Traino Antonio C, Di Martino Fabio, Grosso Mariano, Monzani Fabio, Dardano Angela, Caraccio Nadia, Mariani Giuliano, Lazzeri Mauro
Sezione di Fisica Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Nucl Med Commun. 2006 May;27(5):439-46. doi: 10.1097/00006231-200605000-00005.
The possibility of predicting the final volume of Graves' disease thyroids submitted to 131I therapy could allow the physician to decide what activity to administer based on the desired volume reduction instead of on a fixed value of the thyroid radiation absorbed dose. In this paper the relationship between maximum uptake of 131I, fractional reduction of thyroid volume and outcome of Graves' disease is discussed.
The results are based on ultrasonography thyroid volume measurements before administration of therapy and at the moment of recovery from Graves' disease (thyroid stimulating hormone >0.3 microIU x ml(-1) in the absence of anti-thyroid drug therapy) and on measurements of 131I uptake in 40 patients. It is shown that the possibility of curing Graves' disease may be individually related to the final volume of the patient's thyroid. An equation is presented to calculate the 'optimal' final thyroid volume.
A comparison between the traditional method, based on absorbed dose, and the final method, based on volume, has been carried out retrospectively. In the first case a median activity of 529 MBq has been administered; in the second, a median activity of 394 MBq (non-parametric Wilcoxon test, P<0.05) should be administered. The corresponding thyroid median absorbed doses are, respectively, 353 Gy and 320 Gy (non-parametric Wilcoxon test, P<0.02).
A method to evaluate individually the 'optimal' final thyroid mass is presented and discussed. The method based on 'volume reduction' could probably reduce the activity and the thyroid absorbed dose compared to the method based on 'empirical' calculations, thus allowing the administration of 131I therapy to be optimized.
预测接受¹³¹I治疗的格雷夫斯病甲状腺最终体积的可能性，可使医生根据期望的体积缩小情况而非固定的甲状腺辐射吸收剂量值来决定给予何种活度。本文讨论了¹³¹I的最大摄取量、甲状腺体积的分数减少与格雷夫斯病结局之间的关系。
结果基于治疗前及格雷夫斯病恢复时（在无抗甲状腺药物治疗的情况下促甲状腺激素>0.3微国际单位/毫升）的甲状腺超声体积测量，以及40例患者的¹³¹I摄取量测量。结果表明，治愈格雷夫斯病的可能性可能与患者甲状腺的最终体积个体相关。给出了一个计算“最佳”最终甲状腺体积的方程。
对基于吸收剂量的传统方法和基于体积的最终方法进行了回顾性比较。在第一种情况下，给予的活度中位数为529兆贝可；在第二种情况下，应给予的活度中位数为394兆贝可（非参数威尔科克森检验，P<0.05）。相应的甲状腺吸收剂量中位数分别为353戈瑞和320戈瑞（非参数威尔科克森检验，P<0.02）。
提出并讨论了一种个体评估“最佳”最终甲状腺质量的方法。与基于“经验”计算的方法相比，基于“体积缩小”的方法可能会降低活度和甲状腺吸收剂量，从而使¹³¹I治疗的给药得以优化。
