Department of Internal Medicine, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey.
Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey.
Endocr Pract. 2022 Aug;28(8):749-753. doi: 10.1016/j.eprac.2022.05.001. Epub 2022 May 7.
We aimed to determine the factors predicting hypothyroidism after radioactive iodine (RAI) treatment in patients with toxic adenoma and toxic multinodular goiter.
We retrospectively collected the data of 237 patients with toxic multinodular goiter or toxic adenoma who had consecutively received RAI treatment between 2014 and 2020 at 2 medical centers. Patients who received the second RAI treatment and whose medical records could not be accessed were excluded from the study. Finally, 133 patients were included in the study. RAI was administered at an empirical dose of 15 or 20 mCi.
The median age of the 133 participants was 69 years (interquartile range, 62-75 years), and 64.7% of the participants were women. A total of 42.1% of the patients had toxic adenoma, whereas 57.9% of patients had toxic multinodular goiter. The median follow-up was 24 months (interquartile range, 11-38 months). During the follow-up, 61.7% of patients became euthyroid, 30.8% developed hypothyroidism, and 7.5% remained hyperthyroid. The median month of hypothyroidism onset was 4 months (interquartile range, 2-9 months). Regression analysis revealed 2 factors that could predict hypothyroidism: thyroid-stimulating hormone (odds ratio, 2.548; 95% CI, 1.042-6.231; P = .04) and thyroid volume (odds ratio, 0.930; 95% CI, 0.885-0.978; P = .005).
Overall, 30.8% of the cases developed hypothyroidism after the RAI treatment. Approximately 78% of hypothyroidism developed within the first 10 months. The risk of hypothyroidism was higher in patients with higher thyroid-stimulating hormone and smaller thyroid volume.
本研究旨在探讨毒性结节性甲状腺肿和毒性腺瘤患者接受放射性碘（RAI）治疗后发生甲状腺功能减退的相关预测因素。
我们回顾性收集了 2014 年至 2020 年期间在两家医疗中心连续接受 RAI 治疗的 237 例毒性结节性甲状腺肿或毒性腺瘤患者的数据。排除接受第二次 RAI 治疗且无法获取病历的患者。最终，共有 133 例患者纳入研究。RAI 治疗的经验剂量为 15 或 20 mCi。
133 名参与者的中位年龄为 69 岁（四分位距，62-75 岁），64.7%为女性。42.1%的患者为毒性腺瘤，57.9%的患者为毒性多结节性甲状腺肿。中位随访时间为 24 个月（四分位距，11-38 个月）。随访期间，61.7%的患者甲状腺功能恢复正常，30.8%的患者发生甲状腺功能减退，7.5%的患者仍处于甲状腺功能亢进状态。甲状腺功能减退的中位发病时间为 4 个月（四分位距，2-9 个月）。回归分析显示，有 2 个因素可预测甲状腺功能减退：促甲状腺激素（比值比，2.548；95%置信区间，1.042-6.231；P=0.04）和甲状腺体积（比值比，0.930；95%置信区间，0.885-0.978；P=0.005）。
总体而言，RAI 治疗后有 30.8%的患者发生甲状腺功能减退。约 78%的甲状腺功能减退发生在治疗后 10 个月内。促甲状腺激素水平较高和甲状腺体积较小的患者发生甲状腺功能减退的风险更高。
