^131I治疗青少年儿童甲状腺功能亢进症

The treatment of hyperthyroidism in adolescents and children with ^131I

甲状腺功能亢进症（甲亢）是青少年和儿童常见的内分泌疾病，影响青少年和儿童各个系统的发育成熟，特别是骨骼系统和神经系统，其自然缓解率低，需要采取积极、安全、有效的治疗方法。抗甲状腺药物（ATD）、甲状腺次全切除术和^131I治疗是治疗青少年和儿童甲亢的三种方法。ATD常为内科医师的首选，但其治疗缓解率较低，服药时间长，停药后复发率高，并且其不良反应在青少年和儿童比成年人多见；甲状腺切除术的成功率和并发症与手术医师的技术水平有极大的关系，且术后颈部会留有瘢痕；^131I用于甲亢治疗已经有60余年，数千名青少年和儿童患者接受过此治疗，到目前为止未发现治疗后甲状腺癌及其他恶性肿瘤的发病率、患者的生育率、流产率和后代畸形率等与普通人群有明显差别，其治疗缓解率高，不良反应少，可以作为对ATD效果不佳、有服药禁忌证或服药后出现不良反应的青少年和儿童甲亢治疗的首选。^131I治疗甲亢后最常见的转归是甲减，可给予甲状腺激素替代治疗，但因青少年和儿童对甲状腺激素的依赖性大，对射线的敏感性强，宜采用小剂量^131I以达到理想控制。

Hyperthyroidism in adolescents and children is a common endocrinium disorder, which disturbs the development of diverse body systems, especially of skeletal and central nervous systems. The patients with hyperthyroidism have a lower long-term, spontaneous remission of the disease. The majority of adolescents and children patients with hyperthyroidism have to receive an effective, safe therapy. Currently, there are three methods for treating hyperthyroidism. They include in antithyroid drugs （ATD）, surgery and radioactive iodine （^131I） therapy. ATD always is the first line way to these patients with hyperthyroidism for endocrinologist yet. But the remission rate of hyperthyroidism for ATD is lower, the remission of hyperthyroidism also need spend longer time, and side effects of ATD are more common in adolescents and children than in adult. The success ratio and complications of surgery are mainly depended on the technic of surgeons, ^131I has been used as the treatment of hyperthyroidism for more than six decades. So far, there are still no enough evidences to show that the incidence of thyroid cancer and other malignant diseases, the patients＇ fertility rate, rate of abortion and malformation of descendants in hyperthyroidism patients following ^131I were marked difference with that in other people. The remission rate of hyperthyroidism following ^131I was higher and its side effects were less. ^131I therapy can be the first choice to adolescents and children with hyperthyroidism who are no suitable to ATD therapy. Hypothyroidism is most often one outcome of pediatric patients with hyperthyroidism after ^131I therapy. Hence, the patients with hypothyroidism have to receive the replacement treatment of thyroxine. Since the development of adolescents and children are more dependent on thyroxine and adolescents and children are more sensitive to the radioactive rays than adults, it is more suitable to get ideal control with a relative lower dosage of ^131I to adolescents and children with hyperthyroidism.