^(131)Ⅰ治疗甲亢后早发甲低的临床分析

Clinical analysis of early-onset hypothyroidism aftr ^(131)Ⅰ in treating hyperthyroidism

目的:分析131I治疗甲状腺功能亢进(简称甲亢)后早发甲状腺功能减退(简称甲低)的临床特点和远期随访结果。方法:对150例131I治疗甲亢后1年内出现甲低的患者进行临床分析,并对其中120例进行门诊随访1～5年,平均3年。结果:(1)暂发性甲低组40例,占33.33%,其中1年内甲状腺功能恢复正常者28例,再发甲亢者12例。远期随访显示,甲状腺功能正常者有5例在1～4年后出现甲低;甲亢者中有6例在3个月～2年甲状腺功能恢复正常,4例在3个月～2年后出现永久性甲低。(2)永久性甲低组80例,占66.67%,其中95%(76例)在131I治疗后1～6个月出现甲低;有临床症状者占85%(68例);有用小剂量131I(≤185MBq)者占83.75%(67例)。结论:早发甲低中多为永久性甲低,后者中服用小剂量131I治疗者多;暂发性甲低的转归不能用于预测以后的甲状腺功能。

Objective：To analyse the clinical features and long-term follow-up results of early-onset hypothyroidism ater ^131I in treating hyperthyroidism.Methods：150 patients with hyperthyoidism who developed hypothyroidism within 12 months ater ^131I therapy were analysed clinically by clinical symptoms and plasma T3,T4 and thyroid-stimulating hormone （TSH）.120 of them were divided into two groups according to the occurrence of hypothyroidism after one yeay of treatment.Results：（1）There were 40 patients with transient hypothyroidism in the group 1,70%（28/40） of them returned to euthyroidism and 30%（12/40） of them developed hyperthyroidism again within 1 year after ^131I treatment.The long-term folowup shooed that 5 patients with euthyroidism and 4 patientswith hyperthyroidism developed permanent hypothyroidism and 4 patients with hyperthyroidism developed permanent hypothyroidism after 3 months-3 years as well as 6 patients with hyperthyroidism returned to euthyroidism after 3 months～2 year.（2）There were 80 patients with permanent hypothyroidism in the group 2,83.75%（67/80） of them were treated with low dwse ^131I,and 85%（68/80） of cases in this group were found with clinical hypothyroid symptom.Conclusion：Classically,early-onset hypothyroidism was permanent hypothyroidism.The incidence of permanent hypothyroidism in the patients treated with low dose ^131I treatment did not predict the future thyroid function.