Burch H B, Solomon B L, Wartofsky L, Burman K D
Walter Reed Army Medical Center, Washington, D.C.
Ann Intern Med. 1994 Oct 15;121(8):553-9. doi: 10.7326/0003-4819-121-8-199410150-00001.
To determine the relative effects on thyroid hormone levels of discontinuing antithyroid drug therapy and subsequent ablation with radioiodine in patients with hyperthyroid Graves disease.
A clinical trial with a prospective analysis of the relative change in thyroid hormone levels over time in response to therapy in two study groups.
An outpatient endocrine clinic at a tertiary care hospital.
21 patients with a clinical diagnosis of hyperthyroid Graves disease scheduled to receive ablation therapy with radioiodine (131I): 17 patients were pretreated with antithyroid drugs, and 4 were not.
Antithyroid drugs were stopped 6 days before radioiodine therapy. Patients were monitored clinically and biochemically with measurement of free and total levels of thyroxine (T4) and triiodothyronine (T3) on days -6, -3, -1; the day of radioiodine therapy; and days 1, 2, 3, 4, 5, 7, and 14.
Before radioiodine treatment and compared with baseline measurement, the mean increase in free T4 levels after discontinuation of antithyroid therapy was 86% (95% CI, 16.1% to 156%), with a concurrent mean increase in free T3 levels of 71.6% (CI, 31% to 112%). Radioiodine therapy resulted in a mean decrease in free T3 levels of 28.7% (CI, -44.1% to -13.2%), a mean decrease in total T3 levels of 22.9% (CI, -39.4% to -6.4%), and stability in free and total T4 levels rather than aggravation of thyrotoxicosis. A smaller group of patients not receiving antithyroid drugs experienced a course qualitatively similar to that of pretreated patients after 131I treatment, with a mean reduction in free T4 levels of 39.8% (CI, -69.9% to -9.7%) and a mean decrease in free T3 levels of 49.4% (CI, -93.7% to -5.1%).
Short-term increases in thyroid hormone levels in patients with Graves disease receiving radioiodine ablation occur primarily as a result of discontinuing antithyroid therapy rather than as a result of treatment with 131I. Stability or decrease in thyroid hormone levels, rather than further elevation, occurs during the 2-week interval after ablation therapy with 131I. Antithyroid drug therapy before radioiodine ablation may have little effect on the short-term biochemical course after 131I therapy for Graves disease. The homogeneity of our sample regarding age, diagnosis, and general health may prevent application of these findings to other populations without further study.
确定停用抗甲状腺药物治疗及随后用放射性碘消融对甲状腺功能亢进型格雷夫斯病患者甲状腺激素水平的相对影响。
一项临床试验，对两个研究组中甲状腺激素水平随时间对治疗反应的相对变化进行前瞻性分析。
一家三级护理医院的门诊内分泌诊所。
21例临床诊断为甲状腺功能亢进型格雷夫斯病且计划接受放射性碘（131I）消融治疗的患者：17例患者接受了抗甲状腺药物预处理，4例未接受。
在放射性碘治疗前6天停用抗甲状腺药物。在第-6、-3、-1天；放射性碘治疗当天；以及第1、2、3、4、5、7和14天，对患者进行临床和生化监测，测定游离和总甲状腺素（T4）及三碘甲状腺原氨酸（T3）水平。
在放射性碘治疗前并与基线测量相比，停用抗甲状腺治疗后游离T4水平的平均升高为86%（95%CI，16.1%至156%），同时游离T3水平平均升高71.6%（CI，31%至112%）。放射性碘治疗导致游离T3水平平均降低28.7%（CI，-44.1%至-13.2%），总T3水平平均降低22.9%（CI，-39.4%至-6.4%），游离和总T4水平保持稳定，而非甲状腺毒症加重。一小群未接受抗甲状腺药物治疗的患者在131I治疗后经历了与预处理患者在性质上相似的病程，游离T4水平平均降低39.8%（CI，-69.9%至-9.7%），游离T3水平平均降低49.4%（CI，-93.7%至-5.1%）。
接受放射性碘消融的格雷夫斯病患者甲状腺激素水平的短期升高主要是由于停用抗甲状腺治疗，而非131I治疗的结果。在131I消融治疗后的2周间隔内甲状腺激素水平保持稳定或降低，而非进一步升高。放射性碘消融前的抗甲状腺药物治疗对格雷夫斯病131I治疗后的短期生化病程可能影响不大。我们样本在年龄、诊断和总体健康方面的同质性可能会阻止在未经进一步研究的情况下将这些发现应用于其他人群。
