Feng Wenwen, Shi He, Yang Yanli, Liu Jing, Chen Shiying, Ren Minghui, Li Yajie, Liu Wei, Cui Dai
Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, Jiangsu, China.
Int J Endocrinol. 2024 Nov 8;2024:7535093. doi: 10.1155/2024/7535093. eCollection 2024.
The utilization of radioactive iodine-131I (RAI) has long been established as a cost-effective and conventional treatment for managing Graves' disease (GD). However, the accurate prediction of the clinical response to RAI treatment remains difficult. The successful resolution of GD through RAI therapy is typically characterized by the induction of hypothyroidism or euthyroidism. Thus, the principal aim of this study was to identify plausible predictors of RAI efficacy in the treatment of GD. The clinical data of 613 GD patients, who underwent RAI treatment for the first time, were retrospectively analyzed, including age, gender, duration of hyperthyroidism, presence or absence of ocular signs, thyroid volume, thyroid weight, thyroid function (FT3, FT4, and TSH), radioactive iodine uptake (RAIU) at 2 h/6 h/24 h (2-h/6-h/24-h RAIU) prior to RAI treatment, the highest RAIU (RAIU), and administered activity of 131I and 131I activity per gram of thyroid tissue. Success of RAI treatment was defined as achieving hypothyroidism or euthyroidism for more than 1 year after the initial treatment. Univariate and multivariate logistics regression analyses were conducted to identify factors that influence the efficacy of RAI treatment for GD. And at last, based on the results of the multivariate logistic regression analysis, a nomogram model was established. In this study, the success rate of RAI treatment for GD was 91.2% (559/613). Univariate analysis demonstrated that several factors, including age (=0.005), thyroid volume (=0.001), thyroid-stimulating hormone (TSH, =0.042), ratio of RAIU at 6 h to 24 h (6-h/24-h RAIU, =0.048), total 131I activity (=0.026), and 131I activity per gram of thyroid tissue (=0.001), were significantly associated with treatment outcome. Multivariate logistic regression analysis indicated thyroid volume and 131I activity per gram of thyroid tissue as significant independent predictors of radioactive iodine therapy (RIT) efficacy. The area under the ROC curve of the established nomogram model was 0.769 (95% confidence interval [CI]: 0.692-0.846), indicating that the model has good discriminatory ability. Calculated-dose RAI is effective in the treatment of GD. The smaller thyroid volume and the higher 131I activity per gram of thyroid tissue are predictors of RAI efficacy in the treatment of GD.
长期以来，放射性碘-131I（RAI）的应用一直被认为是治疗格雷夫斯病（GD）的一种经济有效的传统方法。然而，准确预测RAI治疗的临床反应仍然困难。通过RAI治疗成功治愈GD的典型特征是诱发甲状腺功能减退或甲状腺功能正常。因此，本研究的主要目的是确定RAI治疗GD疗效的合理预测因素。对613例首次接受RAI治疗的GD患者的临床资料进行回顾性分析，包括年龄、性别、甲亢病程、有无眼部体征、甲状腺体积、甲状腺重量、甲状腺功能（FT3、FT4和TSH）、RAI治疗前2小时/6小时/24小时的放射性碘摄取率（2小时/6小时/24小时RAIU）、最高RAIU（RAIU）以及131I的给药活度和每克甲状腺组织的131I活度。RAI治疗成功的定义为初始治疗后1年以上实现甲状腺功能减退或甲状腺功能正常。进行单因素和多因素逻辑回归分析以确定影响RAI治疗GD疗效的因素。最后，根据多因素逻辑回归分析结果建立了列线图模型。在本研究中，RAI治疗GD的成功率为91.2%（559/613）。单因素分析表明，年龄（=0.005）、甲状腺体积（=0.001）、促甲状腺激素（TSH，=0.042）、6小时与24小时的RAIU比值（6小时/24小时RAIU，=0.048）、131I总活度（=0.026）和每克甲状腺组织的131I活度（=0.001）等几个因素与治疗结果显著相关。多因素逻辑回归分析表明，甲状腺体积和每克甲状腺组织的131I活度是放射性碘治疗（RIT）疗效的重要独立预测因素。所建立列线图模型的ROC曲线下面积为0.769（95%置信区间[CI]：0.692-0.846），表明该模型具有良好的鉴别能力。计算剂量的RAI对GD治疗有效。甲状腺体积越小和每克甲状腺组织的131I活度越高是RAI治疗GD疗效的预测因素。
