Husseni Maha Abd El-Kareem El-Sayed
Department of Oncology and Nuclear Medicine (NEMROCK), Nuclear Medicine Unit, Cairo University, Cairo, Egypt.
World J Nucl Med. 2016 Jan-Apr;15(1):30-7. doi: 10.4103/1450-1147.167582.
The purpose of this study is to evaluate and compare the incidence of hypothyroidism following different fixed radioactive iodine-131 ((131)I) activities in the treatment of Graves' disease (GD) and to investigate the predictive factors that may influence its occurrence. This retrospective analysis was performed on 272 patients with GD who were treated with (131)I, among whom 125 received 370 MBq and 147 received 555 MBq. The outcome was categorized as hypothyroidism, euthyroidism, and persistent hyperthyroidism. Multiple logistic regression analysis was performed to identify significant risk factors that affect the development of hypothyroidism. The incidence of hypothyroidism following the first low activity was 24.8% with a high treatment failure rate of 58.4%, compared with 48.3% and 32% following high activity. The overall cumulative incidence of hypothyroidism following repeated activities was 50.7%, out of which 73.9% occurred after the first activity and 20.3% after the second activity. The higher (131)I activity (P < 0.001) and average and mild enlargement of the thyroid gland (P = 0.004) were identified as significant independent factors that increase the rate of incidence of hypothyroidism (Odds ratios were 2.95 and 2.59). No correlation was found between the development of hypothyroidism and the factors such as age, gender, presence of exophthalmos, previous antithyroid medications, and the durations, and Technetium-99m (Tc-99m) pertechnetate thyroid uptake. In view of the high treatment failure rate after first low activity and lower post high activity hypothyroid incidence, high activity is recommended for GD patients, reserving the use of 370MBq for patients with average sized and mildly enlarged goiter; this increases patient convenience by avoiding multiple activities to achieve cure and long-term follow-up.
本研究的目的是评估和比较不同固定放射性碘-131（¹³¹I）活度治疗格雷夫斯病（GD）后甲状腺功能减退的发生率，并调查可能影响其发生的预测因素。对272例接受¹³¹I治疗的GD患者进行了这项回顾性分析，其中125例接受370MBq，147例接受555MBq。结果分为甲状腺功能减退、甲状腺功能正常和持续性甲状腺功能亢进。进行多因素logistic回归分析以确定影响甲状腺功能减退发生的显著危险因素。首次低活度治疗后甲状腺功能减退的发生率为24.8%，治疗失败率高达58.4%，而高活度治疗后分别为48.3%和32%。重复治疗后甲状腺功能减退的总体累积发生率为50.7%，其中73.9%发生在首次治疗后，20.3%发生在第二次治疗后。较高的¹³¹I活度（P<0.001）以及甲状腺平均轻度肿大（P=0.004）被确定为增加甲状腺功能减退发生率的显著独立因素（比值比分别为2.95和2.59）。未发现甲状腺功能减退的发生与年龄、性别、突眼的存在、既往抗甲状腺药物治疗、病程以及高锝酸盐甲状腺摄取等因素之间存在相关性。鉴于首次低活度治疗后治疗失败率高且高活度治疗后甲状腺功能减退发生率较低，建议GD患者采用高活度治疗，对于甲状腺肿平均大小且轻度肿大的患者保留使用370MBq；这样可以避免多次治疗以实现治愈和长期随访，从而提高患者的便利性。
