儿童及青少年甲亢^(131)I治疗的临床探讨

Clinical study of children or adolescent hyperthyroidism after iodine-131 therapy

目的:探讨儿童或青少年甲亢131I治疗的适应证、临床疗效及副作用等问题。方法:对58例8～20岁的儿童或青少年甲亢131I治疗后随访5年以上的病例资料进行回顾性分析,以评价131I治疗儿童或青少年甲亢的适应证、临床疗效、副作用等问题。结果:58例儿童或青少年甲亢患者采用131I治疗的原因分析,30例因服用内科抗甲状腺药物(Antithyroid drug,ATD)治疗效果不佳,8例不能坚持ATD治疗,12例因ATD治疗后出现白细胞减少、皮肤过敏、肝功能受损等副作用,8例因甲状腺肿大明显(Ⅲ度肿大)而直接采用131I治疗。58例患者131I治疗后完全治愈45例(治愈率77.6%),好转12例(20.7%),无效1例(1.7%),总有效率为98.3%(57/58),发生永久性甲减10例(17.2%)。所有患者治疗后均未出现明显近期副作用,随访5年以上无发生甲状腺癌、白血病及其他癌症的病例。对其中12例已生育患者调查,后代均健康,无致畸现象发生。结论:131I治疗儿童或青少年甲亢疗效肯定、相对安全,无明显近期和远期副作用,对ATD治疗效果不佳、不能坚持ATD治疗、ATD治疗后出现明显副作用或甲状腺肿大特别明显的青少年甲亢患者,131I治疗是值得推荐的方法。

Objective： To probe into the indication, clinical curative effect and side effect of children or adolescent hyper thyroidism with 131I therapy. Methods： 58 cases （age range from 8-20 years） treated with 131I for Graves＇ disease over 5 years follow-up were retrospective studied, and the indication, clinical curative effect and side effect of the treatment with 131I were discussed. Results： The reasons to select 131I therapy of all patients were analyzed, 30 of them had no good therapeu tic effect with antithyroid drugs （ATD）, 8 of them could＇t adhere to the treatment with ATD, 12 of them presented side effect （including skin allergy, decreasing of leukocyte and impairing of liver function） after ATD treatment, and 8 cases had obviously goitrous （degree III） and used the treatment of 131I. Over 5 years follow-up, 45 cases （77.6%） were once cured among the 58 patients, improvement in 12 cases （20.7%）, hypothyroidism in 10 cases （17.2%）, and ineffective in 1 ease （1.7%）. There were no early side effect and thyroid cancer, leukemia or other malignancies in all cases after treatment, neither were teratogenesis in progeny of 12 legitimate. Conclusion： 131I is found to be an effective and safe treatment of Graves＇ disease in children or adolescents, for patients who have no ideal therapeutic effect, can＇t adhere to treatment, present side effect with ATD therapy, and have obviously goitrous, it can be the preferred mode of the therapy.