Franklyn J A, Daykin J, Holder R, Sheppard M C
Department of Medicine, University of Birmingham, Queen Elizabeth Hospital, Edgbaston, UK.
QJM. 1995 Mar;88(3):175-80.
In view of uncertainty regarding the most appropriate radioiodine dose for patients with hyperthyroidism due to toxic nodular disease or Graves' disease, we prospectively studied outcome in patients with these disorders given a single 5 mCi (185 MBq) dose of radioiodine. We studied 103 patients receiving their first radioiodine dose; 44 with toxic nodular hyperthyroidism and 59 with Graves' hyperthyroidism. Thyroid status (off anti-thyroid drug therapy) at 6 and 12 months after radioiodine was related to diagnosis, use of carbimazole before or after radioiodine, and physical and biochemical findings. At 6 months, persistent hyperthyroidism was less frequent in toxic nodular disease than in Graves' disease (34.1% vs. 55.9%, p < 0.05); hypothyroidism was also less frequent (11.4% vs. 27.1%, p < 0.05). Those with persistent hyperthyroidism at 6 months were given a second (10 mCi, 370 MBq) dose of radioiodine. At 12 months after the first dose, 80.6% of the group with toxic nodular hyperthyroidism were either euthyroid or hypothyroid, and 74.5% of those with Graves' disease were euthyroid or hypothyroid, the rate of hypothyroidism again being less in toxic nodular disease (19.4% vs. 58.8%, p < 0.05). Logistic regression and stepwise discriminant analysis demonstrated that 'cure' (euthyroidism or hypothyroidism) at 6 months was related to serum free T4 at presentation (p < 0.001) and administration of carbimazole before or after radioiodine (p < 0.001) (severe hyperthyroidism and carbimazole increasing the likelihood of persistent hyperthyroidism) but was not related to the diagnosis of toxic nodular or Graves' hyperthyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)
鉴于毒性结节性疾病或格雷夫斯病所致甲状腺功能亢进患者最合适的放射性碘剂量存在不确定性，我们对接受单次5毫居里（185兆贝可）放射性碘治疗的这些疾病患者的预后进行了前瞻性研究。我们研究了103例首次接受放射性碘治疗的患者；其中44例为毒性结节性甲状腺功能亢进，59例为格雷夫斯甲状腺功能亢进。放射性碘治疗后6个月和12个月时的甲状腺状态（停用抗甲状腺药物治疗）与诊断、放射性碘治疗前后是否使用卡比马唑以及体格和生化检查结果相关。6个月时，毒性结节性疾病患者持续甲状腺功能亢进的发生率低于格雷夫斯病患者（34.1%对55.9%，p<0.05）；甲状腺功能减退的发生率也较低（11.4%对27.1%，p<0.05）。6个月时持续甲状腺功能亢进的患者接受了第二次（10毫居里，370兆贝可）放射性碘治疗。首次给药后12个月时，毒性结节性甲状腺功能亢进组80.6%的患者甲状腺功能正常或减退，格雷夫斯病组74.5%的患者甲状腺功能正常或减退，毒性结节性疾病患者甲状腺功能减退的发生率再次较低（19.4%对58.8%，p<0.05）。逻辑回归和逐步判别分析表明，6个月时的“治愈”（甲状腺功能正常或减退）与就诊时的血清游离T4（p<0.001）以及放射性碘治疗前后是否使用卡比马唑（p<0.001）相关（重度甲状腺功能亢进和卡比马唑会增加持续甲状腺功能亢进的可能性），但与毒性结节性或格雷夫斯甲状腺功能亢进的诊断无关。（摘要截短至250字）
