128例巨大甲状腺肿合并Graves甲亢^(131)Ⅰ治疗临床疗效分析

Analysis of 128 cases of Graves disease with large goiter treated with ^(131)Ⅰ

目的探讨131Ⅰ碘治疗巨大甲状腺肿合并Graves甲亢的效果和影响因素。方法 128例Graves甲亢患者经SPECT估重、触诊、超声等方法综合判断甲状腺质量为(122.0±36.8)g(90～228 g),男性40例,女性88例,年龄(38.6±11.0)岁。按照如下公式计算131Ⅰ剂量:131Ⅰ剂量(MBq)=甲状腺质量(g)×每克甲状腺组织131Ⅰ剂量(MBq/g)/24 h摄131Ⅰ率(%)。给予131Ⅰ剂量为(662.3±432.9)MBq(222～3 700)。随访时间(15.9±9.9)个月(3～44.7个月)。6个月后治疗效果不佳者行第二次治疗。结果一次131Ⅰ治疗后3个月,68例(53.1%)甲状腺功能恢复正常,32例(25.0%)症状有所减轻,24例(18.8%)发生甲状腺功能减退症(甲减),4例(3.0%)甲亢症状加重。102例(79.6%)肿大的甲状腺恢复正常,24例(18.8%)甲状腺质量有所缩小,2例(1.35%)甲状腺质量增加。一次131Ⅰ治疗后6个月,84例(65.6%)甲状腺功能恢复正常,22例(17.2%)症状有所减轻,20例(17.2%)发生甲状腺功能减退症(甲减),2例(1.35%)甲亢症状加重。110例(85.9%)肿大的甲状腺恢复正常,16例(12.5%)甲状腺质量有所缩小,2例(1.35%)甲状腺质量增加。24例治疗失败患者,进行第二次放射性碘治疗后6个月后,14例(58.3%)甲状腺功能恢复正常,1例(4.1%)症状有所减轻,9例(37.5%)发生甲状腺功能减退症(甲减)。16例(66.7%)肿大的甲状腺恢复正常,8例(33.3%)甲状腺质量有所缩小。结论 131Ⅰ治疗可迅速缩小巨大甲状腺肿合并Graves甲亢患者甲状腺大小,并迅速缓解其症状,是替代外科手术的有效方法。重复治疗可有效治疗甲亢,但甲减发生率明显升高。个体化的131Ⅰ使用剂量可以优化治疗效果。

Objective To analysis the effects and factors of Graves disease with large goiter treated with 131Ⅰ.Methods 128 cases including 40 male and 88 female,（38.6 ±11.0）years old,with graves disease with Large Goiter（range 90~450g）,the administered dose of 131Ⅰ was calculated using the following formula： The dose of 131Ⅰ（MBq） = thyroid weight（g）× dose of 131Ⅰ per g thyroid tissue（MBq/g）/ the absorption rate of 131Ⅰ in 24 hours.The dose of 131Ⅰ was given about 662.3±432.9（222~3 700）MBq.The second treatment was arranged when the treatment effects are not so good after 6 months,follow-up：15.9±9.9（3~44.7）months.Results 3 months after the first 131Ⅰ,thyroid function of 68 cases（53.1%） returned to normal,symptoms of 32（25.0%） cases relieved somewhat,24（18.8%） cases became hypothyroidism,4 cases（3.0%） became seriously.Thyroid weight of 102（79.6%）patients backed to normal,24（18.8%） patients reduced somewhat and 2（1.35%） patients increased.6 months after one dose of 131Ⅰ,thyroid function of 84 cases（65.6%） returned to normal,symptoms of 22 cases（17.2%） relived somewhat,20（17.2%） cases became hypothyroidism,hyperthyroidism symptoms of 2 cases（1.35%） became serious.Thyroid weight of 110 patients（85.9%） became normal,16 patients（12.5%） reduced somewhat and 2 patients（1.35%） increased.24 patients who failed in the first treatment received the second treatment after 6 months,thyroid function of 14 cases（58.3%） returned to normal,the symptoms of 1cases（4.1%） relieved somewhat,9 cases（37.5%）became hypothyroidism.Thyroid weight of 16 patients（66.7%） became normal,8 patients（33.3%） reduced somewhat.Conclusion Treatment with 131Ⅰ is an effective method for graves disease with Large Goiter,Repeated treatment can cure graves disease effectively,but often occur hypothyroidism.