Stewart T, Rochon J, Lenfestey R, Wise P
J Nucl Med. 1985 Jun;26(6):592-9.
Between November 1965 and December 1983, 293 patients were treated for Graves' disease using 131I. All patients were asked to identify a stressful event antedating the onset of overt clinical symptoms. Eighty-one patients were able to do this (27.6%). Six patients were lost to follow-up, the others were followed from 1 to 155 mo. Two hundred forty-four patients received a single treatment, 49 required two or more treatments. Stress and nonstress individuals were consistent with respect to age, sex, number of treatments and the dose of radioiodine. Patients with stress initiating the symptoms of Graves' disease became hypothyroid earlier, 50% at 12 mo compared with 36 mo for the nonstress group, p = 0.01. At 10 yr 5% of the stress group remained euthyroid compared with 17% nonstress. We conclude that stress in the 12 mo or less before the onset of clinical symptoms potentiates the development of hypothyroidism induced by a standard dose of radioiodine.
1965年11月至1983年12月期间，293例格雷夫斯病患者接受了¹³¹I治疗。所有患者均被要求确认在明显临床症状出现之前发生的应激事件。81例患者能够做到这一点（27.6%）。6例患者失访，其余患者随访1至155个月。244例患者接受了单次治疗，49例需要两次或更多次治疗。有应激和无应激的患者在年龄、性别、治疗次数和放射性碘剂量方面一致。由应激引发格雷夫斯病症状的患者甲状腺功能减退出现得更早，12个月时为50%，而非应激组为36个月，p = 0.01。10年后，应激组5%的患者甲状腺功能仍正常，而非应激组为17%。我们得出结论，在临床症状出现前12个月或更短时间内的应激会增强标准剂量放射性碘诱发甲状腺功能减退的发生。
