High dose 131I therapy for the treatment of hyperthyroidism caused by Graves' disease
High dose 131I therapy for the treatment of hyperthyroidism caused by Graves' disease
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DOI：
10.1210/jc.87.3.1073
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发表时间：
2002-03-01
影响因子：
5.8
通讯作者：
Larsen, PR
中科院分区：
文献类型：
--
作者：
Alexander, EK;Larsen, PR
放射性碘（I-131）已成为甲状腺功能亢进患者最广泛使用的治疗方法。是由美国的格雷夫斯病引起的然而，不同的I-131给药方案仍然存在显著的差异，很明显，大多数患者在治疗后最终发展为甲状腺功能减退。为了避免持续的甲状腺功能亢进，我们采用了基于24小时甲状腺I-123摄取测量的高剂量I-131治疗方案，旨在在I-123给药24小时后向甲状腺输送8 mCi （296 MBq）。为了评估该方案的疗效，我们回顾了我们7年的临床经验。1993年至1999年间，我们用I-131治疗了261例由Graves病引起的甲状腺功能亢进患者（219例女性，42例男性）[平均剂量，14.6 mCi (540 MEBq)]。治疗前，207例（79%）接受过抗甲状腺药物治疗（109丙硫脲嘧啶和98甲巯咪唑）。我们在治疗后1年确定了他们的甲状腺状态与年龄、抗甲状腺药物预处理、预处理甲状腺大小以及治疗后24小时甲状腺中保留的I-131剂量的关系。在261例患者中，225例（86%）患者在治疗1年后甲状腺功能正常或甲状腺功能减退，36例（14%）患者持续存在甲状腺功能亢进，需要第二次治疗。持续性甲状腺功能亢进患者年龄较轻（P < 0.01），甲状腺体积较大（P < 0.01），甲状腺I-123预处理摄取值较高（P < 0.01），血清T-4浓度较高（P < 0.01），且在给予I-131前服用抗甲状腺药物的可能性较大（P = 0.01）。其中5例出现短暂性甲状腺功能减退，随后出现甲状腺毒症。24 h时I-131的保留剂量与持续甲状腺功能亢进之间呈渐近的反比关系，尽管递送量高达400 muCi (14.8 MBq)/g，但失败率仍为5-10%。I-131剂量可在给药后24小时在甲状腺中积累8 mCi (296 MBq)，是大多数Graves甲亢患者的有效治疗方法。甲状腺较大、血清T-4浓度较高、24小时甲状腺I-123摄取值较高的年轻患者以及抗甲状腺药物治疗超过4个月的患者治疗失败的风险较高。这类患者建议使用更高剂量的I-131。
Radioactive iodine (I-131) has become the most widely used therapy for patients with hyperthyroidism. caused by Graves' disease in the United States. There remains, however, significant variability among I-131 dosing regimens, and it is clear that most patients ultimately develop hypothyroidism after therapy. To avoid persistent hyperthyroidism, we adopted a high dose I-131 therapy protocol based on measurement of 24-h thyroid I-123 uptake designed to deliver 8 mCi (296 MBq) to the thyroid gland 24 h after I-123 administration. To evaluate the efficacy of this protocol, we reviewed our clinical experience over a 7-yr period.We treated 261 patients (219 women and 42 men) with hyperthyroidism caused by Graves' disease with I-131 [mean dose, 14.6 mCi (540 MEBq)] between 1993 and 1999. Before treatment, 207 (79%) had received an antithyroid drug (109 propylthiouracil and 98 methimazole). We determined their thyroid status 1 yr after treatment in relation to age, pretreatment with an antithyroid drug, pretreatment thyroid size, and dose of I-131 retained in the thyroid 24 h after treatment.Among the 261 patients, 225 (86%) were euthyroid or hypothyroid 1 yr after treatment, and 36 patients (14%) had persistent hyperthyroidism and required a second treatment. The patients who had persistent hyperthyroidism were younger (P < 0.01), had larger thyroid glands (P < 0.01), higher pretreatment thyroid I-123 uptake values (P < 0.01), and higher serum T-4 concentrations (P < 0.01) and were more likely to have taken antithyroid medication before administration of I-131 (P = 0.01). Five of these patients developed transient hypothyroidism, followed by thyrotoxicosis. There was an asymptotic, inverse relationship between the retained dose of I-131 at 24 h and persistent hyperthyroidism, revealing a 5-10% failure rate despite delivery of up to 400 muCi (14.8 MBq)/g.A dose of I-131 that results in accumulation of 8 mCi (296 MBq) in the thyroid gland 24 h after administration is an effective treatment for the majority of patients with Graves' hyperthyroidism. Young patients with larger thyroid glands, higher serum T-4 concentrations, and higher 24-h thyroid I-123 uptake values, and those pretreated with antithyroid medication for greater than 4 months are at higher risk for treatment failure. A higher dose of I-131 may be advisable in such patients.