唐山地区Graves甲亢患者¹³¹I治疗后发生永久性甲减的相关因素研究

A Study on the Related Factors of Permanent Hypothyroidism after ¹³¹I Therapy in Graves’ Hyperthyroidism Patients in Tangshan Area

摘要: 目的：分析在唐山高碘饮食地区，Graves病患者在接受放射性碘(¹³¹I)治疗后可能发生永久性甲状腺功能减退症的相关因素研究。方法：回顾性收集了2021年1月~2025年5月，于华北理工大学附属医院核医学科因Graves病行放射性碘(¹³¹I)治疗后的患者临床资料。根据首次治疗后复查时间超过一年的患者的疗效，筛选出永久性甲减组和非永久性甲减组，整理患者的相关临床数据通过统计学分析方法进行系统整理与处理。结果：本研究通过对患者的一般情况(性别、年龄、病程、是否吸烟)、是否服用ATD治疗、甲状腺情况、甲状腺激素水平(T3, T4, FT3, FT4, TSH)、治疗前自身抗体滴度(TgAb, TPOAb, TRAb)、最高摄碘率、单位给药量、以及尿碘含量，分别对其进行了单因素分析，分析结果提示病程、甲状腺质地、TSH、FT3、FT4、尿碘含量对放射性碘(¹³¹I)治疗Graves病出现永久性甲减密切相关。故将其这些有意义的相关影响因素的综合作用进行多维度、多因素的Logistic回归分析，最后得出其中病程长短、甲状腺质地、TSH、FT3、FT4、对¹³¹I治疗后Graves患者发生永久性甲减无明显显著相关性(P > 0.05)。尿碘是唯一对¹³¹I治疗后Graves患者发生永久性甲减具有统计学意义的因素(P < 0.05)，尿碘每降低1 μg/L，预测增加1.3%的概率发生永久性甲减。尿碘水平越高，发生永久性甲减的概率越低。本研究后续对Graves甲亢患者¹³¹I治疗后发生永久性甲减对发生的正相关因素(尿碘)进行ROC曲线分析，获得相应曲线下面积、最佳截断值、灵敏性、特异性、约登指数，结果显示，尿碘AUC为0.650 (SE = 0.038, P = 0.003)，具有中等预测效能；其最佳截断值为131.000，对应灵敏度0.891、特异度0.717。提示尿碘对¹³¹I治疗后永久性甲减具有统计学意义的预测价值，且预测效能为中等水平(AUC为0.5~0.7)。经综合比较，尿碘最佳截断值约为131.000 μg/L，此时约登指数最大，灵敏度为0.891，特异度为0.717。结论：本研究结果显示，尿碘水平对Graves病患者放射性碘(¹³¹I)治疗后永久性甲减的发生具有一定预测价值，且尿碘为保护性因素，即尿碘水平越高，永久性甲减发生风险越低。唐山地区为高碘饮食习惯区域，尿碘水平可较好反映患者近期碘摄入状况，该地区Graves病患者经放射性碘(¹³¹I)治疗后，永久性甲减发生率低于低碘饮食地区。本研究可为临床上预测放射性碘治疗后永久性甲减的发生提供理论依据，同时为个体化治疗方案的优化提供更为可靠的参考。

Abstract: Objective: To analyze the related factors of permanent hypothyroidism in patients with Graves’ disease after radioactive iodine (¹³¹I) treatment in the high-iodine diet area of Tangshan. Methods: The clinical data of patients with Graves’ disease who underwent ¹³¹I treatment in the Department of Nuclear Medicine of the Affiliated Hospital of North China University of Science and Technology from January 2021 to May 2025 were retrospectively collected. According to the efficacy of the first treatment, patients with a follow-up time of more than one year after the first treatment were divided into the permanent hypothyroidism group and the non-permanent hypothyroidism group. The relevant clinical data of the patients were systematically organized and processed through statistical analysis methods. Results: This study conducted a univariate analysis on various factors including patients’ general conditions (gender, age, disease duration, smoking status), whether they were treated with ATD, thyroid condition, thyroid hormone levels (T3, T4, FT3, FT4, TSH), pre-treatment autoantibody titers (TgAb, TPOAb, TRAb), maximum iodine uptake rate, unit dosage, and urinary iodine content. The analysis results indicated that disease duration, thyroid texture, TSH, FT3, FT4, and urinary iodine content were closely related to the occurrence of permanent hypothyroidism in patients with Graves’ disease treated with radioactive iodine (¹³¹I). Therefore, a multidimensional and multifactorial logistic regression analysis was performed on the combined effects of these significant influencing factors. The analysis ultimately revealed that disease duration, thyroid texture, TSH, FT3, and FT4 showed no significant correlation (P > 0.05) with the development of permanent hypothyroidism in Graves’ patients after ¹³¹I treatment. Urinary iodine was the only factor with statistical significance (P < 0.05) for the development of permanent hypothyroidism in Graves’ patients after ¹³¹I treatment. For every 1 μg/L decrease in urinary iodine, the probability of developing permanent hypothyroidism increased by 1.3%. The higher the urinary iodine level, the lower the probability of developing permanent hypothyroidism. In this study, a ROC curve analysis was conducted on the positive correlation factors (urinary iodine) of permanent hypothyroidism after ¹³¹I treatment in Graves’ hyperthyroidism patients. The area under the curve (AUC), optimal cut-off value, sensitivity, specificity, and Youden index were obtained. The results showed that the AUC of urinary iodine was 0.650 (SE = 0.038, P = 0.003), indicating a moderate predictive power. The optimal cut-off value was 131.000, with a corresponding sensitivity of 0.891 and specificity of 0.717. This suggests that urinary iodine has a statistically significant predictive value for permanent hypothyroidism after ¹³¹I treatment, and the predictive power is at a moderate level (AUC of 0.5 to 0.7). After comprehensive comparison, the optimal cut-off value of urinary iodine was approximately 131.000 μg/L, at which the Youden index was the largest, with a sensitivity of 0.891 and specificity of 0.717. Conclusion: The results of this study show that the level of urinary iodine has a certain predictive value for the occurrence of permanent hypothyroidism after radioactive iodine (¹³¹I) treatment in patients with Graves’ disease, and urinary iodine is a protective factor. That is, the higher the level of urinary iodine, the lower the risk of permanent hypothyroidism. Tangshan area is a region with a high iodine diet habit, and the level of urinary iodine can better reflect the recent iodine intake status of patients. After radioactive iodine (¹³¹I) treatment, the incidence of permanent hypothyroidism in patients with Graves’ disease in this area is lower than that in areas with a low iodine diet. This study can provide a theoretical basis for predicting the occurrence of permanent hypothyroidism after radioactive iodine treatment in clinical practice, and at the same time provide a more reliable reference for the optimization of individualized treatment plans.