Oexle C, Reinhardt M, Moser E
Abteilung Nuklearmedizin, Klinikum der Albert-Ludwigs Universität, Freiburg i. Br., Deutschland.
Nuklearmedizin. 1998;37(6):192-6.
The presented study examines prospectively the efficiency of a dose concept for radioiodine therapy (RIT) adapted to the pretherapeutic 99mTc-pertechnetate thyroid uptake under suppression (TcTUs) in patients with multifocal (MFA) and disseminated (DISA) autonomy. This concept considers the total thyroid as target volume and uses target doses from 150 Gy to 300 Gy according to the TcTUs, which is as a measure for the "autonomous volume" of the thyroid.
The data of 75 patients (54 female, 21 male; age 71 +/- 9 years) with MFA of DISA were evaluated. RIT was performed on patients presenting with normal values for free triiodothyronine and thyroxine and endogenous suppression of the basal thyrotropin (TSH). The following target dose were used for a TcTUs of 1.5-2.5% 150 Gy, for 2.51-3.5% 200 Gy, for 3.51-4.5% 250 Gy, and for > 4.5% 300 Gy. The radiation dose to be administered was calculated using a modified Marinelli formula. The therapy was considered as successful. When the basal TSH was above 0.5 mU/l and autonomous areas had disappeared in thyroid scintigraphy or the TcTU was below 1.5%, respectively. The average follow-up period was 8 +/- 4 months.
The success rates average to 92%. Only in one case a subsequent subclinical hypothyroidism and in a further case an immunogenic hyperthyroidism occurred.
The presented data indicate that even patients with a marked autonomy (TcTUs > 3.5%) can thus expected to be cured by of a one time therapy with success rate of over 90% using the presented dose concept. The rate of early hypothyroidism can altogether be estimated as very low.
本研究前瞻性地考察了一种放射性碘治疗（RIT）剂量方案的有效性，该方案适用于多灶性（MFA）和弥漫性（DISA）自主性甲状腺疾病患者，根据治疗前99m锝高锝酸盐甲状腺摄取受抑制情况（TcTUs）进行调整。该方案将整个甲状腺视为靶体积，并根据TcTUs使用150 Gy至300 Gy的靶剂量，TcTUs作为甲状腺“自主性体积”的一种度量。
对75例患有MFA或DISA的患者（54例女性，21例男性；年龄71±9岁）的数据进行评估。对游离三碘甲状腺原氨酸和甲状腺素值正常且基础促甲状腺激素（TSH）内源性受抑制的患者进行RIT治疗。对于TcTUs为1.5 - 2.5%的患者，使用150 Gy的靶剂量；对于2.51 - 3.5%的患者，使用200 Gy；对于3.51 - 4.5%的患者，使用250 Gy；对于>4.5%的患者，使用300 Gy。使用改良的马林内利公式计算要给予的辐射剂量。若基础TSH高于0.5 mU/l且甲状腺闪烁显像中自主性区域消失或TcTUs低于1.5%，则认为治疗成功。平均随访期为8±4个月。
成功率平均为92%。仅1例出现随后的亚临床甲状腺功能减退，另1例出现免疫性甲状腺功能亢进。
所呈现的数据表明，即使是自主性明显（TcTUs>3.5%）的患者，使用所提出的剂量方案进行一次性治疗，预期治愈率超过90%。早期甲状腺功能减退的发生率总体估计非常低。
