Pediatric Endocrine Unit , MassGeneral Hospital for Children and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Clin Endocrinol (Oxf). 2009 Dec;71(6):884-91. doi: 10.1111/j.1365-2265.2009.03565.x. Epub 2009 Feb 25.
Radioactive iodine ((131)I) therapy is increasingly viewed as a safe and effective treatment for paediatric and adolescent hyperthyroidism. Our objective was to estimate treatment response and its predictors and describe current referral practices for (131)I therapy.
Retrospective study.
One hundred and thirty-one children 30 days-21 years old with laboratory evidence of hyperthyroidism, seen in an academic paediatric and adolescent endocrinology practice.
Rate of referral, indications for (131)I, predictors of poor treatment response.
Thirty-eight of 102 patients with persistent hyperthyroidism (37%) received (131)I (160 μCi/g thyroid tissue/(131)I uptake), as did an additional 10 patients initially evaluated by adult thyroidologists. Primary indications were intolerance to (29%) or poor control on (19%) antithyroid drugs, patient preference (50%) and unknown (2%). Of 48 patients treated with (131)I, 89% and 11% became hypothyroid after one and two (131)I doses, respectively. The goal of (131)I therapy was attainment of hypothyroidism. 'Poor treatment response' (seen in 27%) was defined as requirement for a second (131)I dose or failure to achieve hypothyroidism after 6 months. Predictors of poor treatment response included: previous use of antithyroid drugs (37%vs. 0%, P = 0.02), ophthalmopathy (58%vs. 8%, P = 0.002), and an interval of ≥ 12 months from diagnosis to (131)I (50%vs. 10%, P = 0.003). A very elevated free T4 tended to be more prevalent in those with poor response.
In children and adolescents with hyperthyroidism, high rates of success after (131)I are achievable. Use of antithyroid drugs, pre-existing eye disease and prolonged time to (131)I may confer relative resistance to (131)I.
放射性碘 ((131)I) 治疗越来越被视为治疗儿童和青少年甲状腺功能亢进症的安全有效的方法。我们的目的是评估治疗反应及其预测因素，并描述目前对 ((131)I) 治疗的转诊实践。
回顾性研究。
131 名年龄在 30 天至 21 岁之间的儿童，他们的实验室检查显示有甲状腺功能亢进症，这些患者在一家学术性儿科和青少年内分泌科诊所就诊。
转诊率、(131)I 的适应证、治疗反应不良的预测因素。
102 例持续性甲状腺功能亢进症患者中有 38 例 (37%)接受了 (131)I（甲状腺组织 160 μCi/g/(131)I 摄取率），另有 10 例最初由成人甲状腺科医生评估的患者也接受了 (131)I。主要适应证为不耐受 (29%)或抗甲状腺药物控制不佳 (19%)、患者偏好 (50%)和未知 (2%)。48 例接受 (131)I 治疗的患者中，分别有 89%和 11%在接受一次和两次 (131)I 剂量后出现甲状腺功能减退。(131)I 治疗的目标是实现甲状腺功能减退。“治疗反应不佳”（发生率为 27%）定义为需要第二次 (131)I 剂量或在 6 个月后未能实现甲状腺功能减退。治疗反应不良的预测因素包括：先前使用抗甲状腺药物（37%vs. 0%，P = 0.02）、眼病（58%vs. 8%，P = 0.002）和诊断至 (131)I 治疗的间隔时间≥12 个月（50%vs. 10%，P = 0.003）。治疗反应不佳者的游离 T4 水平往往较高。
在患有甲状腺功能亢进症的儿童和青少年中，(131)I 治疗后的成功率很高。抗甲状腺药物的使用、预先存在的眼部疾病和向 (131)I 治疗的时间延长可能导致对 (131)I 的相对耐药。
