Department of Radiology and Nuclear Medicine, Faculty of Medicine, Burapha University, Chonburi, Thailand.
Department of Internal Medicine, Queen Sirikit Hospital, Chonburi, Thailand.
Endocrinol Metab (Seoul). 2024 Oct;39(5):758-766. doi: 10.3803/EnM.2024.1950. Epub 2024 Oct 14.
Previous studies of fixed-dose radioiodine therapy (RIT) for Graves' disease (GD) have utilized a variety of techniques and reported differing success rates. This study sought to compare the efficacy of RIT using two fixed-dose protocols and to estimate the optimal radioiodine (RAI) activity for the treatment of GD.
This retrospective trial enrolled 658 patients with GD who received RIT between January 2014 and December 2021. Participants were divided into two groups: protocol 1, which utilized a thyroid size-specific RAI dose, and protocol 2, which employed a modified dose calculation approach. The primary outcome assessed was the presence of euthyroidism or hypothyroidism at the 6-month follow-up. The success rates of RIT were compared between the two protocols.
The RIT success rate was marginally lower for protocol 2 than for protocol 1 (63.6% vs. 67.2%); however, the risk of treatment failure did not differ considerably between the groups (relative risk, 1.1089; 95% confidence interval, 0.8937 to 1.3758; P=0.3477). The median RAI activity associated with protocol 2 was lower than that for protocol 1 (10.7 mCi vs. 15.0 mCi, P=0.0079), and the frequency of hypothyroidism was significantly lower in the protocol 2 group (39.0% vs. 48.9%, P=0.0117).
The success rate of the modified dose calculation protocol was comparable to that of the thyroid size-specific RAI dose protocol. The former approach reduced RAI activity and the incidence of hypothyroidism following RIT without compromising the success rate.
既往研究显示，固定剂量放射性碘（RAI）治疗 Graves 病（GD）采用了多种技术，报告的成功率也不尽相同。本研究旨在比较两种固定剂量方案的 RAI 治疗 Graves 病的疗效，并估计治疗 GD 的最佳 RAI 活度。
本回顾性试验纳入了 2014 年 1 月至 2021 年 12 月期间接受 RAI 治疗的 658 例 GD 患者。参与者被分为两组：方案 1 采用甲状腺大小特异性 RAI 剂量，方案 2 采用改良剂量计算方法。主要终点为 6 个月随访时是否存在甲状腺功能正常或甲状腺功能减退。比较两种方案的 RAI 治疗成功率。
方案 2 的 RAI 治疗成功率略低于方案 1（63.6% vs. 67.2%），但两组间治疗失败的风险无显著差异（相对风险 1.1089；95%置信区间 0.8937 至 1.3758；P=0.3477）。方案 2 的 RAI 活度中位数低于方案 1（10.7 mCi vs. 15.0 mCi，P=0.0079），且方案 2 组的甲状腺功能减退发生率显著低于方案 1 组（39.0% vs. 48.9%，P=0.0117）。
改良剂量计算方案的成功率与甲状腺大小特异性 RAI 剂量方案相当。前者降低了 RAI 治疗后的活度和甲状腺功能减退的发生率，同时不影响成功率。
