El-Kareem Maha Abd, Derwish Wajeeh Abdulrazak, Moustafa Hosna Mohamed
Department of Radiotherapy and Nuclear Medicine (NEMROCK), Nuclear Medicine Unit, Cairo University, Cairo, Egypt.
Nucl Med Commun. 2014 Sep;35(9):900-7. doi: 10.1097/MNM.0000000000000152.
The aim of this study was to evaluate response and compare the success rate of two different doses of iodine-131 ((131)I) therapy in the treatment of Graves' disease and investigate the factors that may affect outcome. A retrospective analysis was carried out on 321 patients treated with (131)I for Graves' disease. Group 1 (155 patients) received 8 mCi and group 2 (166 patients) received 12 mCi. The therapy was considered successful if euthyroidism or hypothyroidism was achieved within 1 year of therapy. The outcome was compared with multiple parameters. A significant difference in the outcome between the two groups was found in favor of the second group (P<0.001). Logistic regression analysis showed that lower dose, technetium-99m pertechnetate thyroid uptake greater than 20.9%, and moderate and marked goiter were independent variables associated significantly with a lower response rate (odds ratio 2.601, 4.023, and 3.309, respectively), whereas previous surgical treatment was associated with a higher response rate (odds ratio 3.071). No correlation was found between outcome and age, presence of exophthalmos, previous treatment with methimazole, and its duration. The response rate to the second dose was significantly increased compared with the first one by 27.8%; there was no correlation among the above-mentioned factors and its outcome. The third dose controlled the disease in 81.3% of the remaining patients and control was achieved in the rest after the fourth dose. (131)I is a very effective therapy for Graves' disease, with a cure rate of 100% after four doses. Higher first dose activity is recommended in the presence of poor prognostic factors. The second dose is not necessarily increased in the nonresponders.
本研究的目的是评估疗效，比较两种不同剂量的碘-131（¹³¹I）治疗Graves病的成功率，并研究可能影响治疗结果的因素。对321例接受¹³¹I治疗Graves病的患者进行了回顾性分析。第1组（155例患者）接受8毫居里，第2组（166例患者）接受12毫居里。如果在治疗后1年内实现甲状腺功能正常或甲状腺功能减退，则认为治疗成功。将治疗结果与多个参数进行比较。发现两组之间的治疗结果存在显著差异，第二组更具优势（P<0.001）。逻辑回归分析显示，较低剂量、99m锝高锝酸盐甲状腺摄取率大于20.9%以及中度和重度甲状腺肿是与较低缓解率显著相关的独立变量（优势比分别为2.601、4.023和3.309），而既往手术治疗与较高缓解率相关（优势比为3.071）。未发现治疗结果与年龄、突眼的存在、既往甲巯咪唑治疗及其疗程之间存在相关性。与第一剂量相比，第二剂量的缓解率显著提高了27.8%；上述因素与其治疗结果之间无相关性。第三剂量使其余患者中的81.3%疾病得到控制，第四剂量后其余患者也实现了疾病控制。¹³¹I是治疗Graves病的一种非常有效的疗法，四剂后的治愈率为100%。存在不良预后因素时，建议首剂给予更高的活度。对于无反应者，不一定增加第二剂的剂量。
