131Ⅰ治疗Graves病合并白细胞减少的疗效分析

Graves病(GD)目前治疗方法主要有抗甲状腺药物(ATD)、手术及131Ⅰ治疗.ATD治疗的主要不良反应是白细胞减少,甚至出现粒细胞缺乏.少数患者在GD确诊时就有白细胞减少,不宜行ATD治疗,有些患者由于合并心脏病又不适宜手术治疗.本科于2003年4月-2007年6月应用131Ⅰ治疗GD合并白细胞减少患者48例,取得较好的疗效,现报道如下.     

131Ⅰ治疗Graves病合并白细胞减少的疗效分析

Graves病(GD)目前治疗方法主要有抗甲状腺药物(ATD)、手术及131Ⅰ治疗.ATD治疗的主要不良反应是白细胞减少,甚至出现粒细胞缺乏.少数患者在GD确诊时就有白细胞减少,不宜行ATD治疗,有些患者由于合并心脏病又不适宜手术治疗.本科于2003年4月-2007年6月应用131Ⅰ治疗GD合并白细胞减少患者48例,取得较好的疗效,现报道如下.     

131Ⅰ治疗Graves病合并白细胞减少的疗效分析

Graves病(GD)目前治疗方法主要有抗甲状腺药物(ATD)、手术及131Ⅰ治疗.ATD治疗的主要不良反应是白细胞减少,甚至出现粒细胞缺乏.少数患者在GD确诊时就有白细胞减少,不宜行ATD治疗,有些患者由于合并心脏病又不适宜手术治疗.本科于2003年4月-2007年6月应用131Ⅰ治疗GD合并白细胞减少患者48例,取得较好的疗效,现报道如下.     

131Ⅰ治疗Graves病合并白细胞减少的疗效分析

Graves病(GD)目前治疗方法主要有抗甲状腺药物(ATD)、手术及131Ⅰ治疗.ATD治疗的主要不良反应是白细胞减少,甚至出现粒细胞缺乏.少数患者在GD确诊时就有白细胞减少,不宜行ATD治疗,有些患者由于合并心脏病又不适宜手术治疗.本科于2003年4月-2007年6月应用131Ⅰ治疗GD合并白细胞减少患者48例,取得较好的疗效,现报道如下.     

131Ⅰ治疗Graves病合并白细胞减少的疗效分析

Graves病(GD)目前治疗方法主要有抗甲状腺药物(ATD)、手术及131Ⅰ治疗.ATD治疗的主要不良反应是白细胞减少,甚至出现粒细胞缺乏.少数患者在GD确诊时就有白细胞减少,不宜行ATD治疗,有些患者由于合并心脏病又不适宜手术治疗.本科于2003年4月-2007年6月应用131Ⅰ治疗GD合并白细胞减少患者48例,取得较好的疗效,现报道如下.     

131Ⅰ治疗Graves病合并白细胞减少的疗效分析

Graves病(GD)目前治疗方法主要有抗甲状腺药物(ATD)、手术及131Ⅰ治疗.ATD治疗的主要不良反应是白细胞减少,甚至出现粒细胞缺乏.少数患者在GD确诊时就有白细胞减少,不宜行ATD治疗,有些患者由于合并心脏病又不适宜手术治疗.本科于2003年4月-2007年6月应用131Ⅰ治疗GD合并白细胞减少患者48例,取得较好的疗效,现报道如下.     

131Ⅰ治疗Graves病合并白细胞减少的疗效分析

Graves病(GD)目前治疗方法主要有抗甲状腺药物(ATD)、手术及131Ⅰ治疗.ATD治疗的主要不良反应是白细胞减少,甚至出现粒细胞缺乏.少数患者在GD确诊时就有白细胞减少,不宜行ATD治疗,有些患者由于合并心脏病又不适宜手术治疗.本科于2003年4月-2007年6月应用131Ⅰ治疗GD合并白细胞减少患者48例,取得较好的疗效,现报道如下.     

131Ⅰ治疗Graves病合并白细胞减少的疗效分析

Graves病(GD)目前治疗方法主要有抗甲状腺药物(ATD)、手术及131Ⅰ治疗.ATD治疗的主要不良反应是白细胞减少,甚至出现粒细胞缺乏.少数患者在GD确诊时就有白细胞减少,不宜行ATD治疗,有些患者由于合并心脏病又不适宜手术治疗.本科于2003年4月-2007年6月应用131Ⅰ治疗GD合并白细胞减少患者48例,取得较好的疗效,现报道如下.     

131Ⅰ治疗Graves病合并白细胞减少的疗效分析

Graves病(GD)目前治疗方法主要有抗甲状腺药物(ATD)、手术及131Ⅰ治疗.ATD治疗的主要不良反应是白细胞减少,甚至出现粒细胞缺乏.少数患者在GD确诊时就有白细胞减少,不宜行ATD治疗,有些患者由于合并心脏病又不适宜手术治疗.本科于2003年4月-2007年6月应用131Ⅰ治疗GD合并白细胞减少患者48例,取得较好的疗效,现报道如下.     

131Ⅰ治疗Graves病合并白细胞减少的疗效分析

Graves病(GD)目前治疗方法主要有抗甲状腺药物(ATD)、手术及131Ⅰ治疗.ATD治疗的主要不良反应是白细胞减少,甚至出现粒细胞缺乏.少数患者在GD确诊时就有白细胞减少,不宜行ATD治疗,有些患者由于合并心脏病又不适宜手术治疗.本科于2003年4月-2007年6月应用131Ⅰ治疗GD合并白细胞减少患者48例,取得较好的疗效,现报道如下.     

不同方法治疗Graves病的回顾性对比研究

 目的 通过对Graves病患者服用抗甲状腺药物(ATD)、放射碘(RAI)或手术治疗后甲状腺功能改变的长期回顾性队列研究,了解上述方法 的疗效及并发症,为Graves病治疗方案的选择提供依据.方法 病例选自在我院门诊及住院的既往Graves病88例,根据治疗方法 的不同将研究对象分为ATD组、RAI组和甲状腺手术组.收集治疗后的甲状腺功能转归情况,进行回顾性的对比研究.结果　(1)Graves病患者治疗后甲减的发生率在RAI组(38.9%)和手术组(30.0%)均明显高于ATD治疗组(6.3%,均P＜0.05);(2)3种方法 中,ATD组的甲亢未治愈比例最高为21.9%;(3)3组间甲功恢复正常的比率无明显差异(P＞0.05);(4)TPOAb或TgAb阳性者在RAI或手术治疗后更易于发生永久性甲减.结论 ATD、131I和手术治疗Graves病的有效率相仿,但手术或RAI也是导致甲减的危险因素,甲状腺抗体阳性者更易发生治疗后甲减.     

131I与抗甲状腺药物治疗甲状腺功能亢进症的综合评价

目的对131I和抗甲状腺药物(ATD)治疗甲状腺功能亢进症(甲亢)进行综合评价,定量评价两种方法的优劣.方法甲亢治愈为0分,好转为1分,无效为2分;治疗后出现突眼或突眼加重、甲亢性心脏病(甲心病)、肝功能受损、血象降低者为2分;出现暂时性甲状腺功能减退症(甲低)者为1分,永久性甲低者为2分;甲亢治愈后复发者为2分;将各项得分和总分进行比较.结果 131I治疗组230例总得分319分,平均得分1.39,ATD治疗组250例总得分569分,平均得分2.20,两者差异有显著性(t=6.982,P<0.001);131I疗效优于ATD;发生突眼方面两者无差别,但ATD对突眼的改善优于131I;131I治疗后甲低的发生率高于ATD (χ2=55.65,P=0.001);甲亢治愈后复发明显低于ATD治疗,出现甲亢性心脏病、血象、肝功能受损等方面低于ATD (χ2=39.50,P<0.001).结论 131I治疗甲亢疗效优于ATD治疗,尽管有甲低、突眼等发生,但甲亢复发及出现其他系统损伤较ATD治疗少.     

Graves病药物治疗后TSH增高伴摄99Tcm增强患者131I治疗

目的：探讨甲状腺功能亢进症（甲亢）抗甲状腺药物（ATD）治疗后促甲状腺激素（TSH）增高伴摄99Tcm增强患者131I治疗的可能性和必要性。方法：27例经临床ATD治疗后TSH增高伴摄99Tcm增强患者分3组，治疗组15例，及时进行131I治疗；随访观察组12例，仅作随访观察，均随访年，结果：治疗组15例中9例血清游离三碘甲状腺原氨酸（FT3），游离甲状腺激素（FT4），TSH水平及甲状腺显像均恢复正常。有2例5－6个月复查甲亢复发，第2次治疗后恢复正常，1例为早发甲低，甲低发生率为6．7％，随访观察组12例在1－4个月内均复发为典型甲亢，复发率100％，结论：甲亢ATD治疗后TSH增高伴摄99Tcm增强患者宜及时进行131I治疗。     

Cost-utility analysis of antithyroid drug therapy versus 131I therapy for Graves' disease

There is no comparative cost-utility study between 131I therapy and antithyroid drugs (ATD) therapy for Graves' disease, though 131I therapy has higher remission rate and less side effects. The objective of the study was to analyze the cost-utility of ATD therapy versus 131I therapy by calculating life-long medical costs and utility, based on the responses of Graves' disease patients to questionnaires. To determine the expected cost and expected utility, a decision tree analysis was designed on the basis of the 2 competing strategies of ATD therapy versus 131I therapy. A simulation of 1000 female patients weighing > or =50 kg who assumed to experience the onset of Graves' disease at the age of 30, to first complain of thyrotoxic symptoms and moderate goiter 2-3 mo. previously, and to undergo a 40-years-long cohort study, was created for each strategy using a decision tree and baselines of other relevant variables. The variables and costs were based on the literature and hospital bills. The maximum and minimum values of utility were defined as 1.0 and 0.0, respectively. Future costs and utilities were discounted 5%. The medical costs and utilities were 85,739-88,650 yen/patient/40 years and 16.47-16.56/patient/40 years, respectively, for the ATD therapy strategy, and 81,842 yen/patient/40 years and 17.41/patient/40 years, respectively, for the 131I therapy strategy. These results quantitatively demonstrated that the 131I therapy strategy was superior to the ATD therapy strategy in terms of both cost and utility. 131I therapy should be used more widely in Japan because of its greater utility and lower cost.     

^131I治疗青少年儿童甲状腺功能亢进症

甲状腺功能亢进症（甲亢）是青少年和儿童常见的内分泌疾病,影响青少年和儿童各个系统的发育成熟,特别是骨骼系统和神经系统,其自然缓解率低,需要采取积极、安全、有效的治疗方法。抗甲状腺药物（ATD）、甲状腺次全切除术和^131I治疗是治疗青少年和儿童甲亢的三种方法。ATD常为内科医师的首选,但其治疗缓解率较低,服药时间长,停药后复发率高,并且其不良反应在青少年和儿童比成年人多见;甲状腺切除术的成功率和并发症与手术医师的技术水平有极大的关系,且术后颈部会留有瘢痕;^131I用于甲亢治疗已经有60余年,数千名青少年和儿童患者接受过此治疗,到目前为止未发现治疗后甲状腺癌及其他恶性肿瘤的发病率、患者的生育率、流产率和后代畸形率等与普通人群有明显差别,其治疗缓解率高,不良反应少,可以作为对ATD效果不佳、有服药禁忌证或服药后出现不良反应的青少年和儿童甲亢治疗的首选。^131I治疗甲亢后最常见的转归是甲减,可给予甲状腺激素替代治疗,但因青少年和儿童对甲状腺激素的依赖性大,对射线的敏感性强,宜采用小剂量^131I以达到理想控制。     

The role of nuclear medicine in the management of Graves' disease.

131I therapy is safe and effective for most Graves' disease patients. It is being used more frequently in previously restricted populations such as children, adolescents, and women of childbearing age. It affords prompt, consistent relief of hyperthyroidism, but permanent hypothyroidism ensues in almost all patients. This complication is readily diagnosed with modern in vitro assays and inexpensive, life-long replacement therapy renders the patient asymptomatic and able to resume a normal lifestyle. Recent changes in NRC requirements have further liberalized the use of 131I for Graves' disease in the USA, permitting more patients to be treated with effective outpatient therapy. The controversial role of 131I in exacerbation of GO has been further clarified and preventive measures are available.     

131I联合糖皮质激素治疗Graves眼病疗效的Meta分析

目的 对131I+糖皮质激素（GC）治疗Graves眼病（GO）进展的有效性和安全性进行系统评价。 方法 检索PubMed、Embase、Cochrane Library和中国知网、万方数据知识服务平台中关于131I+GC治疗GO的相关研究,检索时间从建库至2021年7月20日。根据纳入和排除标准筛选文献、提取数据。应用Stata 15.0软件进行Meta分析,比较131I+GC治疗与单纯131I治疗对不同时期 Graves 甲状腺功能亢进症（GH）合并GO患者的疗效,并分析静脉注射与口服GC 2种用药方式对GO治疗及其并发症发生情况的影响。采用χ2检验的P值和 I2对文献进行异质性评价,GO病情进展情况用相对危险度（RR）表示,采用Egger法和剪补法对纳入文献的发表偏倚和敏感性进行分析,采用Z检验分析2种用药方式的治疗效能。 结果 最终纳入22篇文献,其中15篇文献为随机对照试验类,7篇文献为队列研究类。131I+GC治疗较131I治疗对GH合并GO患者的疗效更佳,差异有统计学意义（Z=3.18,RR=0.37,95%CI:0.20~0.68,P=0.004）;标准剂量GC（0.3~0.5 mg/kg）较低剂量GC（0.2~0.3 mg/kg）能更好地预防GO的进展。不同的用药方式对预防GO进展的影响不大。 结论 131I+GC治疗对预防GH合并GO患者的病情进展是有效的,特别是活动期的GO患者;标准剂量GC较低剂量GC能更好地控制GO的进展,但同时产生更多的并发症;静脉注射与口服GC 2种用药方式对131I治疗后的GO患者疗效相当。     

Early prediction of hypothyroidism following 131I treatment for Graves' disease

The aim of this study was twofold. Firstly to assess the post treatment predictive value of various biochemical and immunological tests for early hypothyroidism after 131I therapy for Graves' disease, and secondly to determine whether or not pretreatment with Carbimazole protects against post treatment hypothyroidism. The early changes observed in serum T3, T4, TSH, thyroid microsomal and thyroglobulin antibody levels were found to be of no predictive value. A sharp rise, around 2 months, in TRAb levels following 131I therapy indicated that hypothyroidism was likely to occur. This rise was thought to reflect a greater degree of thyroid damage. Lower levels of thyroglobulin in patients who had become hypothyroid by 12 months after treatment would support this view. Five weeks Carbimazole pretreatment in this relatively small group of patients did not appear to protect against hypothyroidism.     

Discriminant factors affecting early outcome of radioiodine treatment for Graves' disease

Pretreatment clinical, biochemical, iodine-131 (131I) scan and tracer-kinetic parameters were studied in 827 Chinese patients with Graves' disease treated with radioactive iodine. One year after 131I therapy, 56.7% were euthyroid, 33.9% were still thyrotoxic and 9.4% were hypothyroid. Discriminant analysis of all pretreatment variables identified thyroid mass, presenting free thyroxine index and 4 h 131I uptake as the three variables most helpful in discriminating the early outcome group of 131I therapy. The findings suggest that patients with large goitres and severe disease may require higher doses of 131I for treatment of Graves' disease.     

Long-term follow-up study of I-131 therapy for Graves' disease--index associated with late-onset hypothyroidism

We have studied the follow-up of thyroid function in the patients with late-onset hypothyroidism and euthyroidism after I-131 therapy of hyperthyroidism. Thirty three patients who did not need the thyroid treatment until ten years after I-131 therapy were classified as euthyroid group. And eleven patients who needed the thyroid supplement of thyroid hormone for late-onset hypothyroidism were classified as hypothyroid group. Patients in both groups who required only a single dose of I-131 for successful treatment of hyperthyroidism had similar age, gland size, 24 hour I-131 uptake, pretreatment serum T3 uptake level and T4 concentration, and I-131 treatment dose. Subclinical hypothyroidism occurred in 28.6% of euthyroid group and 66.7% of hypothyroid group four months after I-131 therapy. The levels of T3 were recovered to higher than normal range at 6 months in euthyroid group, while the levels of T3 were kept within the normal range in the seventy percent of hypothyroid group. Patients who were still lower in the level of T3 uptake than normal range at 6 months had a higher incidence of late-onset hypothyroidism. Our observation showed no significant difference in the course of follow-up studies after I-131 therapy between the patients with late-onset hypothyroidism and euthyroidism.