Bonnema Steen Joop, Bennedbaek Finn Noe, Veje Annegrete, Marving Jens, Hegedüs Laszlo
Department of Endocrinology and Metabolism, Odense University Hospital, DK-5000 Odense C, Denmark.
J Clin Endocrinol Metab. 2006 Aug;91(8):2946-51. doi: 10.1210/jc.2006-0226. Epub 2006 May 30.
A randomized clinical trial was performed to clarify whether continuous use of methimazole (MTZ) during radioiodine ((131)I) therapy influences the final outcome of this therapy.
Consecutive patients with Graves' disease (n = 30) or a toxic nodular goiter (n = 45) were rendered euthyroid by MTZ and randomized to stop MTZ 8 d before (131)I (-MTZ; n = 36) or to continue MTZ until 4 wk after (131)I (+MTZ; n = 39). Calculation of the (131)I activity included an assessment of the (131)I half-life and the thyroid volume.
The 24-h thyroid (131)I uptake was lower in the +MTZ group than in the -MTZ group (44.8 +/- 15.6% vs. 62.1 +/- 9.9%, respectively; P < 0.001). At 3 wk after therapy, no significant change in serum free T(4) index was observed in the +MTZ group (109 +/- 106 vs. 83 +/- 28 nmol/liter at baseline; P = 0.26), contrasting an increase in the -MTZ group (180 +/- 110 vs. 82 +/- 26 nmol/liter; P < 0.001). The number of cured patients was 17 (44%) and 22 (61%) in the +MTZ and -MTZ groups, respectively (P = 0.17). Cured patients tended to have a lower 24-h thyroid (131)I uptake (50.1 +/- 13.8% vs. 56.4 +/- 17.1%; P = 0.09). By adjusting for a possible interfactorial relationship through a regression analysis (variables: randomization, 24- and 96-h thyroid (131)I uptake, type and duration of disease, age, gender, presence of antithyroid peroxidase antibodies, thyroid volume, dose of MTZ), only the continuous use of MTZ correlated with treatment failure (P = 0.006), whereas a low 24-h thyroid (131)I uptake predicted a better outcome (P = 0.006).
Continuous use of MTZ hinders an excessive increase of the thyroid hormones during (131)I therapy of hyperthyroid diseases. However, such a strategy seems to reduce the final cure rate, although this adverse effect paradoxically is attenuated by the concomitant reduction of the thyroid (131)I uptake.
进行了一项随机临床试验，以阐明在放射性碘（¹³¹I）治疗期间持续使用甲巯咪唑（MTZ）是否会影响该治疗的最终结果。
连续纳入患有格雷夫斯病（n = 30）或毒性结节性甲状腺肿（n = 45）的患者，先用MTZ使甲状腺功能正常，然后随机分为在¹³¹I治疗前8天停用MTZ（-MTZ组；n = 36）或继续使用MTZ直至¹³¹I治疗后4周（+MTZ组；n = 39）。¹³¹I活度的计算包括对¹³¹I半衰期和甲状腺体积的评估。
+MTZ组的24小时甲状腺¹³¹I摄取率低于-MTZ组（分别为44.8±15.6%和62.1±9.9%；P<0.001）。治疗后3周，+MTZ组血清游离T₄指数无显著变化（基线时为109±106 vs. 83±28 nmol/L；P = 0.26），而-MTZ组有所升高（180±110 vs. 82±26 nmol/L；P<0.001）。+MTZ组和-MTZ组的治愈患者数分别为17例（44%）和22例（61%）（P = 0.17）。治愈患者的24小时甲状腺¹³¹I摄取率往往较低（50.1±13.8% vs. 56.4±17.1%；P = 0.09）。通过回归分析调整可能的因素间关系（变量：随机分组、24小时和96小时甲状腺¹³¹I摄取率、疾病类型和病程、年龄、性别、抗甲状腺过氧化物酶抗体的存在、甲状腺体积、MTZ剂量）后，仅持续使用MTZ与治疗失败相关（P = 0.006），而低24小时甲状腺¹³¹I摄取率预示着更好的结果（P = 0.006）。
在甲状腺功能亢进疾病的¹³¹I治疗期间，持续使用MTZ可抑制甲状腺激素过度升高。然而，这种策略似乎会降低最终治愈率，尽管这种不良反应因甲状腺¹³¹I摄取率的同时降低而有所减轻。
