Department of Nuclear Medicine, Institute Verbeeten, PO Box 90120, 5000 LA Tilburg, the Netherlands.
Clin Nucl Med. 2013 Jun;38(6):401-6. doi: 10.1097/RLU.0b013e3182817c78.
The objective of this study was to identify patient characteristics positively and independently associated with I-iodide treatment failure in a large cohort of patients with Graves hyperthyroidism treated with either a calculated "standard" activity of 3.7 MBq/mL (0.1 mCi) or 7.4 MBq/mL (0.2 mCi) of thyroid volume.
Data on 385 consecutive patients were prospectively collected. Clinical treatment outcome up to 1 year in relation to thyroid volume, 5- and 24-hour I uptake, 5/24-hour I uptake ratio, and the administered activity of radioiodine were analyzed.
Overall treatment results were hypothyroidism in 46%, euthyroidism in 29%, and recurrent hyperthyroidism in 26% of patients. Thyroid volume (P = 0.000), 5/24-hour uptake ratio (P = 0.000), and 5- and 24-hour uptake alone (respectively, P = 0.000 and P = 0.002) were significantly associated with therapy outcome. Patients with a combination of a thyroid volume greater than 50 mL and a 5/24-hour uptake ratio 0.8 or greater showed treatment failure in 70% and 42% (respectively, 3.7 MBq/mL, n = 20; and 7.4 MBq/mL, n = 41).Thyroid volume and 5/24-hour uptake ratio were positively and independently associated with recurrent hyperthyroidism (respectively, odds ratio [OR], 5.3; 95% confidence interval [CI], 2.39-11.76; and OR, 2.97; 95% CI, 1.59-5.59). Higher activities of 7.4 MBq/mL I were associated with a lower risk of treatment failure (OR, 0.34; 95% CI, 0.18-0.62).
Large thyroid volumes and high 5/24-hour uptake ratios are positively and independently associated with recurrent hyperthyroidism following I therapy in Graves hyperthyroidism. Higher success rates can be achieved when account is taken of these poor prognostic factors. In consequence, these patients should be treated with activities greater than 7.4 MBq/mL.
本研究的目的是在接受计算的“标准”甲状腺体积 3.7MBq/mL（0.1mCi）或 7.4MBq/mL（0.2mCi）碘-131 治疗的 Graves 甲亢患者的大队列中，确定与碘-131 治疗失败阳性和独立相关的患者特征。
前瞻性收集了 385 例连续患者的数据。分析了甲状腺体积、5 小时和 24 小时碘摄取、5/24 小时碘摄取比以及放射性碘的给药活性与 1 年临床治疗结果的关系。
患者的总体治疗结果为甲状腺功能减退 46%、甲状腺功能正常 29%和甲亢复发 26%。甲状腺体积（P=0.000）、5/24 小时摄取比（P=0.000）和 5 小时和 24 小时摄取（分别为 P=0.000 和 P=0.002）与治疗结果显著相关。甲状腺体积大于 50mL 且 5/24 小时摄取比大于 0.8 的患者，70%和 42%（分别为 3.7MBq/mL，n=20；和 7.4MBq/mL，n=41）治疗失败。甲状腺体积和 5/24 小时摄取比与甲亢复发呈正相关和独立相关（分别为优势比[OR]，5.3；95%置信区间[CI]，2.39-11.76；和 OR，2.97；95% CI，1.59-5.59）。较高的 7.4MBq/mL I 活性与治疗失败的风险降低相关（OR，0.34；95%CI，0.18-0.62）。
Graves 甲亢患者碘-131 治疗后，大甲状腺体积和高 5/24 小时摄取比与甲亢复发呈正相关和独立相关。当考虑到这些不良预后因素时，可以获得更高的成功率。因此，这些患者应接受大于 7.4MBq/mL 的治疗。
