[自主性甲状腺肿放射性碘治疗后免疫性甲状腺功能亢进的发生情况]

[Occurrence of immune hyperthyroidism after radioiodine therapy of autonomous goiter].

作者信息

Hirsch C, Spyra J L, Langhammer H R, Laubenbacher C, Senekowitsch-Schmidtke R, Schwaiger M

机构信息

Nuklearmedizinische Klinik und Poliklinik, Technischen Universität, Isar, Müncheu.

出版信息

Med Klin (Munich). 1997 Mar 15;92(3):130-7. doi: 10.1007/BF03043269.

DOI:10.1007/BF03043269

PMID:9173203

Abstract

AIM

The goal of the study was to examine the prevalence of Graves' disease following I-131 treatment of autonomous goiter with special regard to pretreatment scintigraphic patterns.

PATIENTS AND METHOD

Pre- and posttreatment in-vitro and in-vivo parameters were studied in 375 consecutive patients treated with I-131 therapy for nodular or diffuse autonomous goiter. All patients included were within ambulant control for at least 2.5 months following treatment. According to the pretreatment Tc-99m pertechnetate scan 59% (220/375) had multifocal (MF), 23% (86/375) unifocal (UF), 10% (38/375) mixed focal-disseminated (FD) and 8% (31/375) disseminated (D) scintigraphic patterns.

RESULTS

In 93.9% (352/375), the autonomous tissue was totally, in 2.1% (8/375) partially and in 1.6% (6/375) insufficiently eliminated. In 2.4% (9/375) a relapse of hyperthyroidism was observed 2 to 10 months following I-131 therapy. In 8 patients a relapse of hyperthyroidism was accompanied or followed by an elevation of the previously non-elevated TSH-receptor antibody (TRAb) level and in 1 patient by an TRAb increase to the upper borderline range implicating Graves' disease. With the prevalence of Graves' disease following I-131 therapy a statistically significant difference in pretreatment Tc-99m pertechnetate scintigraphic patterns was found: 0% of unifocal (0/86) or multifocal (0/220), however 18% (7/38) of focal-disseminated and 7% (2/31) of disseminated scintigraphic patterns. From the 366 patients without relapse of hyperthyroidism 2 (MF) had elevated pre- and posttreatment TRAb levels and 3 (D) had elevated TRAb levels for the first time after I-131 therapy.

CONCLUSION

There is a low overall prevalence (2.4%) of Graves' disease following I-131 therapy for nodular or diffuse autonomous goiter. However, the prevalence of posttreatment Graves' disease is highly dependent upon pretreatment scintigraphic patterns exhibiting focal-disseminated or disseminated patterns.

摘要

目的

本研究的目的是特别针对治疗前的闪烁扫描模式，研究131碘治疗自主性甲状腺肿后格雷夫斯病的患病率。

患者与方法

对375例接受131碘治疗结节性或弥漫性自主性甲状腺肿的连续患者的治疗前和治疗后的体外及体内参数进行了研究。所有纳入患者在治疗后至少2.5个月处于门诊随访中。根据治疗前高锝酸盐锝99m扫描结果，59%（220/375）为多灶性（MF），23%（86/375）为单灶性（UF），10%（38/375）为混合性局灶性-弥漫性（FD），8%（31/375）为弥漫性（D）闪烁扫描模式。

结果

93.9%（352/375）的自主性组织被完全消除，2.1%（8/375）部分消除，1.6%（6/375）消除不充分。在131碘治疗后2至10个月，观察到2.4%（9/375）的患者甲亢复发。8例甲亢复发患者伴有或随后出现先前未升高的促甲状腺素受体抗体（TRAb）水平升高，1例患者TRAb升高至临界上限范围，提示格雷夫斯病。131碘治疗后格雷夫斯病的患病率在治疗前高锝酸盐锝99m闪烁扫描模式上存在统计学显著差异：单灶性（0/86）或多灶性（0/220）患者中患病率为0%，然而局灶性-弥漫性患者中患病率为18%（7/38），弥漫性闪烁扫描模式患者中患病率为7%（2/31）。在366例无甲亢复发的患者中，2例（MF）治疗前和治疗后TRAb水平升高，3例（D）在131碘治疗后首次出现TRAb水平升高。