^(131)I合并小剂量碳酸锂治疗Graves病的临床探讨

Clinical investigation of ^(131)I therapy combined with low-dose lithium carbonate for Graves disease

目的探讨放射性核素131I合并小剂量碳酸锂治疗Graves病的临床疗效。方法治疗前口服碳酸锂250mg,1次/d,共5周。于第三周末给予Graves患者一次性口服131I,剂量为3.15MBq(80uCi)/g甲状腺组织的60%～70%。随访时间6～24个月(平均14个月),按随访结果分成痊愈、好转、无效三类。结果单次131I合并小剂量碳酸锂治疗Graves患者,痊愈率(106例)、好转率(28例)、无效率(8例)分别为74.6%、19.7%、5.6%,对23例Graves患者进行重复治疗(未再次服用碳酸锂)后痊愈为10例、好转8例、无效5例,分别占43.5%、34.8%、21.7%。其中,首次131I治疗后半年随访为甲状腺功能减退症(简称甲减)者25例,占17.6%。结论131I合并小剂量碳酸锂治疗Graves病疗效显著,同时可以减少131I的使用剂量,降低了药物的毒性反应。

Objective To investigate the clinical curative effects of ^131I therapy combined with lowdose lithium carbonate for Graves disease. Methods Patients with Graves disease took lithium carbonate （250mg, once per day） orally for 5 weeks. Then they were treated with ^131I （doses = 3.15 MBq（80 uCi）/g, based on 60%-70% of the thyroid size）. We kept track from 6 to 24 months （averaging 14 months） and classified the results into three： cured, improved or no effect. Results After a single cycle of ^131I therapy combined with low-dose lithium carbonate, 106 patients with Groves disease were cured, 28 were improved and 8 saw no effects, respectively 74.6%, 19.7% and 5.6% among the 142 patients. We then treated 23 of them with another ^131I therapy （without lithium carbonate）. 10 of such were cured （43.5%）, 8 were improved （34.8%） and the other 5 saw no effects. Among all patients, hypothyroidism was observed from 25 （17.6%）, 6 months after the first ^131I therapy. Conclusions Notable curative results were observed from ^131I therapy combined with low-dose lithium carbonate for Graves disease. Moreover, the dosage of ^131I was therefore decreased, which also lowered the toxicity response.