Dralle H, Lang W, Pretschner D P, Pichlmayr R, Hesch R D
Langenbecks Arch Chir. 1985;365(2):79-89. doi: 10.1007/BF01261135.
Clinical course, indications for surgical treatment, and results of treatment in 8 female patients with iodine induced thyrotoxicosis (IIT) are reported. The diagnosis of IIT could be established in all patients by a) clinical hyperthyroidism, b) increased T3 and T4 serum concentrations, and c) previous iodine contamination. Sources of iodine were radiographic contrast agents for urography (n = 4), oral cholecystography (n = 3), intravenous cholangiography (n = 1), phlebography (n = 1), and cranial computer tomography (n = 1). The onset of hyperthyroidism occurred 1-8 weeks after iodine exposure. Indications for surgical treatment of IIT were: 1. autonomous nodular goiter (n = 6), and 2. iodine exacerbation of preexisting thyrotoxicosis in patients with Graves' disease (n = 2). Corresponding to the different pathogenesis of autonomous and immunogenetic goiter the following surgical treatment is recommended: Enucleation of solitary autonomous adenomas or unilateral lobectomy in case of large adenomas, subtotal bilateral lobectomy in toxic multinodular goiter or, preferentially, unilateral lobectomy combined with subtotal resection of the contralateral thyroid lobe; "Near-total" thyroidectomy in Graves' immunopathy.
本文报告了8例碘致甲状腺毒症（IIT）女性患者的临床病程、手术治疗指征及治疗结果。所有患者均可通过以下几点确诊IIT：a）临床甲亢；b）血清T3和T4浓度升高；c）既往有碘接触史。碘的来源包括用于尿路造影的放射造影剂（4例）、口服胆囊造影剂（3例）、静脉胆管造影剂（1例）、静脉造影剂（1例）和头颅计算机断层扫描造影剂（1例）。甲亢在碘接触后1 - 8周出现。IIT的手术治疗指征为：1. 自主性结节性甲状腺肿（6例）；2. 格雷夫斯病患者原有甲状腺毒症的碘加重（2例）。根据自主性和免疫遗传性甲状腺肿的不同发病机制，建议采用以下手术治疗方法：孤立性自主性腺瘤摘除术或大型腺瘤行单侧甲状腺叶切除术；毒性多结节性甲状腺肿行双侧甲状腺次全切除术，或优先行单侧甲状腺叶切除术并联合对侧甲状腺叶次全切除术；格雷夫斯免疫病行“近全”甲状腺切除术。
