甲状腺动脉栓塞术治疗Graves病

The clinical experience of interventional embolization in treatment of Graves disease

目的 探讨栓塞甲状腺动脉治疗Graves病的方法并观察疗效。方法 选择 10例临床确诊的Graves病患者 ,经内科治疗病情反复或药物致粒细胞减少或外科手术后复发 ,使用PVA微球共栓塞 2 5支甲状腺动脉。结果 10例栓塞后随访 5～ 8个月 ,血清游离三碘甲状腺原氨酸 (FT3)中位值自2 0 .90 pmol/L(13.36～ 5 0 .92pmol/L)降至 7.81pmol/L(3.6 7～ 35 .3pmol/L)、游离甲状腺素 (FT4 )中位值自 5 7.9pmol/L(30 .96～ 5 7.9pmol/L以上 )降至 2 8.13pmol/L(2 0 .44～ 39.6 0 pmol/L) ,(P <0 .0 0 5 )。 7例临床症状缓解 ,并停用抗甲状腺药物。 3例FT3、FT4 偏高 ,但与术前相比明显下降 ,用药较术前减少 ,无严重并发症。结论 介入治疗Graves病是一种安全、有效的治疗方法 。

Objective To evaluate the method and result of thyroid artery embolization as a new therapy for Graves disease.Methods Ten patients with Graves disease underwent selective thyroid artery embolization. Totally 25 thyroid arteries were embolized with PVA microspheres. The indications to this therapy were as following: Graves disease with recurrent clinical symptoms or with leucopenia during the period of treating with administration of antithyroid drugs or recurrence after subtotal thyroidectomy. Results Serum level of thyroid hormones dropped significantly [median FT 3 from 20.90pmol/L(13.36～50.92pmol/L) to 7.81pmol/L(3.67～35.3pmol/L), median FT 4 from 57.9pmol/L(30.96～57.9pmol/L) to 28.13pmol/L(20.44～39.60pmol/L), ( P <0.005)] and then followed up for 5～8 months. The symptoms of hyperthyroidism were controlled in 7 patients and the remaining 3 cases were treated with lower dosage of antithyroid drug therapy. None serious complications were found. Conclusions Thyroid artery embolization represents a promising new method for treating Graves disease with safety and good clinical results. Further investigation would be required to assess its long term effect.