Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
J Formos Med Assoc. 2020 May;119(5):925-932. doi: 10.1016/j.jfma.2020.01.014. Epub 2020 Feb 10.
BACKGROUND/PURPOSE: Few studies exist investigating the effectiveness of radioiodine (RAI) therapy for hyperthyroidism patients in Asia. We herein investigated the real-world efficacy of single-dose RAI therapy in Taiwanese patients with Graves' disease (GD).
This is a retrospective study of 243 patients with GD recorded between 1989 and 2016 in a tertiary referral hospital. Eu- or hypothyroid after RAI therapy were defined as the successful group. Kaplan-Meier curve and cox-regression model were used for analysis of prognostic factors.
Of the 243 patients, 187 were females, with mean age of 46.9 ± 13.6 years. Most patients (63.8%) did not choose RAI as the first-line therapy. The median dose was 7 mCi, with a mean follow-up period of 107.1 ± 82.8 months. The overall success rate was 70.9%. Univariate analysis revealed calculated- or fixed-dose (P = 0.015), goiter size (P < 0.001), and RAI dose (P = 0.022) were the factors affecting RAI effectiveness, multivariate analysis indicated goiter size was the independent factor. Patients with grade 0-2 goiter had a higher success rate than patients with grade 3 goiter (HR = 2.1, 95%CI = 1.34-3.27, P = 0.001), although the former were treated with lower RAI dose than the latter (7.8 ± 3.2 mCi vs 8.8 ± 3.3 mCi, P = 0.049). However, if the grade 3 goiters became smaller within 3 months of therapy, the success rate was not inferior to grade 0-2 goiter.
In Taiwan, RAI therapy for GD patients reached an overall success rate of 70.9%, with a median dose of 7 mCi. This study identified patients with grade 3 goiter need a more aggressive RAI regimen.
背景/目的：亚洲地区关于放射性碘（RAI）治疗甲状腺功能亢进症（甲亢）患者疗效的研究较少。本研究旨在调查 RAI 单剂量治疗台湾格雷夫斯病（GD）患者的真实疗效。
这是一项对 1989 年至 2016 年期间在一家三级转诊医院接受治疗的 243 例 GD 患者的回顾性研究。RAI 治疗后甲状腺功能减退或甲状腺功能减退被定义为成功组。采用 Kaplan-Meier 曲线和 Cox 回归模型分析预后因素。
243 例患者中，187 例为女性，平均年龄为 46.9±13.6 岁。大多数患者（63.8%）未选择 RAI 作为一线治疗。中位剂量为 7mCi，平均随访时间为 107.1±82.8 个月。总体成功率为 70.9%。单因素分析显示，计算剂量或固定剂量（P=0.015）、甲状腺肿大小（P<0.001）和 RAI 剂量（P=0.022）是影响 RAI 疗效的因素，多因素分析表明甲状腺肿大小是独立因素。0-2 级甲状腺肿患者的成功率高于 3 级甲状腺肿患者（HR=2.1，95%CI=1.34-3.27，P=0.001），尽管前者接受的 RAI 剂量低于后者（7.8±3.2mCi 比 8.8±3.3mCi，P=0.049）。然而，如果 3 级甲状腺肿在治疗后 3 个月内缩小，成功率并不逊于 0-2 级甲状腺肿。
在台湾，RAI 治疗 GD 患者的总体成功率为 70.9%，中位剂量为 7mCi。本研究发现 3 级甲状腺肿患者需要更积极的 RAI 方案。
