Division of Endocrinology, Pontifical Catholic University of Campinas (Puccamp), Campinas, São Paulo, Brazil.
Clin Nucl Med. 2012 Mar;37(3):241-4. doi: 10.1097/RLU.0b013e31823ea6e0.
To investigate the effectiveness of 2 fixed iodine (¹³¹I) doses for the treatment for Graves hyperthyroidism and their impact on eye disease.
We prospectively examined 76 patients who received a fixed dose of 370 MBq (group 1) and 52 patients who received 555 MBq ¹³¹I (group 2). Patients were followed up for 12 months and considered in remission when they were in a stable euthyroid or hypothyroid state in the absence of antithyroid drugs 12 months after ¹³¹I administration. Eight patients with active eye disease received a daily dose of 0.5 mg/kg prednisone per kilogram of body weight at the time of radioiodine therapy for 1 month.
The remission rate obtained was similar in groups 1 (73.7%) and 2 (80.8%; P = 0.35). Hypothyroidism was diagnosed in 56.5% of the 370-MBq group and 71.1% of the 555-MBq group patients (P = 0.13). There was no correlation among clinical features, thyroid uptake, antibody levels, serum hormones levels, and outcome. However, logistic regression analysis demonstrated that patients with large thyroid glands had 2.4 times less chance to go into remission (odds ratio; 95% confidence interval = 1.18-4.96). None of the patients developed eye disease during any fixed-dose treatment regimen or worsened their previously diagnosed ophthalmopathy.
Fixed doses of 370 MBq and 555 MBq ¹³¹I provided similar remission rates; however, outcome was influenced by the thyroid size. We propose that 370 MBq ¹³¹I should be the routine treatment dose for all Graves disease patients, reserving a dose of 555 MBq ¹³¹I to palpable large goiters, without any additional concern to eye disease.
研究两种固定碘（¹³¹I）剂量治疗格雷夫斯甲亢的疗效及其对眼病的影响。
我们前瞻性地检查了 76 名接受 370MBq 固定剂量¹³¹I（组 1）和 52 名接受 555MBq ¹³¹I 治疗的患者（组 2）。患者在¹³¹I 治疗后 12 个月内无抗甲状腺药物且处于稳定的甲状腺功能正常或甲状腺功能减退状态时被认为处于缓解期。8 例活动性眼病患者在放射性碘治疗时给予每日 0.5mg/kg 体重泼尼松治疗 1 个月。
组 1（73.7%）和组 2（80.8%；P=0.35）的缓解率相似。56.5%的 370-MBq 组和 71.1%的 555-MBq 组患者被诊断为甲状腺功能减退（P=0.13）。临床特征、甲状腺摄取、抗体水平、血清激素水平与结局之间无相关性。然而，逻辑回归分析表明，甲状腺较大的患者缓解的机会减少 2.4 倍（比值比；95%置信区间=1.18-4.96）。在任何固定剂量治疗方案中，均无患者发生眼病或原有眼病恶化。
370MBq 和 555MBq ¹³¹I 固定剂量提供相似的缓解率；然而，结局受甲状腺大小的影响。我们建议 370MBq ¹³¹I 应成为所有格雷夫斯病患者的常规治疗剂量，将 555MBq ¹³¹I 保留给可触及的大甲状腺肿，而无需额外关注眼病。
