Sabri O, Schulz G, Zimny M, Schreckenberger M, Zimny D, Wagenknecht G, Kaiser H J, Dohmen B M, Bares R, Büll U
Klinik für Nuklearmedizin der RWTH Aachen, Deutschland.
Nuklearmedizin. 1998 May;37(3):83-9.
Of this study was to determine whether success of radioiodine therapy (RIT) in Graves' disease depends on thyroid volume, function, thyroideal receptor antibodies (TRAK), thyreostasis, therapeutic dosage, 131I uptake, or effective half-life.
78 patients received an average of 626 +/- 251 MBq of iodine-131 orally for thyroid ablation. 60 were assessed for successful therapy 3 months after RIT.
In patients showing hyperthyreosis or a TRAK value > 11 U/l at the beginning of RIT, a significantly lower therapeutic dosage and effective iodine half-life were found than in non-hyperthyreotic patients or patients with TRAK < or = 11 U/l. Patients with a thyroid volume < or = 25 ml showed a significantly lower 131I uptake, but a significantly higher relative uptake (131I uptake/ volume) than patients with a thyroid volume > 25 ml. All failures were treated thyreostatically during RIT and showed a significantly lower therapeutic iodine dosage and relative uptake, as well as a significantly higher thyroid volume than patients with a successful therapy. RIT caused a thyroid volume reduction of 44%, with therapy failures showing a significantly lower volume reduction. Patients who received a therapeutic dosage of < or = 250 Gy showed significantly worse results than did those who had received > 250 Gy. Only one case of therapy failure received a dosage > 250 Gy, while 50% of failures received dosages > 200 Gy but < 250 Gy. Multivariate analyses (MANOVA, factor analyses) showed thyreostasis as the decisive negative factor for a successful course of therapy.
Since most treatment failures occurred in patients under thyreostatic medication we recommend raising the target dosage to 250 Gy for these cases.
本研究旨在确定格雷夫斯病放射性碘治疗（RIT）的成功是否取决于甲状腺体积、功能、甲状腺受体抗体（TRAK）、甲状腺功能稳定状态、治疗剂量、131I摄取率或有效半衰期。
78例患者口服平均626±251MBq的碘-131进行甲状腺消融。60例患者在RIT治疗3个月后接受成功治疗评估。
在RIT开始时表现为甲状腺功能亢进或TRAK值>11U/L的患者中，发现治疗剂量和有效碘半衰期明显低于非甲状腺功能亢进患者或TRAK≤11U/L的患者。甲状腺体积≤25ml的患者131I摄取率明显较低，但相对摄取率（131I摄取率/体积）明显高于甲状腺体积>25ml的患者。所有治疗失败的患者在RIT期间均接受甲状腺功能稳定治疗，与治疗成功的患者相比，其治疗碘剂量和相对摄取率明显较低，甲状腺体积明显较大。RIT使甲状腺体积减少44%，治疗失败的患者体积减少明显更低。接受治疗剂量≤250Gy的患者结果明显比接受>250Gy的患者差。只有1例治疗失败的患者接受的剂量>250Gy，而50%的治疗失败患者接受的剂量>200Gy但<250Gy。多变量分析（多因素方差分析、因子分析）显示甲状腺功能稳定状态是治疗成功过程中的决定性负面因素。
由于大多数治疗失败发生在接受甲状腺功能稳定药物治疗的患者中，我们建议对于这些病例将目标剂量提高到250Gy。
