Boj Carceller D, Liévano Segundo P, Navarro Beltrán P, Sanz París A, de Castro Hernández P, Monreal Villanueva M, Abós Olivares D
Servicio de Endocrinología y Nutrición, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Rev Esp Med Nucl. 2011 May-Jun;30(3):156-61. doi: 10.1016/j.remn.2011.01.004. Epub 2011 Apr 9.
To assess the effectiveness of radioactive iodine (RAI) therapy and the incidence of hypothyroidism post RAI in patients with subclinical hyperthyroidism or clinical hyperthyroidism with Multinodular Goiter (MNG).
A retrospective study of 69 consecutive patients treated with (131)I for MNG during the year 2008 observed for six months. All patients received a single fixed dose of 16 mCi (592 MBq) weighted by the gland size. They were categorized into two groups: subclinical hyperthyroidism or clinical hyperthyroidism. We compared the success rate and the incidence of hypothyroidism.
The thyroid dysfunction was corrected in 82.09% of the patients. Success rate was 100% in the clinical hyperthyroidism group and 78.13% in the subclinical hyperthyroidism group (P=0.105). The overall incidence of hypothyroidism was 16.42%; 25.00% of patients with clinical hyperthyroidism and 14.55% with subclinical hyperthyroidism developed this secondary effect (P=0.400). No statistically significant differences were found in the success rate in the incidence of hypothyroidism when the results were analyzed according to the thyrotropin decrease in patients with subclinical hyperthyroidism. Seven patients had positive anti-thyroid peroxidase antibodies (anti-TPO) before therapy. The incidence of hypothyroidism was significantly higher in them (57.14% vs 11.67%; P=0.011). Cardiac arrhythmias were four times more frequent in patients with clinical hyperthyroidism. Previous treatment with thiamazol positively affected the outcome.
A single fixed weighted dose of (131)I is highly effective and safe for the control of clinical and subclinical hyperthyroidism due to MNG. Patients with anti-TPO antibodies may have a high risk of developing post-iodine hypothyroidism.
评估放射性碘（RAI）治疗亚临床甲亢或伴有多结节性甲状腺肿（MNG）的临床甲亢患者的疗效以及RAI治疗后甲状腺功能减退的发生率。
对2008年期间连续69例接受（131）I治疗MNG的患者进行为期6个月的回顾性研究。所有患者根据腺体大小接受单一固定剂量16毫居里（592兆贝可）的治疗。他们被分为两组：亚临床甲亢组或临床甲亢组。我们比较了成功率和甲状腺功能减退的发生率。
82.09%的患者甲状腺功能异常得到纠正。临床甲亢组的成功率为100%，亚临床甲亢组为78.13%（P = 0.105）。甲状腺功能减退的总体发生率为16.42%；临床甲亢患者中有25.00%、亚临床甲亢患者中有14.55%出现了这种继发效应（P = 0.400）。根据亚临床甲亢患者促甲状腺激素降低情况分析结果时，在成功率和甲状腺功能减退发生率方面未发现统计学显著差异。7例患者在治疗前抗甲状腺过氧化物酶抗体（抗-TPO）呈阳性。他们的甲状腺功能减退发生率显著更高（57.14%对11.67%；P = 0.011）。临床甲亢患者心律失常的发生率高出四倍。先前使用甲巯咪唑治疗对结果有积极影响。
单一固定加权剂量的（131）I对于控制由MNG引起的临床和亚临床甲亢高效且安全。抗-TPO抗体阳性的患者发生碘后甲状腺功能减退的风险可能较高。
