Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Department of Endocrinology and Diabetes, Sandwell and West Birmingham Hospitals, Birmingham, UK.
Clin Endocrinol (Oxf). 2022 Nov;97(5):664-675. doi: 10.1111/cen.14719. Epub 2022 Mar 21.
Thyroid status in the months following radioiodine (RI) treatment for Graves' disease can be unstable. Our objective was to quantify frequency of abnormal thyroid function post-RI and compare effectiveness of common management strategies.
Retrospective, multicentre and observational study.
Adult patients with Graves' disease treated with RI with 12 months' follow-up.
Euthyroidism was defined as both serum thyrotropin (thyroid-stimulating hormone [TSH]) and free thyroxine (FT4) within their reference ranges or, when only one was available, it was within its reference range; hypothyroidism as TSH ≥ 10 mU/L, or subnormal FT4 regardless of TSH; hyperthyroidism as TSH below and FT4 above their reference ranges; dysthyroidism as the sum of hypo- and hyperthyroidism; subclinical hypothyroidism as normal FT4 and TSH between the upper limit of normal and <10 mU/L; and subclinical hyperthyroidism as low TSH and normal FT4.
Of 812 patients studied post-RI, hypothyroidism occurred in 80.7% and hyperthyroidism in 48.6% of patients. Three principal post-RI management strategies were employed: (a) antithyroid drugs alone, (b) levothyroxine alone, and (c) combination of the two. Differences among these were small. Adherence to national guidelines regarding monitoring thyroid function in the first 6 months was low (21.4%-28.7%). No negative outcomes (new-onset/exacerbation of Graves' orbitopathy, weight gain, and cardiovascular events) were associated with dysthyroidism. There were significant differences in demographics, clinical practice, and thyroid status postradioiodine between centres.
Dysthyroidism in the 12 months post-RI was common. Differences between post-RI strategies were small, suggesting these interventions alone are unlikely to address the high frequency of dysthyroidism.
放射性碘（RI）治疗格雷夫斯病（Graves' disease）后甲状腺功能在数月内可能不稳定。我们的目的是量化 RI 后甲状腺功能异常的频率，并比较常见管理策略的效果。
回顾性、多中心和观察性研究。
接受 RI 治疗的 Graves 病成年患者，随访时间为 12 个月。
甲状腺功能正常定义为血清促甲状腺激素（thyroid-stimulating hormone [TSH]）和游离甲状腺素（free thyroxine [FT4]）均在参考范围内，或仅一项可用时，也在参考范围内；甲状腺功能减退定义为 TSH≥10mU/L，或无论 TSH 如何，FT4 均低于正常值；甲状腺功能亢进定义为 TSH 低于参考范围，FT4 高于参考范围；甲状腺功能紊乱定义为甲状腺功能减退和甲状腺功能亢进的总和；亚临床甲状腺功能减退定义为 FT4 正常，TSH 在正常值上限和＜10mU/L 之间；亚临床甲状腺功能亢进定义为 TSH 低，FT4 正常。
在 812 名接受 RI 治疗后的患者中，80.7%的患者发生甲状腺功能减退，48.6%的患者发生甲状腺功能亢进。三种主要的 RI 后管理策略是：（a）单独使用抗甲状腺药物，（b）单独使用左甲状腺素，和（c）两者联合使用。这些策略之间的差异很小。在最初 6 个月内监测甲状腺功能的国家指南的遵循率较低（21.4%-28.7%）。甲状腺功能紊乱与新发/加重格雷夫斯眼病、体重增加和心血管事件等不良后果无关。各中心间的人口统计学、临床实践和 RI 后甲状腺状态存在显著差异。
RI 后 12 个月内甲状腺功能紊乱很常见。RI 后策略之间的差异很小，这表明这些干预措施单独使用不太可能解决甲状腺功能紊乱的高频率。
