131I治疗少儿型甲亢的疗效观察

Observation of Curative Effect Using 131I to Treat Hyperthyroidism in Children

目的 研究和随访接受131I治疗的少儿型甲亢患者的临床资料,探讨少儿型患者131I治疗的可行性.方法 观察病例共158例,按年龄分为儿童（60例）和少年组（98例）.患者在接受131I治疗前均停用ATD 一个月,禁碘3周,并作以下各项检查：TT3、TT4、FT3、FT4、TSH、甲状腺吸碘率测定、血常规、肝功能、心电图等,根据B超甲状腺检查或甲状腺核素显像法结合触诊确定甲状腺重量.131I治疗剂量（MBq）=预计给予的每克甲状腺组织实际摄取131I的剂量（MBq）×甲状腺重量（g）/ 甲状腺最高摄131I率（%）.预计给予的每克甲状腺组织实际摄取剂量通常为0.74～1.85MBq,并参考年龄、病程、病情酌情增减.治疗后每3个月左右测定患者甲状腺激素水平以及TSH水平,随访时间1～8年.结果 儿童组：痊愈55.0%（33/60）,好转20.0%（12/60）,总有效率为75.0%（45/60）,无效11.7%（7/60）,甲减13.3%（8/60）;少年组：痊愈58.2%（57/98）,好转18.4%（18/98）,总有效率为76.5%（75/98）,无效9.2%（9/98）,甲减14.3%（14/98）.两组病例治疗效果、总有效率、甲减的发生率均无显著性差异,说明疗效不受患者年龄的影响.疗效出现的时间经随访发现,131I 治疗后3个月即取得满意疗效,FT3、FT4均降至正常.所有患者生长发育良好,甲减病例131I的用药剂量与同组非甲减病例所用剂量无明显差异.结论 131I治疗是少儿型甲亢患者的有效治疗方法,但不作为首选治疗方法;对于ATD 治疗效果不佳或不能坚持正规ATD 治疗的少儿型甲亢患者,及时迅速进行131I治疗有利于生长发育和提高生活质量.甲减发生率与年龄和剂量无关,主要受个体敏感性因素的影响.

Objective To study and follow-up visit of the clinical information of hyperthyroidism in children who receive 131I treatment and explore the feasibility of 131I treatment to them. Methods To observe 158 cases,including 47 male cases, 111 female cases.The ages of the patients are between 8 - 17 and average age is 14.9.Course ofdisease is at least 1 month and 8 years to the most.The 158 cases are divided into children group and youth group according to their ages.The patients stop taking ATD for 1 month before 131I treatment and are forbidden using iodine for 3 weeks.They also take the following inspection：TT3,TT4,FT3,FT4,TSH,mensurat ion of the efficiency of thyroid gland absorbing iodine,blood routine,liver function,cardiogram etc.The weight of.thyroid gland will be confirmed according to B ultrasonic inspection or radionuclide thyroid imaging,as well as palpate.Dosage of 131I =estimated actual ingested dosage of 131I by each gram of thyroid gland tissue （MBq）＊weight of thyroid gland（g）/highest efficiency of thyroid gland ingesting 131 I （%）.Estimated actual ingested dosage of 131I by each gram thyroid gland tissue is usually 0.74 - 1.85MBq and shall be increased or decreased referring to age,course of disease and state of illness.The patients＇thyroid gland hormone level and TSH level shall be mensurated about every 3 months after treatment.Time of follow-up visit is at least 1 year and 8 years to the most.The curative effect is based on the countercheck result after half year of treatment.The curative effect includes healed, improved,and invalidated hypothyroidism. Results Children group：33 cases healed（55.0%）,12 cases improved（20.0%）,8 cases of hypothyroidism（13.3%）.Total effective rate is 75.0%.Youth group：57 cases healed（58.2%）, 18 eases improved（18.4%）, 14 cases of hypothyroidism（14.3 %）.Total effective rate is 76.5%. There is no remarkable difference between the 2 groups in term of curative effect,total effective rate and odds of hypothyroidism.The time of getting satisfactory effect,according to the follow-up visit,is 3 months after treatment. FT3,FT4 both drop to normal level.All the patients grow well.There is no distinct difference of the dosage of 131I between hypothyroidism case and none- hypothyroidism case in the same group,which indicates that the emergence of hypothyroidism is irrelevant with age and dosage,only mainly affected by individual＇s sensibility. Conclusion 131I treatment is an effective way to cure hyperthyroidism in children,but it is not a prior curative method.For those hyperthyroidism in children who have not good curative effect to ATD treatment or could not persist on normal ATD treatment,the timely 131I treatment will help them grow and improve their living qualities.