甲状腺动脉栓塞治疗甲状腺机能亢进

Thyroid artery embolization for hyperthyroidism

目的 探讨栓塞甲状腺动脉治疗甲状腺机能亢进的方法并观察疗效。方法 使用微球栓塞剂共栓塞 2 2例甲状腺机能亢进病人的 5 2支甲状腺动脉。选择的适应证为拟行外科手术术前药物准备失败者和手术出血风险大或拟行131I治疗的巨大甲状腺者。结果 2 1例病人栓塞后 1个月内血清三碘甲状腺氨酸中位值自 8 8nmol/L(4 3～ 43 0nmol/L)降至 4 0nmol/L(1 1～ 9 2nmol/L) ,甲状腺素中位值自 2 0 6 4nmol/L(77 4～ 748 2nmol/L)降至 144 5nmol/L(2 5 8～ 2 79 9nmol/L) ,(P <0 0 1)。临床症状缓解或消失。随访超过 6个月的 12例在停用或间断使用抗甲状腺药物的情况下可有效控制症状。 2例抗甲状腺抗体阳性者短期复发后再次栓塞。未见发生甲状腺功能低下或甲状旁腺功能异常。 1例并发严重对比剂过敏反应。结论 作为手术和131I治疗的替代疗法或外科术前准备方法 ,甲状腺动脉栓塞是甲状腺机能亢进综合治疗中可供选择的有效手段。其长期疗效有待进一步观察。

Objective To evaluate the method and result of thyroid artery embolization as a new therapy for hyperthyroidism. Methods Twenty two patients with hyperthyroidism underwent selective thyroid artery embolization. Totally 52 thyroid arteries were embolized with microspheres. The indications to this therapy were following: hyperthyroid patients having indications to surgical and 131 I therapy, clinically being difficult to complete the preparation for subtotal thyroidectomy and having high risk for surgical process because of their huge thyroid gland. Results Serum level of thyroid hormones dropped significantly [median T3 from 8 8 nmol/L(4 3～ 43 0 nmol/L) to 4 0 nmol/L(1 1～9 2 nmol/L), median T4 from 206 4 nmol/L(77 4～748 2 nmol/L) to 144 5 nmol/L(25 8～279 9 nmol/L), P <0 01] and symptoms of hyperthyroidism were controlled in 21 patients within 1 month after embolization. The symptoms of twelve patients followed up for more than 6 months were effectively controlled through low dose antithyroid medication. Two patients who were positive in antithyroid antibody recurred 1 month later and underwent second embolization. No hypothyroidism and hypoparathyroidism were observed after the interventional procedure. Severe allergenic reaction of ionic contrast occurred in 1 patient. Conclusion Thyroid artery embolization is an effective alternative for surgical and 131 I treatment of hyperthyroidism. A long term follow up study is still needed.