Nygaard B, Jarløv A E, Hegedüs L, Schaadt B, Kristensen L O, Hansen J M
Department of Internal Medicine and Endocrinology F, Herlev Hospital, University of Copenhagen, Denmark.
Thyroid. 1994 Summer;4(2):167-71. doi: 10.1089/thy.1994.4.167.
The aim of the present study was to assess thyroid scintigraphies after 131I treatment of autonomous thyroid nodules with respect to evolution of the hot nodules as well as the extranodular tissue. A 99mTc pertechnetate scintigraphy was carried out 1-16 years (median 8 years) after 131I treatment of a solitary autonomous nodule in 66 patients remaining euthyroid. At the time of diagnosis, 9 of the patients were euthyroid and 57 were hyperthyroid, of whom 27 received antithyroid drug therapy prior to 131I treatment. The scintigraphies were evaluated twice by 4 specialists (3 endocrinologists and 1 specialist in nuclear medicine). There was total agreement between the 4 observers in 50 and 52% in the first and second evaluation, respectively. The interobserver variation was evaluated by means of omega coefficients and omega ranged from 0.18 to 0.76 indicating poor to substantial agreement. A solitary autonomous nodule with suppression of the extranodular thyroid tissue persisted in 50% of the patients, whereas a solitary cold nodule, homogeneous uptake or inhomogeneous uptake was found in 15, 22, and 13%, respectively. We conclude that although euthyroidism is achieved by radioiodine treatment, a hot nodule suppressing the 99mTc pertechnetate in the extranodular tissue is still found in 50% of the patients even when serum TSH has been normal for years. Antithyroid drug therapy prior to 131I treatment was more frequent in this group of patients.
本研究的目的是评估131I治疗自主性甲状腺结节后甲状腺闪烁显像，观察热结节以及结节外组织的变化情况。对66例仍保持甲状腺功能正常的患者，在131I治疗孤立性自主性结节后1 - 16年（中位时间8年）进行了99mTc高锝酸盐闪烁显像。诊断时，9例患者甲状腺功能正常，57例患者甲状腺功能亢进，其中27例在131I治疗前接受了抗甲状腺药物治疗。4位专家（3位内分泌学家和1位核医学专家）对闪烁显像进行了两次评估。在第一次和第二次评估中，4位观察者的完全一致率分别为50%和52%。通过欧米伽系数评估观察者间的差异，欧米伽系数范围为0.18至0.76，表明一致性从差到强。50%的患者存在孤立性自主性结节且结节外甲状腺组织受抑制，而分别有15%、22%和13%的患者发现孤立性冷结节、均匀摄取或不均匀摄取。我们得出结论，尽管放射性碘治疗可实现甲状腺功能正常，但即使血清TSH多年来一直正常，仍有50%的患者存在抑制结节外组织中99mTc高锝酸盐摄取的热结节。在这组患者中，131I治疗前接受抗甲状腺药物治疗的情况更为常见。
