Nygaard B, Hegedüs L, Gervil M, Hjalgrim H, Søe-Jensen P, Hansen J M
Department of Internal Medicine, Herley University Hospital, Denmark.
BMJ. 1993 Oct 2;307(6908):828-32. doi: 10.1136/bmj.307.6908.828.
To investigate the long term effect of radioactive iodine on thyroid function and size in patients with non-toxic multinodular goitre.
Consecutive patients with multinodular non-toxic goitre selected for radioactive iodine treatment and followed for a minimum of 12 months (median 48 months) after an intended dose of 3.7 MBq/g thyroid tissue corrected to a 100% uptake of iodine-131 in 24 hours.
69 patients with a growing multinodular non-toxic goitre causing local compression symptoms or cosmetic inconveniences. The treatment was chosen because of a high operative risk, previous thyroidectomy, or refusal to be operated on.
Standard thyroid function variables and ultrasonically determined thyroid volume before treatment as well as 1, 2, 3, 6, and 12 months after treatment and then once a year.
56 patients were treated with a single dose of 131I, 12 with two doses, and one with four doses. In 45 patients treated with one dose and remaining euthyroid the median thyroid volume was reduced from 73 (interquartile range 50-106) ml to 29 (23-48) ml at 24 months in the 39 patients in whom this was measured during follow up. The median reduction was 40 (22-48) ml (60% reduction, p < 0.0001), half of which occurred within three months. Patients treated with two doses as well as those developing hypothyroidism and hyperthyroidism had a significant reduction in thyroid volume. Eleven patients developed hypothyroidism (cumulative five year risk 22%, 95% confidence interval 4.8% to 38.4%). Side effects were few: three cases of hyperthyroidism and two cases of radiation thyroiditis. Only one patient was dissatisfied with the result; she was referred for operation six months after treatment.
A substantial reduction in thyroid volume accompanied by a low incidence of hypothyroidism and few side effects makes the use of radioactive iodine an attractive alternative to surgery in selected cases of non-toxic multinodular goitre.
研究放射性碘对非毒性多结节性甲状腺肿患者甲状腺功能及大小的长期影响。
连续选取接受放射性碘治疗的多结节性非毒性甲状腺肿患者，在给予预期剂量为3.7MBq/g甲状腺组织（校正为24小时碘-131摄取率100%）后，随访至少12个月（中位时间48个月）。
69例多结节性非毒性甲状腺肿患者，甲状腺肿大且出现局部压迫症状或影响美观。因手术风险高、既往有甲状腺切除术史或拒绝手术而选择该治疗方法。
治疗前以及治疗后1、2、3、6和12个月，然后每年一次的标准甲状腺功能指标以及超声测定的甲状腺体积。
56例患者接受单次131I治疗，12例接受两次治疗，1例接受四次治疗。在45例接受单次治疗且仍保持甲状腺功能正常的患者中，随访期间测量的39例患者在24个月时甲状腺体积中位数从73（四分位间距50 - 106）ml降至29（23 - 48）ml。中位数减少40（22 - 48）ml（减少60%，p < 0.0001），其中一半在三个月内发生。接受两次治疗的患者以及出现甲状腺功能减退和甲状腺功能亢进的患者甲状腺体积均显著减小。11例患者出现甲状腺功能减退（累积五年风险22%，95%置信区间4.
