Cepková Jitka, Horáček Jiří, Vižďa Jaroslav, Doležal Jiří
University Hospital Hradec Králové, Charles University in Prague, Faculty of Medicine in Hradec Králové, Czech Republic: 4th Department of Internal Medicine - Hematology.
University Hospital Hradec Králové, Charles University in Prague, Faculty of Medicine in Hradec Králové, Czech Republic: Department of Nuclear Medicine.
Acta Medica (Hradec Kralove). 2014;57(2):49-55. doi: 10.14712/18059694.2014.39.
The clinical outcome of 153 Graves' disease patients treated with a wide dose range of radioactive iodine-131 (RAI) was analyzed retrospectively. Six to nine months after the first dose of RAI 60 patients (39%) were hypothyroid (or rather thyroxine-substituted) and 26 (17%) were euthyroid, while 67 patients (44%) did not respond properly: in 32 (21%) their antithyroid drug (ATD) dose could be reduced but not withdrawn (partial response) and 35 (23%) remained hyperthyroid or the same dose of ATD was necessary (no response). The outcome did not correspond significantly to the administered activity of RAI (medians 259, 259, 222, and 259 MBq for hypothyroid, euthyroid, partial, and no response subgroups, respectively), or the activity retained in the gland at 24 h (medians 127, 105, 143, and 152 MBq). The effect was, however, clearly, and in a stepwise pattern, dependent on initial thyroid volume (17, 26, 33 and 35 ml, P < 0.001) or activity per gram tissue retained at 24 h (6.02, 4.95, 4.75, and 4.44 MBq/g, P = 0.002). Also, higher residual level of thyrotoxicosis at the time of RAI treatment was connected with worse outcome. The dose-dependency of outcome was further analyzed. When our sample was divided into tertiles, according to the adjusted dose, the same modest success rates (47%) were seen in the lower and middle tertiles. However, doses higher than 5.88 MBq/g (the upper tertile) resulted in success rate of 75%. Finer division into decils has shown a threshold-like increase in cure rate between the 7th and the 8th decil. In the first 7 decils (doses ≤ 6 MBq/g) the complete response rate was 45 to 50%, in the 8th decil (6.0 to 7.8~MBq/g) it rose to 80% and was not further increased with increasing dose. Direct comparison of higher (> 6 MBq/g, cure rate 80%) and lower (≤ 6 MBq/g, cure rate 46%) doses gave highly significant difference (P < 0.001). With our dosing range we found a dose-dependent clinical outcome that suggests an optimum delivered dose near 6.5 MBq/g, resulting in successful treatment of ca 80% patients.
对153例接受大剂量范围放射性碘-131（RAI）治疗的格雷夫斯病患者的临床结果进行了回顾性分析。首次给予RAI后6至9个月，60例患者（39%）出现甲状腺功能减退（或更确切地说是甲状腺素替代治疗），26例（17%）甲状腺功能正常，而67例患者（44%）反应不佳：32例（21%）患者的抗甲状腺药物（ATD）剂量可减少但不能停用（部分反应），35例（23%）仍为甲状腺功能亢进或仍需相同剂量的ATD（无反应）。结果与所给予的RAI活度（甲状腺功能减退、甲状腺功能正常、部分反应和无反应亚组的中位数分别为259、259、222和259 MBq）或24小时腺体中保留的活度（中位数分别为127、105、143和152 MBq）无显著相关性。然而，效果明显且呈逐步变化，取决于初始甲状腺体积（分别为17、26、33和35 ml，P<0.001）或24小时每克组织保留的活度（分别为6.02、4.95、4.75和4.44 MBq/g，P = 0.002）。此外，RAI治疗时甲状腺毒症的残留水平越高，预后越差。进一步分析了结果的剂量依赖性。根据调整后的剂量将我们的样本分为三分位数，较低和中间三分位数的成功率相同（47%）。然而，高于5.88 MBq/g（上三分位数）的剂量导致成功率为75%。更细分为十分位数显示，在第7和第8十分位数之间治愈率呈阈值样增加。在前7个十分位数（剂量≤6 MBq/g）中，完全缓解率为45%至50%，在第8个十分位数（6.0至7.8~MBq/g）中，缓解率升至80%，且随着剂量增加不再进一步升高。对较高剂量（>6 MBq/g，治愈率80%）和较低剂量（≤6 MBq/g，治愈率46%）进行直接比较，差异具有高度显著性（P<0.001）。在我们的给药范围内，我们发现了剂量依赖性的临床结果，表明最佳给药剂量接近6.5 MBq/g，可使约80%的患者得到成功治疗。
