Department of General Medicine, Sengkang General Hospital, Singapore.
Ann Acad Med Singap. 2019 Jun;48(6):181-187.
Our study aimed to identify the factors associated with successful first-time radioactive iodine (RAI) treatment in patients with Graves' disease (GD).
This is a restrospective study of patients with GD who were treated with RAI. Treatment success was defined as onset of permanent hypothyroidism or euthyroidism after 1 dose of RAI at 1-year follow-up.
There were 388 GD patients who underwent RAI treatment between January 2014 and December 2015. Of these, 74% achieved treatment success. Median time to achieve permanent hypothyroidism was 2 months. Male gender, smoking, higher antithyroid drug dosage, lower thyroid stimulating hormone (TSH) level, large goitre size and TSH receptor antibody (TRAb) titre at time of RAI were significantly associated with treatment failure. Multivariate analysis showed that larger goitre size and higher TRAb titre were associated with lower first-time RAI success.
Larger goitre size and higher TRAb titre predict lower success of RAI therapy in GD patients. Treatment decisions and strategies should be customised for patients who present with these characteristics.
本研究旨在确定 Graves 病（GD）患者首次放射性碘（RAI）治疗成功的相关因素。
这是一项对 2014 年 1 月至 2015 年 12 月期间接受 RAI 治疗的 GD 患者进行的回顾性研究。成功治疗定义为在 1 年随访时，1 剂 RAI 后出现永久性甲状腺功能减退或甲状腺功能正常。
共有 388 例 GD 患者接受了 RAI 治疗。其中，74%的患者治疗成功。达到永久性甲状腺功能减退的中位时间为 2 个月。男性、吸烟、抗甲状腺药物剂量更高、甲状腺刺激激素（TSH）水平更低、甲状腺肿大较大以及 RAI 时 TSH 受体抗体（TRAb）滴度较高与治疗失败显著相关。多因素分析显示，甲状腺肿大较大和 TRAb 滴度较高与首次 RAI 成功率较低相关。
甲状腺肿大较大和 TRAb 滴度较高提示 GD 患者 RAI 治疗成功率较低。对于具有这些特征的患者，应制定个体化的治疗决策和策略。
