Szumowski Piotr, Abdelrazek Saeid, Sykała Monika, Mojsak Małgorzata, Żukowski Łukasz, Siewko Katarzyna, Maliszewska Katarzyna, Adamska Agnieszka, Popławska-Kita Anna, Krętowski Adam, Myśliwiec Janusz
Department of Nuclear Medicine, Medical University of Bialystok, M. Skłodowskiej-Curie St. 24A, 15-276, Bialystok, Poland.
Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M. Skłodowskiej-Curie St. 24A, 15-276, Bialystok, Poland.
Endocrine. 2020 Jan;67(1):136-142. doi: 10.1007/s12020-019-02100-x. Epub 2019 Oct 4.
It is possible to raise the rate of the uptake of I in the thyroid gland (RAIU) by increasing the endogenous TSH level through appropriate use of methimazole (MMI) prior to I therapy. The purpose of this paper is to assess the impact of pre treatment with MMI on the efficacy of I therapy in non-toxic multinodular goitre (NMG).
Thirty-one patients with NMG received I treatment in order to reduce the volume of the thyroid (TVR). Those in group 1 (n = 16) were administered 10 mg of methimazole for 6 weeks. Four days after its discontinuation, they received I. Patients in group 2 (n = 15) were given a placebo instead of MMI. The therapeutic activity of I was constant (800 MBq) and was repeated every 6 months. Treatment was discontinued when TVR reached <40 ml.
In group 1, RAIU increased approximately twofold. Ten patients from group 2 and four patients from group 1 received further doses of I. The median of time until TVR decreased below 40 ml was 9 months [6-12 months] and 18 months [14-22 months] in group 2. At 2 years after the I therapy, the occurrence of hypothyroidism did not differ significantly (36% in group 1 and 33% in group2, p = 0.074).
Radioiodine treatment of NMG preceded with appropriate application of MMI is efficient thanks to increased RAIU, shorter period of treatment, and lower frequency of I administration, without an increase in the incidence of post-treatment hypothyroidism.
在碘治疗前通过适当使用甲巯咪唑（MMI）提高内源性促甲状腺激素（TSH）水平，有可能提高甲状腺对碘的摄取率（RAIU）。本文旨在评估MMI预处理对非毒性多结节性甲状腺肿（NMG）碘治疗疗效的影响。
31例NMG患者接受碘治疗以减少甲状腺体积（TVR）。第1组（n = 16）患者服用10 mg甲巯咪唑，持续6周。停药4天后，他们接受碘治疗。第2组（n = 15）患者给予安慰剂而非MMI。碘的治疗活性恒定（800 MBq），每6个月重复一次。当TVR降至<40 ml时停止治疗。
在第1组中，RAIU增加了约两倍。第2组的10例患者和第1组的4例患者接受了进一步剂量的碘治疗。第2组中TVR降至40 ml以下的中位时间为9个月[6 - 12个月]，第1组为18个月[14 - 22个月]。碘治疗后2年，甲状腺功能减退的发生率无显著差异（第1组为36%，第2组为33%，p = 0.074）。
在适当应用MMI的前提下，放射性碘治疗NMG是有效的，这得益于RAIU增加、治疗周期缩短、碘给药频率降低，且治疗后甲状腺功能减退的发生率并未增加。
