Harada T, Katagiri M, Shimaoka K, Ito K
Division of Endocrine Surgery, Kawasaki Medical School, Okayama, Japan.
Jpn J Surg. 1989 Jan;19(1):29-37. doi: 10.1007/BF02471563.
Radioactive iodine treatment is currently the most popular treatment modality for hyperthyroidism in many patients of the world. In Japan, however, a considerable number of patients with hyperthyroidism have undergone successful surgery. To elucidate the advantages and disadvantages of surgical and 131I treatment, the thyroid function of 66 patients from each group was compared, 5 to 8 years after treatment. None of the surgically treated patients had been reoperated upon on, whereas 12 (18 per cent) of the patients treated with 131I required 2 or more doses. The number of patients with normal ranges of serum T3, T4 and TSH values was almost identical: 33 (50 per cent) of the postoperative patients and 31 (47 per cent) of the post-irradiated patients. In the surgically treated group, there was no tendency for hypothyroidism to develop with the passage of the time. However, although the distribution of T3 and T4 in the normal control and postoperative groups showed a normal bell-shaped distribution, the post-irradiated group did not exhibit this distribution. The normal control group and the postoperative group showed positive correlations of T3 and T4 but the post-irradiated group did not (p less than 0.05). When the titers of antithyroglobulin and antimicrosomal antibodies prior to therapy were compared with those following therapy, they had decreased in 41 per cent and 76.8 per cent, respectively, of the postoperative cases, but in only 24.2 per cent and 45.5 per cent of the post-irradiated cases.
放射性碘治疗目前是世界上许多甲亢患者最常用的治疗方式。然而，在日本，相当数量的甲亢患者已成功接受了手术治疗。为了阐明手术治疗和¹³¹I治疗的优缺点，对每组66例患者治疗后5至8年的甲状腺功能进行了比较。接受手术治疗的患者均未再次接受手术，而接受¹³¹I治疗的患者中有12例（18%）需要2剂或更多剂量。血清T3、T4和TSH值在正常范围内的患者数量几乎相同：术后患者中有33例（50%），接受放疗后的患者中有31例（47%）。在手术治疗组中，未发现甲状腺功能减退随时间推移而发展的趋势。然而，尽管正常对照组和术后组中T3和T4的分布呈正常的钟形分布，但放疗后组并未呈现这种分布。正常对照组和术后组中T3和T4呈正相关，但放疗后组并非如此（p<0.05）。当比较治疗前和治疗后的抗甲状腺球蛋白和抗微粒体抗体滴度时，术后病例中分别有41%和76.8%的抗体滴度下降，但放疗后病例中仅分别有24.2%和45.5%的抗体滴度下降。
