高峰前移的甲亢患者¹³¹I核素治疗可行性的探讨

The Feasibility Study of ¹³¹I Radionuclide Therapy in Hyperthyroidism Patients with Peak Forward

摘要: 目的：为了探讨¹³¹I核素治疗Graves病对甲亢高峰前移患者是否具有疗效，以及方法学的研究。方法：根据Graves病诊断标准，排除其它相关影响因素，对64例高峰前移的甲亢患者一般经ATD控制病情，在甲硫咪唑停药一周，丙基硫氧嘧啶停药至少2周后，完善相关检查，行¹³¹I核素治疗，考虑到高峰前移，有效半衰期缩短，分别根据病程、大小、质地等影响因素通过比一般患者加大剂量50%~100%进行治疗。分别于治疗后1、3、6个月进行TSH、FT3、FT4。Graves病疗效判定标准依次为治愈、好转、无效、甲减。结果：6个月¹³¹I核素治疗后复查64例Graves病患者一次性治愈36例(56.25%)，好转23例(35.94%)，无效3例(4.69%)，甲减2例(3.13%)，仍然高峰前移3例(4.69%)；二次治愈17例(26.56%)，好转8例(12.5%)，无效0例(0%)，甲减1例(1.56％)；三次治愈5例(7.81%)，好转3例(4.69%)，甲减0例(0%)；四次治愈3例(4.69%)，好转0例(0%)，甲减0例(0%)。结论：甲亢高峰前移的患者，按照一般甲亢核素治疗方法，由于有效半衰期较短，疗效较差，但实际上通过加大剂量，多次治疗，还是可以取得较好的治疗效果。对于那些内科ATD治疗后致肝功能损害或白细胞下降，但又不愿意手术治疗的高峰前移患者来说，大剂量碘放射性同位素治疗仍不失为一个较好的治疗手段。

Abstract: Objective: To investigate the efficacy of ¹³¹I nuclide therapy in hyperthyroidism with peak forward and its clinical significance. Methods: According to the diagnostic criteria of Graves’ disease, 64 patients with hyperthyroidism who had peak forward were controlled by ATD. After one week of discontinuation of methimazole, or at least two weeks after discontinuation of propylthiouracil, and finishing relevant examination, ¹³¹I radionuclide therapy can be conducted. Taking into account the peak forward, effective shortened half-life and respectively, according to course, size, texture and other factors, radionuclide treatment may increase the dose of 50% - 100% in patients. TSH, FT3 and FT4 were performed at 1, 3 and 6 months after treatment with ¹³¹I radionuclide in 64 patients with Graves’ disease. Graves’ disease efficacy criteria were cured, improved, ineffective, hypothyroidism. Results: In the first time, 36 patients were cured (56.25%), 23 patients were improved (35.94%), 3 patients were ineffective (4.69%) and 2 patients were hypothyroidism (3.13%); in the second time, 17 patients were cured (26.56%), 8 patients were improved (12.50%), no patient was ineffective (0%) and 2 patients were hypothyroidism (1.56%); in the third time, 5 patients were cured (7.81%), 3 patients were improved (4.69%), and no patient was hypothyroidism (0%); in the fourth time, 3 patients were cured (4.69%), no patient was improved (0%), and no patient was hypothyroidism (0%). Conclusion: In hyperthyroidism with peak forward, according to the general treatment of hyperthyroidism radionuclide therapy, due to the short effective half-life, efficacy is poor, but in fact by increasing the dose, taking multiple treatment, the method can still achieve better therapeutic effect. High-dose iodine radioisotope therapy is still a good treatment for patients with peak forward who are reluctant to undergo surgical treatment, after ATD therapy with liver damage or leukopenia.