甲状腺激素药物对孤立性毒性甲状腺结节放射性碘治疗期间 I 内治疗半衰期的影响。

The influence of thyroid hormone medication on intra-therapeutic half-life of I during radioiodine therapy of solitary toxic thyroid nodules.

机构信息

Department of Nuclear Medicine, University Hospital, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany.

出版信息

Sci Rep. 2022 Aug 17;12(1):13925. doi: 10.1038/s41598-022-18170-3.

DOI:10.1038/s41598-022-18170-3

PMID:35978004

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9385611/

Abstract

Despite a significantly improved dietary iodine supply, solitary toxic thyroid nodules (STN) are still a common clinical problem in former iodine deficient areas. Radioiodine treatment (RIT) is a well-established therapeutic option with few side effects and high success rates. As radioiodine biokinetics are individual for every patient, the necessary activity has to be calculated individually by a pre-therapeutic measurement of the intra-therapeutic effective half-life (EHL) in a radioiodine uptake test (RIUT). A suppressive medication with triiodothyronine (T3) or tetraiodothyronine (T4) is often needed to suppress uptake in normal thyroid tissue. Therefore, the aim of this study was to quantify the possible influence of this medication on intra-therapeutic radioiodine biokinetics. A cohort of 928 patients with STN undergoing RIUT and RIT was analysed. Patients were subdivided into 3 groups. Group T3: medication with T3 (n = 274), group T4: medication with T4 (n = 184) and group NM: no additional medication (n = 470). The T3 and T4 subgroups were further subdivided depending on the dose of thyroid hormone medication. In order to analyse the influence of thyroid hormone medication on individual intra-thyroidal biokinetics, the variance of the determined individual EHL between RIUT and RIT within the single groups and within the subgroups was investigated. EHL was significantly decreased between RIUT and RIT in the T3 and T4 subgroups (EHL: T3: 5.9 ± 1.1 d in RIUT and 3.3 ± 1.4 d in RIT (- 43%) (p < 0.05); T4: 5.9 ± 1.2 d in RIUT and 3.4 ± 1.5 d in RIT (- 42%) (p < 0.05). The decrease of EHL did not differ statistically between T3 or T4. However, both showed a highly significant difference compared to the NM group (p < < 0.05). A further subgroup analysis showed a significant dependence of the decrease in EHL related to the dose of thyroid hormone medication of 35-58% (T3) and 15-67% (T4) (p < 0.05). A significantly reduced EHL compared to RIUT in patients receiving thyroid hormone medication was detected. Moreover, a significant correlation between the dose of thyroid hormone medication (T3 or T4) and the decrease of EHL was found. Therefore, an adaption of the calculated activity should be considered in RIUT to obtain the required radiation dose in RIT of patients suffering from STN.

摘要

尽管碘的膳食供应有了显著改善，但孤立性毒性甲状腺结节（STN）在碘缺乏地区仍然是一个常见的临床问题。放射性碘治疗（RIT）是一种成熟的治疗选择，副作用少，成功率高。由于每个患者的放射性碘生物动力学都是个体差异的，因此必须通过放射性碘摄取试验（RIUT）中治疗内有效半衰期（EHL）的预治疗测量来单独计算所需的活性。为了抑制正常甲状腺组织的摄取，通常需要使用三碘甲状腺原氨酸（T3）或四碘甲状腺原氨酸（T4）进行抑制性药物治疗。因此，本研究的目的是量化这种药物治疗对治疗内放射性碘生物动力学的可能影响。对 928 例接受 RIUT 和 RIT 的 STN 患者进行了分析。患者分为 3 组。组 T3：服用 T3（n=274），组 T4：服用 T4（n=184），组 NM：无额外药物治疗（n=470）。T3 和 T4 亚组根据甲状腺激素药物剂量进一步细分。为了分析甲状腺激素药物治疗对个体甲状腺内生物动力学的影响，研究了单个组内和亚组内 RIUT 和 RIT 之间确定的个体 EHL 的方差。T3 和 T4 亚组中 RIUT 和 RIT 之间 EHL 显著降低（EHL：T3：RIUT 中 5.9±1.1 d，RIT 中 3.3±1.4 d（-43%）（p<0.05）；T4：RIUT 中 5.9±1.2 d，RIT 中 3.4±1.5 d（-42%）（p<0.05）。EHL 的降低在 T3 或 T4 之间没有统计学差异。然而，与 NM 组相比，这两者都有高度显著的差异（p<0.05）。进一步的亚组分析表明，EHL 降低与甲状腺激素药物剂量之间存在显著相关性，为 35-58%（T3）和 15-67%（T4）（p<0.05）。在接受甲状腺激素治疗的患者中，与 RIUT 相比，EHL 明显降低。此外，还发现甲状腺激素药物剂量（T3 或 T4）与 EHL 降低之间存在显著相关性。因此，在 RIUT 中应考虑调整计算出的活性，以获得接受 STN 治疗的患者 RIT 所需的辐射剂量。