Graves病患者^(131)I治疗前后甲状腺激素动态变化的临床意义

The Significance of Dynamic States in Thyroid Homones in Patients with Graves' Disease before and after131 I Treatment

目的研究 ^(131)I治疗 GD前后甲状腺激素动态变化规律及甲状腺功能变化的关系。方法：对 33例 GD患者一次性给予 ^(131)I 13 5mci～ 7 0mic(平均 4 8mic)治疗。于治疗后 1、 3、 6、 12mo定期复诊，化验 TT3、 TT4、 FT3、 FT4、 TSH，并与治疗前及 25例对照者比较研究，以 TT3、 TT4、 FT3、 FT4， TSH的动态变化作为观察 131Ⅰ治疗前后甲状腺功能变化的指标。结果： TT3、 TT4、 FT3、 FT4变化：治疗前及治疗后 1mo最高，二者相差无显著性 (P<0 05)，治疗后 3mo显著性低于治疗前 (P<0 05)，但较对照组为高 (P<0 05)，治疗后 6mo及 12mo较治疗前显著减低 (P<0 01)但与寻照组相差无显著性 (P>0 05)。② TSH变化：治疗前及治疗后 1月最低，二者相差无显著性 (P>0 05)。治疗后 3mo显著高于治疗前及对照组 (P<0 05)，治疗后 6mo及 12mo明显高于治疗前及对照组 (P<0 01)。③治疗后 12mo治愈率为 90 91％，总有效率为 100％，治疗后 3月及 6mo共发生甲减 5例，占 15 15％。结论： 131Ⅰ治疗 GD安全有效，副作用小。动态检测甲状腺激素变化可以反映甲状腺功能恢复情况及有无并发症发生。

Objective: To study the relation between the changes in the functions of the patients' thyroid and some possible rules of change in the thyroid hormones' dynamic state before and after the patients with Graves' disease (GD) received treatment with131I.Methods:the 33 patients were treated with a single dose of 3.5 mci to 7.0 mci(4.8 mci in average). Return visits were made regularly at on month ,a quarter,half a year,and a year's intervals. In the visits their TT3,TT4,FT3,FTs4 and TSH were tested and contrasted against those before treatment and those of the contrast group,and their dynamic states were set as an index for observing their functional changes before and after treatment.Results:① changes in TT3,TT4,FT3,FTs4: A month before and after treatment witnessed the highest valuse of change, and there was no significant difference before and after treatment(P>0.05),three months later the significance of changes was lower than that before treatment(P<0.05), but higher than the contrast group(P>0.05), half a year and a year later the changes is significantly lower than that before treatment(P<0.05), yet there in no significance as compared with the contrast group(P>0.05).② changes in TSH: A month before and after treatment witnessed the lowerest values of change, and there was no significant difference before and after treatment (P>0.05),three months later the significance of changes was higher than that before treatment and that of the contrast group(P<0.05),and half a year and a year later the significance is definitely higher than that before treatment and that of the contrast group(P<0.05),③ Twelve months later the rate of cur is as high as 90.91％ , and with a 100％ effectiveness rate, while three months and six months later, there occurred 5 cases of hypothyroidism, which is 15.15％ of the observed group.Conclusion: The therapy with131I is safe and effective to Graves' patients with little side effects, as observation the dynamic states of the homone in thyroid can well reflect the recuperation and complications with this treatment.