Nuclear Medicine Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy.
Endocrinology, Diabetology and Metabolism Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy.
Endocrine. 2021 Jul;73(1):107-115. doi: 10.1007/s12020-020-02573-1. Epub 2021 Jan 5.
Aim of our study was to search for variables associated with worse outcomes in patients treated with radioactive iodine (RAI) for hyperthyroidism by a dosimetric-based approach.
Four hundred twenty-four patients with hyperthyroidism related to Toxic Multinodular Goiter (TMG; n = 213), Grave's disease (GD; n = 150) and toxic adenoma (TA; n = 61) treated with RAI between 2000 and 2018 and with at least 12 months follow-up were retrospectively evaluated. Association between outcomes (response vs. no response) at 6 and 12 months and baseline TSH values, anti-thyroid drugs (ATD) duration and posology, RAI absorbed dose and dimensional reduction of target mass at ultrasound was evaluated by Mann-Whitney test. Risk factors for response vs. no-response were analysed by binary logistic regression model.
Overall response rate was 78.7 and 83% at 6 and 12 months, respectively. Both at 6 and 12 months higher TSH baseline values (p < 0.001), lower ATD duration (p = 0.004 and p = 0.043), lower ATD posology (p = 0.014 and p = 0.005), and lower dose to target (D) (327 vs. 373 Gy, p = 0.003) were associated to response. Longer ATD duration and higher ATD posology were independent risk factors for no response at 6 and 12 months in GD and TMG, with no response at 6 months in TA subgroups.
Low TSH levels, longer duration and higher posology of ATD were associated with worse response to RAI. These data confirm that RAI therapy should be considered earlier in patients' management to allow better outcome and avoid ATD toxicity.
本研究旨在通过基于剂量的方法，寻找接受放射性碘（RAI）治疗的甲状腺功能亢进症患者预后较差的相关变量。
回顾性分析 2000 年至 2018 年间接受 RAI 治疗的 424 例甲状腺功能亢进症患者，其中毒性多结节性甲状腺肿（TMG；n=213）、Graves 病（GD；n=150）和毒性腺瘤（TA；n=61），随访时间至少 12 个月。通过 Mann-Whitney 检验评估治疗后 6 个月和 12 个月时结局（反应与无反应）与基础 TSH 值、抗甲状腺药物（ATD）持续时间和剂量、RAI 吸收剂量和超声目标质量体积减少之间的关系。通过二元逻辑回归模型分析反应与无反应的风险因素。
总反应率分别为 6 个月和 12 个月时的 78.7%和 83%。在 6 个月和 12 个月时，较高的 TSH 基础值（p<0.001）、较短的 ATD 持续时间（p=0.004 和 p=0.043）、较低的 ATD 剂量（p=0.014 和 p=0.005）和较低的靶剂量（D）（327 与 373 Gy，p=0.003）与反应相关。在 GD 和 TMG 中，较长的 ATD 持续时间和较高的 ATD 剂量是治疗后 6 个月和 12 个月无反应的独立危险因素，而在 TA 亚组中，治疗后 6 个月无反应。
低 TSH 水平、较长的 ATD 持续时间和较高的 ATD 剂量与 RAI 反应不良相关。这些数据证实，RAI 治疗应更早纳入患者管理，以获得更好的疗效，避免 ATD 毒性。
