Lewis Anthony, Atkinson Brew, Bell Patrick, Courtney Hamish, McCance David, Mullan Karen, Hunter Stephen
Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, BT12 6BA.
Ulster Med J. 2013 May;82(2):85-8.
Radioiodine is the treatment of choice for relapsed hyperthyroidism although the optimum protocol is uncertain. Fixed dose radioiodine is increasingly popular but responses may vary.
To assess the outcome of 131I therapy in hyperthyroidism using a standard dose regimen in a regional referral centre and to explore factors influencing outcome.
We studied 449 patients (M:F 82:367; age range 13-89 y, median 42 y) with hyperthyroidism treated between 2003 and 2007 with a standard dose of 550 MBq 131I. Patients were classified as either Graves' disease, toxic multinodular goitre or indeterminate aetiology. Antithyroid drugs were routinely stopped at least 1 week before radioiodine.
One year after radioiodine 334 (74%) were hypothyroid, 85 (19%) were euthyroid and 30 (7%) had required a further dose of 131I. Patients with Graves' disease were more likely to become hypothyroid than those with toxic multinodular goitre (78% v 37%, p<0.001) and less likely to become euthyroid (11% v 55%, p<0.001). Free T4 >80 pmol/L (normal range 9.0 - 19.0 pmol/L) at presentation was associated with an increased failure rate (17% compared with 5% and 3% for 40-79 pmol/L and <40 pmol/L respectively; p=0.01). Patients with either a small or no goitre were more likely to be successfully treated by a single dose (96%) than those with a medium/large goitre (85%, p<0.001). Anti-thyroid medication was taken by 345 (77%) (carbimazole n=319) patients up to 1 week prior to 131I and was associated with an increased failure rate (8% v 2%, p=0.027) compared to those who had not had antithyroid medication. Logistic regression showed free T4 at presentation to be the only independent risk factor for failure of the first dose of radioiodine (OR 2.5; 95% CI, 1.2-5.1, p=0.012).
A single standard dose of 550 MBq 131I is highly effective in treating hyperthyroidism. The aetiology, severity of hyperthyroidism at diagnosis, goitre size and prior antithyroid medication all had a significant effect on outcome.
放射性碘是复发性甲状腺功能亢进症的首选治疗方法，尽管最佳方案尚不确定。固定剂量放射性碘越来越受欢迎，但治疗反应可能存在差异。
在一个区域转诊中心评估采用标准剂量方案进行¹³¹I治疗甲状腺功能亢进症的效果，并探讨影响治疗效果的因素。
我们研究了2003年至2007年间接受550MBq¹³¹I标准剂量治疗的449例甲状腺功能亢进症患者（男∶女为82∶367；年龄范围13 - 89岁，中位数42岁）。患者被分为格雷夫斯病、毒性多结节性甲状腺肿或病因不明。抗甲状腺药物通常在放射性碘治疗前至少1周停用。
放射性碘治疗1年后，334例（74%）出现甲状腺功能减退，85例（19%）甲状腺功能正常，30例（7%）需要再次给予¹³¹I剂量。格雷夫斯病患者比毒性多结节性甲状腺肿患者更易出现甲状腺功能减退（78%对37%，p<0.001），且甲状腺功能正常的可能性更小（11%对55%，p<0.001）。就诊时游离T4>80pmol/L（正常范围9.0 - 19.0pmol/L）与失败率增加相关（分别为17%，而40 - 79pmol/L和<40pmol/L时为5%和3%；p = 0.01）。甲状腺肿小或无甲状腺肿的患者单剂量治疗成功的可能性（96%）高于中度/大甲状腺肿患者（85%，p<0.001）。345例（77%）（卡比马唑n = 319）患者在¹³¹I治疗前1周内服用过抗甲状腺药物，与未服用抗甲状腺药物的患者相比，失败率增加（8%对2%，p = 0.027）。逻辑回归显示就诊时游离T4是放射性碘首剂治疗失败的唯一独立危险因素（比值比2.5；95%可信区间，1.2 - 5.1，p = 0.012）。
550MBq¹³¹I的单一标准剂量在治疗甲状腺功能亢进症方面非常有效。病因、诊断时甲状腺功能亢进的严重程度、甲状腺肿大小和既往抗甲状腺药物治疗均对治疗效果有显著影响。
