但格雷夫斯病患者的甲状腺功能减退症发病率显著更高（p < 0.001）。相比之下，TNG患者的甲状腺功能正常率显著高于GD患者（p < 0.05）。甲状腺功能亢进症、甲状腺功能正常率、治愈率和持续性甲状腺功能亢进症的发病率在女性和男性之间没有显著差异。诊断时甲状腺功能亢进症的发病年龄与RAI治疗的结果无关。不可触及甲状腺肿患者的甲状腺功能减退症发病率高于中等或大甲状腺肿患者（p < 0.05）。就诊时血清FT3和TT4的平均值与RAI治疗后甲状腺功能减退症的发生相关。逻辑回归分析表明，就诊时血清FT3浓度是单剂量RAI治疗无反应的重要影响因素。诊断时FT3浓度较高的患者更有可能对RAI治疗无反应。
本研究中一组甲状腺功能亢进症患者的结果表明，单一固定剂量10毫居里的RAI在治愈GD以及毒性结节性甲状腺功能亢进症方面非常有效。因此，这些组的治疗方案应该相同。决定RAI治疗效果的最重要因素是治疗开始前诊断时的血清FT3浓度和甲状腺肿大小。因此，在制定治疗计划时应考虑这些因素。如果存在这些因素，应增加RAI的初始剂量。
