Jukić Tomislav, Stanicić Josip, Petric Vlado, Kusić Zvonko
Klinika za onkologiju i nuklearnu medicinu Medicinskog fakulteta, Klinika bolnica Sestre milosrdnice, Zagreb.
Lijec Vjesn. 2010 Nov-Dec;132(11-12):355-60.
The most common etiologic cause of thyrotoxicosis in children and adults is autoimmune Graves' (Basedow's) disease. Antithyroid medications, surgery and radioactive iodine have been used in the treatment of Graves' hyperthyroidism for more than six decades. The use of antithyroid drugs is the most common therapeutic approach. However, long-term remission with antithyroid drugs can be expected in 20-50% of adults and 20-30% of children. The methods for definitive treatment of Graves' hyperthyroidism are iodine-131 (radioiodine) and surgery. Both treatment modalities have benefits and risks and the decision is made according to the age, patient preference and the presence of other co-morbidities, individual characteristics of patients and the availability of certain treatment modality. Radioiodine is simple, safe, effective and economic procedure for definitive treatment of Graves' hyperthyroidism. It is administered ambulatory and can be given to the patient in thyrotoxicosis. Due to many benefits, radioiodine is preferred in most of the adult patients with Graves' hyperthyroidism while only small proportion of patients is sent to surgery. Radioiodine is especially the treatment of choice in elderly patients and patients with heart disease. In these patients radioiodine is indicated immediately after reaching euthyroidism with antithyroid drugs. Surgery is mainly indicated in younger patients, in the case of patient preference or in special indications. Clear indications for surgical treatment of Graves' hyperthyroidism are: suspected or confirmed malignancy, coexisting pathology that demands surgical treatment, pregnancy and breastfeeding, large goiter (> 80 grams) or goiter with symptoms and signs of compression, severe toxic side effects of antithyroid medications, requirement for immediate control of disease, age younger than 5 years and active ophtalmopathy. The risk of surgical treatment is negatively correlated with the surgeon's experience and nowadays, total or near-total thyroidectomy is preferred surgical approach. End point of both treatment modalities is usually hypothyroidism that should not be considered as the consequence of treatment. Moreover, due to thyroid hormones replacement therapy equilibrium can be easily achieved.
儿童和成人甲状腺毒症最常见的病因是自身免疫性格雷夫斯病（巴塞多氏病）。抗甲状腺药物、手术和放射性碘用于治疗格雷夫斯甲亢已有六十多年。使用抗甲状腺药物是最常见的治疗方法。然而，成人中20% - 50%、儿童中20% - 30%使用抗甲状腺药物可实现长期缓解。格雷夫斯甲亢的确定性治疗方法是碘 - 131（放射性碘）和手术。两种治疗方式都有优缺点，治疗决策需根据年龄、患者偏好、其他合并症情况、患者个体特征以及特定治疗方式的可及性来做出。放射性碘是格雷夫斯甲亢确定性治疗的简单、安全、有效且经济的方法。它可门诊给药，可用于甲状腺毒症患者。由于诸多优点，大多数成人格雷夫斯甲亢患者首选放射性碘治疗，只有一小部分患者接受手术。放射性碘尤其适用于老年患者和心脏病患者。这些患者在用抗甲状腺药物达到甲状腺功能正常后应立即进行放射性碘治疗。手术主要适用于年轻患者、患者有偏好或有特殊指征的情况。格雷夫斯甲亢手术治疗的明确指征为：疑似或确诊恶性肿瘤、存在需要手术治疗的合并病变、妊娠和哺乳期、巨大甲状腺肿（> 80克）或有压迫症状和体征的甲状腺肿、抗甲状腺药物严重的毒副作用、需要立即控制病情、年龄小于5岁以及活动性眼病。手术治疗的风险与外科医生的经验呈负相关，如今，全甲状腺切除术或近全甲状腺切除术是首选的手术方式。两种治疗方式的终点通常是甲状腺功能减退，但这不应被视为治疗的后果。此外，通过甲状腺激素替代疗法可轻松实现平衡。
