无机碘口服在Graves病中的研究进展

Research progress of oral inorganic iodine for Graves’disease

碘是人体内重要微量元素之一,是甲状腺激素合成的基本原料。口服的无机碘分为膳食碘和治疗碘,与甲状腺免疫和代谢密切相关。Graves病(Graves’disease,GD)又称弥漫性毒性甲状腺肿,表现为甲状腺功能亢进及高碘代谢状态,临床上常建议Graves病患者限碘甚至忌碘饮食。最新的研究进展显示膳食碘对于抗甲状腺药物治疗的干扰性可能被高估,放射性碘治疗之前严格限制无机碘、择期手术之前强制使用无机碘都不是必需的。此外,无机碘可以作为Graves病的治疗药物,在具有轻型甲亢、低甲状腺自身抗体浓度、较小的甲状腺体积、高碘饮食等特点的患者中探索性应用无机碘显示出不错的成效。当传统的抗甲状腺药物出现副作用而患者仍倾向保守治疗时,无机碘或许能作为替代选择。无机碘因低致畸性、低血液毒性和低骨髓毒性,可以在特殊人群如妊娠期、哺乳期和肿瘤放化疗期的患者中发挥独特作用。本文对膳食碘和治疗碘的研究进程、生物学功能、适用人群及特定情形下的应用进行汇总,旨在为Graves病的诊治提供参考,丰富Graves病患者的诊疗策略以及进一步提高Graves病患者的生存质量。

Iodine is one of the important trace elements in the human body and the basic raw material for thyroid hormone synthesis.Oral inorganic iodine is divided into dietary and therapeutic iodine and is closely related to thyroid immunity and metabolism.Graves’disease(GD),also known as diffuse toxic goitre,is characterised by hyperthyroidism and high iodine metabolism.Clinically,we often advise patients with GD to limit or avoid iodine diet.The latest research progress shows that the interference of dietary iodine in antithyroid drug therapy may be overestimated,and strict restriction of inorganic iodine before radioactive iodine therapy and the use of inorganic iodine compulsorily before elective surgery are unnecessary.In addition,inorganic iodine can be used as a therapeutic drug for GD,and its exploratory application in patients with mild hyperthyroidism,low thyroid autoantibody concentration,small thyroid volume and high iodine diet has shown good results.When traditional antithyroid drugs have side effects,and patients still prefer conservative treatment,inorganic iodine may be an alternative.Given its low teratogenicity,blood toxicity and bone marrow toxicity,inorganic iodine can play a unique role in special groups,such as patients in pregnancy,lactation and tumour radiotherapy and chemotherapy.This paper summarises the research progress,biological function,applicable population and application under specific circumstances of dietary and therapeutic iodine to provide reference for the diagnosis and treatment of GD,enrich the diagnosis and treatment strategies of GD patients and further improve the quality of life of GD patients.