Graves病^(131)I治疗后甲状腺重量和功能的变化

Changes of thyroid weight and function after ^(131)I therapy for Graves′ disease

目的 观察Graves病患者131I治疗后甲状腺重量和功能变化 ,探讨最佳131I治疗剂量。方法 10 3例Graves病患者131I治疗前后均进行核素显像和B超测量甲状腺重量及甲状腺功能测定。结果 甲状腺重量的变化 :90例患者治疗后 6～ 7个月复查甲状腺重量 ,核素显像由 (5 1.5±2 3 .4)g至 (2 7.0± 13 .9) g ;超声测量法由 (47.2± 2 3.7) g至 (2 0 .6± 8.4)g。131I治疗后甲状腺重量下降量与治疗前重量呈正相关 (超声测量法 ) (r =0 .49,P <0 .0 1)。临床随访 (31.0± 13 .4)个月 ,治愈 73例 (70 .9% ) ,甲状腺功能正常 5 8例 (5 6 .3 % ) ;晚发甲减 15例 (其中亚临床甲减 6例 ) (14.6 % ) ;未愈30例 (2 9.1% )。结论 Graves病患者131I治疗后能显著减少甲状腺重量 。

Objective To observe changes of thyroid weight and function after 131 I therapy in Graves′ diseaseandtooptimiseradiationdose for treatment of Graves′ disease. Methods From 1995 to 1998, 103 patients with Graves′ disease were selected (nodule was not found by palpation and nuclear scintigraphy). The mean age was 43 (range 27～64) years. Thyroid weight was estimated by nuclear scintigraph (SC) and ultrasound (US). Thyroid function was determined by serum TT 3, TT 4, FT 3, FT 4 and TSH levels. Results The oral dose of 131 I was (188.7±144.3)MBq. If the dose was larger than 555.0 MBq, it was divided into two doses orally. The thyroid weight of the patients before 131 I therapy was (54.8±32.3)g (SC) and (49.3±27.7)g (US), there was no significant difference between SC and US. The thyroid weight in 90 patients was significantly decreased from (51.5±23.4)g to (27.0±13.9)g by SC, and from (47.2±23.7)g to (20.6±8.4)g by US 6～7 months after 131 I treatment. Reduction of thyroid weight was correlated with that before therapy (determined by US) (r=0.49, P<0.01). Followed up in (31.0±13.4)months, 58 patient appeared euthyroid, 15 patients became latent hypothyroidism (14.6%), 30 patients were still hyperthyroidism and received a second dose of 131 I in 6～12 months after the first 131 I therapy. Conclusion The thyroid weight of the patients with Graves′ disease is significantly reduced (about 50%) after the first dose of 131 I. The reduction of thyroid weight is correlated with the initial thyroid weight.