Department of Surgery, Faculty of Health Sciences, University of Pretoria, South Africa.
S Afr Med J. 2021 Feb 1;111(2):176-179. doi: 10.7196/SAMJ.2021.v111i2.14522.
Radioactive iodine (RAI) is widely used in the treatment of hyperthyroidism. Adjunctive antithyroid drugs (ATDs) are commonly prescribed to treat the hyperthyroid state before the RAI has taken effect. However, there is no consensus on the use of or timing of adjunctive ATD treatment with RAI.
To determine the influence of the ATD carbimazole on the cure rate of RAI treatment for Graves' disease.
A retrospective chart review was conducted in the Department of Nuclear Medicine of the Steve Biko Academic Hospital in Pretoria. The cure rate of patients treated with RAI for Graves' disease was analysed. The effect of adjunctive carbimazole treatment with regard to its use and timing with RAI dosing was analysed. The cure rate was determined in patients treated with carbimazole either before RAI or before and after RAI administration. Cure rate was defined by the biochemical thyroid function status (thyroxine (T4), thyroid-stimulating hormone (TSH)) as euthyroid or hypothyroid from 3 months and sustained at 12 months. The need for a second dose of RAI was recorded.
RAI treatment was administered to 171 patients with Graves' disease. The cure rate was higher in patients receiving a higher dose of RAI. The overall cure rate increased progressively from 3 months and was 91% at 12 months. The cure rate in 97 patients not receiving carbimazole was 98%. The cure rate of the 27 patients on carbimazole treatment given before RAI administration was 81%, and 73% in the 37 patients in whom it was resumed after RAI administration. The overall cure rate was lower in patients who received carbimazole (p<0.001), but especially in patients in whom carbimazole was continued after RAI administration (p<0.001).
Adjunctive carbimazole treatment decreased the RAI cure rate of Graves' disease significantly.
放射性碘（RAI）被广泛用于治疗甲状腺功能亢进症。在 RAI 发挥作用之前，通常会开辅助抗甲状腺药物（ATD）来治疗甲状腺功能亢进状态。然而，对于 RAI 治疗的辅助 ATD 治疗的使用或时机，尚未达成共识。
确定 ATD 卡比马唑对 RAI 治疗格雷夫斯病的治愈率的影响。
对比勒陀利亚史蒂夫·比科学术医院核医学系进行回顾性图表审查。分析了用 RAI 治疗格雷夫斯病的患者的治愈率。分析了辅助卡比马唑治疗的效果，包括其使用和与 RAI 剂量的时机。在接受 RAI 治疗之前、之后或之前和之后接受卡比马唑治疗的患者中，确定了治愈率。治愈率通过生化甲状腺功能状态（甲状腺素（T4）、促甲状腺激素（TSH））来确定，3 个月后为甲状腺功能正常或甲状腺功能减退，12 个月后持续。记录需要第二次 RAI 剂量的情况。
对 171 例格雷夫斯病患者进行了 RAI 治疗。接受较高剂量 RAI 治疗的患者治愈率更高。总治愈率从 3 个月开始逐渐增加，12 个月时达到 91%。未接受卡比马唑治疗的 97 例患者的治愈率为 98%。在接受 RAI 治疗之前开始接受卡比马唑治疗的 27 例患者的治愈率为 81%，在接受 RAI 治疗之后恢复接受卡比马唑治疗的 37 例患者的治愈率为 73%。接受卡比马唑治疗的患者的总体治愈率较低（p<0.001），尤其是在接受 RAI 治疗后继续接受卡比马唑治疗的患者（p<0.001）。
辅助卡比马唑治疗显著降低了 RAI 治疗格雷夫斯病的治愈率。
