甲状腺肿大在甲亢患者中的发生率及^(131)I治疗疗效分析

The Frequency of Goitre in Patients with Hyperthyroidism and Response of ^(131)I Treatment

[目的]观察甲状腺肿大在甲状腺功能亢进症(甲亢)发病人群中的发生率及131I治疗效果。[方法]30名健康志愿者进行超声甲状腺体积的测量,建立甲状腺大小正常参考值。485例临床确诊的甲亢患者在抗甲状腺药物(ATD)或者131I治疗前测量甲状腺体积,依据结果分成肿大和正常两组。其中169例患者采用了131I治疗,观察比较正常组和肿大组的疗效,并与ATD治疗病例相比较。[结果]30名健康志愿者甲状腺体积B超正常参考值为(16.9±6.6)ml。未经治疗的甲亢患者中,甲状腺肿大340例,占70.1%;145例甲状腺体积正常,占29.9%。131I治疗169例,分为甲状腺体积正常组47例(27.8%)和肿大组122例(72.2%)。随访后正常组与肿大组比较,甲功正常分别为23例(48.9%)和71例(58.2%)(χ2=3.29,P>0.05),晚发甲减分别为18例(38.3%)和24例(19.7%)(χ2=6.30,P<0.05),未愈分别为6例(12.8%)和27例(22.1%)(χ2=1.89,P>0.05)。131I治疗169例与ATD治疗225例比较,甲功正常分别为94例(55.6%)和142例(63.1%)(χ2=2.25,P>0.05),晚发甲减分别为42例(24.8%)和2例(0.9%)(χ2=55.90,P<0.01),未愈分别为33例(19.5%)和81例(36.0%)(χ2=12.70,P<0.01)。[结论]甲亢发病人群中甲状腺肿大的发生率为70.1%,甲状腺体积与功能不相关。131I治疗后随访甲功正常和未愈两组无差异,而晚发甲减肿大组明显低于正常组,甲减是131I治疗甲亢的一种自然转归。ATD治疗相对于131I治疗,具有较高的未愈率和较低的甲减发生率。

[ Purpose ] To investigate the frequency of goitre in patients with hyperthyroidism and the response of 13Ⅰ treatment. [Methods]Thyroid volume was measured by ultrasonography in 30 cases of healthy volunteers, in order to establish reference value of normal thyroid volume. Thy- roid volume was measured prior to antithyroid drugs （ATD） or 13Ⅰ therapy in 485 cases of hyper- thyroidism,and divided into two groups based on goitre or normal volumn. Of the 485 cases, 169 cases were treated with 13Ⅰ. The response was compared in normal and goitre groups,as well as in ATD treated patients. [ Results ] Thyroid volume of normal volunteers was （16.9± 6.6）ml. Among untreated hyperthyroidism patients,340 cases were goitre （70.1%）, 145 cases were normal thyroid volume（29.9%）. 169 cases with 13Ⅰ treatment were divided into 47 cases of normal thyroid volume group （27.8%） and 122 cases of goitre group（72.2%）. Euthyroid occurred in 23 cases （48.9%） in normal thyroid volume group and 71 cases （58.2%） in goitre group （X2= 3.29,P〉0.05）,while the late hypothyroidism, 18 cases and 24 cases （X2=6.30,P〈0.05） ;unre- sponse,6 cases and 27 cases 0（2=1.89,P〉0.05）,respectively. Euthyroid occurred in 94 cases （55.6%） of 13Ⅰ treatment group and 142 cases（63.1%） of ATD treatment group （X2=2.25 ,P〉0.05）, while the late hypothyroidism,42 cases and 2 cases（X2=55.90, P〈0.01）;unresponse, 33 cases and 81 cases （X2=12.70,P〈0.01）,respeetively. [Conclusions] The frequency of goitre in hyperthy- roidism patients is 70.1%. The incidence of euthyroid and hyperthyroid have no difference be- tween normal thyroid volume group and goitre group,while the late hypothyroidism in goitre group is lower than that in normal group. Hypothyroidism is an inevitable natural outcome of 13Ⅰ therapy for hyperthyroidism. Compared with 13Ⅰ treatment, ATD treatment has higher proportion of unresponse and lower proportion of hypothyroidism.