Dunkelmann S, Rudolph F, Prillwitz A, Groth P, Schümichen C
Klinik und Poliklinik für Nuklearmedizin, Universität Rostock, Deutschland.
Nuklearmedizin. 1998 Jan;37(1):23-9.
To examine all cases with Graves' disease after radioiodine therapy of autonomously functioning thyroid tissue (AFFT) in order to find the cause.
We retrospectively studied 1428 pts who were treated between 11/93 and 3/97 with radioiodine for AFTT and who underwent at least one control examination.
15 (1.1%) of all pts developed Graves' disease 8.4 (4-13) months after radioiodine therapy. There was no direct suggestion of Graves' disease (TRAK negative, no endocrine ophthalmopathy) in any pt at the time of radioiodine therapy. More detailed analysis of anamnestic data, however, revealed evidence that immunothyropathy predated radioiodine therapy in 11 of the 15 pts. Paradoxical effects of radioiodine therapy manifested as an increase in immunothyropathy in 14 pts, a deterioration in metabolism in 11 pts and a first occurrence of endocrine ophthalmopathy in 5 pts.
Exacerbation of preexisting, functional primarily insignificant immunothyropathia is held responsible in most cases for the observed paradoxical effects after radioiodine therapy, resulting in radiation-induced manifest Graves' disease; however no therapeutical consequences are recommended.
检查所有自主性功能性甲状腺组织（AFFT）放射性碘治疗后发生格雷夫斯病的病例，以找出病因。
我们回顾性研究了1428例在1993年11月至1997年3月期间接受放射性碘治疗AFTT且至少接受过一次对照检查的患者。
所有患者中有15例（1.1%）在放射性碘治疗后8.4（4 - 13）个月发生格雷夫斯病。在放射性碘治疗时，任何患者均无格雷夫斯病的直接迹象（TRAK阴性，无内分泌性眼病）。然而，对既往病史数据的更详细分析显示，15例患者中有11例在放射性碘治疗前就有免疫性甲状腺病的证据。放射性碘治疗的矛盾效应表现为14例患者免疫性甲状腺病加重，11例患者代谢恶化，5例患者首次出现内分泌性眼病。
在大多数情况下，放射性碘治疗后观察到的矛盾效应是由于先前存在的、功能上主要无显著意义的免疫性甲状腺病加重所致，导致放射性诱导的显性格雷夫斯病；然而，不建议采取治疗措施。
