131 I与抗甲状腺药物治疗甲状腺机能亢进症的疗效比较

目的 比较131与抗甲状腺药物（ATD）治疗甲亢的疗效.方法 将640例甲亢患者随机分为两组,分别采用131I（310例）和ATD（330例）治疗,并随访3年,观察疗效和不良反应.结果 两组的治愈率和复发率差异有统计学意义（分别为85.8%对46.7%,4.5%对39.7%,P〈0.01） 突眼转归比较差异无统计学意义（P〉0.05） 甲减发生率比较差异有统计学意义（P〈0.05）.结论 131I治疗甲亢综合疗效优于抗甲亢药物.     

131I治疗Graves甲亢专家共识（2010年）

前言 甲状腺功能亢进症（hyperthyroidism,简称甲亢）以Graves甲亢最多见,我国人群患病率约1.2%.Graves甲亢的主要治疗方法为抗甲状腺药物和131I治疗.近年来,用131I治疗Graves甲亢的患者呈增多趋势,为了进一步规范131I治疗,由多位核医学专家经多次共同商讨,数易其稿,历时2年,就有关131I治疗Graves甲亢临床相关问题形成此共识.     

131I治疗青少年及儿童格雷夫斯甲亢的临床应用随访研究

目的探讨131I治疗青少年及儿童格雷夫斯甲状腺功能亢进症（Graves甲亢）的疗效及安全性。方法89例青少年及儿童Graves甲亢患者行131I治疗。给药剂量采用公式法计算（2.59~4.44 MBq/g）,参考病程、甲状腺质量和最高摄碘率进行修正。均采用一次性空腹口服,有合并症的给予相应处理。治疗后3、6、12个月随访,以后每年随访1次。前瞻性随访观察所有患者131I治疗后的治愈率、甲减率、甲状腺良恶性肿瘤发生情况、生长发育情况及后代健康情况。结果随访至今的患者共80例,失访9例（10.1%）。131I治疗剂量范围为177.6~555.0 MBq,平均剂量为203.5 MBq。随访至12个月,131I治疗青少年及儿童Graves甲亢痊愈率82.50%,有效率98.75%,无效率1.25%;随着时间的推移甲减发生率逐渐升高,15年甲减累计发生率为35%。所有治疗患者生长发育均正常,均育有后代,后代智力及发育均正常。随访病例中无甲状腺癌、白血病等疾病发生。结论131I治疗青少年及儿童Graves甲亢安全且疗效好,不良反应少,值得临床推广应用。     

表皮生长因子受体基因表达与甲状腺功能亢进症131I治疗预后的关系

目的：探讨甲状腺功能亢进症（简称甲亢）组织中表皮生长因子受体（EGFR）基因相对表达与131I治疗预后的关系。方法入组拟行131I治疗的59例Graves甲亢患者作为实验组,平均年龄（46．46±12．95）岁,其中男性16例、女性43例;正常对照组27名,平均年龄（44．66±10．86）岁,其中男性6名、女性21名。入选者采用细针穿刺法获取甲状腺组织,应用荧光实时定量PCR法检测甲亢组织及正常甲状腺组织中EGFR基因的相对表达水平,采用t检验、方差分析及多因素分析探讨EGFR基因相对表达水平与131I治疗预后的关系。结果 EGFR基因在正常甲状腺组织及Graves甲亢组织中都有不同程度的表达;甲亢组织中EGFR的相对表达水平明显高于正常甲状腺组织（1．752±0．660 vs．0．859±0．125,t=4．328, P<0．001）。59例Graves甲亢患者经131I治疗6个月后,失访8例,其中,甲状腺功能减退症（简称甲减）占39．2%（20/51）、完全缓解占41．2%（21/51）、未愈占19．6%（10/51）,甲亢治愈率（甲减+完全缓解）为80．4%。未愈组EGFR相对表达水平显著高于治愈组（甲减+完全缓解）（8．092±3．887 vs．1．383±0．160, t=7．647,P<0．001）;未愈组（8．092±3．887）EGFR相对表达水平高于完全缓解组（1．487±0．479）和甲减组（0．968±0．180）（t=7．364和8．027, P<0．001）。Logistic回归分析显示：口服131I剂量（OR=3．456）、甲状腺质量（OR=3．853）及EGFR相对表达水平（OR=1．423）是甲亢患者131I治疗后影响治疗效果的主要因素。结论 EGFR基因的相对表达可能是预测甲亢131I治疗近期疗效及预后的指标。     

腰椎能谱CT评估Graves甲状腺功能亢进症患者131I治疗前后骨量变化的价值

目的探讨能谱CT成像对Graves甲状腺功能亢进症（简称甲亢）患者骨量评估的价值,以及131I治疗对Graves甲亢患者骨量的影响。方法收集2015年6月至10月期间在我科接受131I治疗的68例Graves甲亢患者[（男性13例、女性55例,年龄（40.6±10.7）岁],治疗前采用双能X线吸收法（DXA）测定腰椎骨密度（BMD）,能谱CT测定第3腰椎钙（水）密度,采用Pearson相关分析及线性回归探讨二者的相关性。治疗后半年随访评价疗效,复查腰椎能谱CT,采用配对t检验比较131I治疗前后骨量变化。结果DXA的测定结果显示,68例Graves甲亢患者中有21例伴有骨量减少（30.9%）,7例伴有骨质疏松（10.3%）。骨量正常组患者的第3腰椎钙（水）密度为（64.33±14.65）g/cm3,骨量减少组为（48.29±4.45）g/cm3,而骨质疏松组为（41.65±1.21）g/cm3,3组间差异有统计学意义（χ2=35.811,P < 0.001）。骨量正常组患者的第3腰椎BMD为（1.252±0.305）g/cm2,骨量减少组为（1.103±0.254）g/cm2,而骨质疏松组为（0.539±0.066）g/cm2,3组间差异有统计学意义（F=12.968,P < 0.001）。Graves甲亢患者的第3腰椎钙（水）密度与DXA测定的腰椎BMD呈高度正相关（r=0.794,假设检验水准α=0.01,t=10.605,P < 0.001）。由线性回归分析得到线性回归方程:第3腰椎钙（水）密度=24.485+34.529腰椎BMD。治疗后半年随访发现,甲亢治愈组患者131I治疗后腰椎钙（水）密度较治疗前增加,骨量改善,差异有统计学意义（t=7.86,P < 0.001）;而甲亢未愈组患者较治疗前变化不显著,差异无统计学意义（t=2.29,P=0.062）。结论能谱CT测得的腰椎钙（水）密度可用于评估Graves甲亢患者的骨量。患者经131I治疗后,骨量可随着甲亢的有效缓解而显著改善。     

131I治疗男性甲状腺亢进症周期性麻痹的临床观察:与抗甲状腺药物治疗比较

目的评价131I治疗男性甲状腺功能亢进症(甲亢)周期性麻痹的临床疗效。方法100例已确诊的男性甲亢周期性麻痹病例,分成131I治疗组(50例)和抗甲状腺药物(ATD)治疗组(50例),分别治疗后随访3年,比较两组的治疗疗效、甲状腺功能减退症(甲减)发生率、甲亢周期性麻痹的复发率及治疗的副反应(粒细胞减低、肝功能受损、药源性皮疹的发生)。结果131I治疗组治疗总有效率为80%,高于ATD治疗组(52%),二者差异有极显著性(χ2=8.73,P<0.01);131I治疗组甲亢周期性麻痹的复发率及副反应的发生均明显低于ATD治疗组(χ2=18.92,P<0.01;χ2=11.11,P<0.01);但131I治疗组的甲减发生率高于ATD治疗组(χ2=6.35,P<0.05)。结论131I治疗明显优于传统的ATD治疗,能有效控制男性甲亢周期性麻痹的反复发作,且用药安全,副反应少。     

265例精细个体化131I治疗Graves甲亢的疗效观察

目的 观察265例Graves甲亢患者精细个体化131I治疗后的疗效。 方法 回顾性分析265例应用131I治疗的Graves甲亢患者的临床资料,引入精细个体化治疗方案矫正系数,根据甲状腺大小、最高吸碘率、是否为毒性结节性或毒性弥漫性甲状腺肿等指标对矫正系数进行精细化,进而调整服131I的剂量,跟踪随访至少6个月。 结果 服药后3个月、6个月患者临床症状显著改善,TSH、血清游离三碘甲腺原氨酸、血清游离甲状腺素较治疗前明显降低,131I治疗后3个月和6个月的有效率分别为63.4%和81.5%,甲减率分别为24.9%和27.9%。 结论 精细个体化131I治疗Graves甲亢能够明显改善患者的临床症状,具有比较可靠的治疗效果。     

强的松联合^131I治疗Graves眼病临床观察

目的探讨强的松联合^131I治疗Graves眼病的临床疗效。方法87例Graves眼病患者，随机分为两组，Ⅰ组采用单纯^131I治疗；Ⅱ组采用^131I加口服强的松治疗，观察两组甲状腺功能和眼病的变化情况，同时对眼病疗效进行多因素相关分析。结果两组之间眼病的有效率有明显差异（39．5％VS68．9％），影响疗效的因素有突眼病程、甲亢未治愈或复发以及甲减。结论强的松联合^131I治疗能明显改善Graves眼病的疗效，Graves眼病的疗效与甲亢疗效以及突眼病程相关。     

强的松联合131I治疗Graves眼病临床观察

目的 探讨强的松联合131 I治疗Graves眼病的临床疗效.方法 87例Graves眼病患者,随机分为两组,I组采用单纯131 I治疗;Ⅱ组采用131 I加口服强的松治疗,观察两组甲状腺功能和眼病的变化情况,同时对眼病疗效进行多因素相关分析.结果 两组之间眼病的有效率有明显差异(39.5%VS68.9%),影响疗效的因素有突眼病程、甲亢未治愈或复发以及甲减.结论 强的松联合131 I治疗能明显改善Graves眼病的疗效,Graves眼病的疗效与甲亢疗效以及突眼病程相关.     

影响131I治疗甲状腺功能亢进疗效的因素

为探讨^131I治疗Graves′病甲亢的疗效及影响疗效的因素，将^131I治疗后1年的患者，根据随访结果分为早发甲状腺功能减低（早发甲减）组、无甲减组，各抽取46例、60例，采用SAS统计软件分析甲状腺重量、最高摄碘率、吸收剂量、甲状腺球蛋白抗体（TGA）和甲状腺微粒体抗体（TMA）与早发甲减的关系。结果发现，两组间甲状腺重量差异有显著性意义（P=0.0106），两组间的吸收剂量差异无显著性意义（P=0.4420），但最高摄碘率差异有显著性意义（t=2.1725，P=0.0321）；两组间的TGA、TMA阳性数差异无显著性意义（X^2=1.156，P=0.282）。提示早发甲减与甲状腺重量、最高摄碘率有关，与计算剂量时所给的吸收剂量、TGA和TMA是否阳性无关。     

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.     

Functional results of radioiodine therapy with a 300-GY absorbed dose in Graves' disease

The aim of this study was to assess the results of high-dose radioiodine therapy given to 43 patients with recurrent hyperthyroidism due to Graves' disease between 1986 and 1992. We chose an intrathyroidal absorbed dose of 300 Gy and determined the applied activity individually, which ranged from 240 to 3120 MBq with a median of 752 MBq. Hyperthyroidism was eliminated in 86% of cases after 3 months and in 100% after 12 months. No patient required a second radioiodine treatment. The incidence of hypothyroidism was 63% after 3 months and 93% after 18 months. Neither the pretherapeutic thyroid-stimulating immunoglobulin level nor the degree of co-existing endocrine ophthalmopathy was correlated with the time at which hypothyroidism developed. Patients with previous radioiodine therapy developed hypothyroidism earlier than patients with previous thyroid surgery. The results show that ablative radioiodine therapy with a 300-Gy absorbed dose is a very effective treatment of hyperthyroidism in Graves' disease, but it should be restricted to patients with recurrent hyperthyroidism combined with severe co-existing disorders or episodes of unfavourable reactions to antithyroid drugs. Correspondence to: U.F. Willemsen     

500例Graves病患者131I治疗后3年随访分析

目的 分析500例Graves病患者131I治疗后3年内不同时期甲状腺功能亢进症(简称甲亢)缓解率和甲状腺功能减退症(简称甲减)发生率,探讨早发甲减的发展规律以及影响131I治疗的因素.方法 500例131I治疗后3年的Graves病患者,平均年龄(39.3±12.6)岁,男女比例1∶5.收集每例患者资料,包括症状、体征、实验室检查、24h摄碘率、有效半衰期、131I剂量,治疗后3、6、9个月以及1、2、3年的甲亢缓解和甲减发生例数,并观察早发甲减者的甲状腺功能变化.用SPSS 15.0软件对数据行t检验、x2检验及多因素logistic逐步回归分析.结果 131I治疗后3个月甲亢缓解率63.8％(319/500),甲减发生率36.6％(183/500);6个月甲亢缓解率67.8％(339/500),甲减发生率43.4％(217/500);9个月甲亢缓解率70.0％(350/500),甲减发生率39.4％(197/500);1年甲亢缓解率72.6％(363/500),甲减发生率38.2％(191/500);2年甲亢缓解率79.6％(398/500),甲减发生率40.8％(204/500);3年甲亢缓解率90.8％(454/500),甲减发生率46.0％(230/500).84例(16.8％)首次治疗后疗效不佳,进行了第2次治疗.260例初次治疗后发生早发甲减,治疗后3年其中70例(26.9％)甲状腺功能恢复正常,178例(68.5％)持续甲减,12例(4.6％)甲亢复发.单次131I治疗后3年甲状腺功能正常192例,甲减200例,此392例为成功组,84例2次治疗者为失败组.对成功组与失败组数据进行单因素分析,筛选出ATD治疗(x2=16.758,P＜0.01)、TRAb(t=-2.074,P=0.039)、甲状腺摄碘率(t=-2.229,P=0.026)、有效半衰期(t=3.827,P＜0.01)、SPECT测定的甲状腺质量(t=-3.153,P =0.002)、每克甲状腺组织计划剂量(t=-2.154,P =0.032)和实际剂量(t=-1.985,P=0.048)为影响131I治疗的有关因素.将这些有关因素进行logistic逐步回归分析,得ATD治疗(Wald=14.227,P＜0.01)和有效半衰期(Wald=4.497,P=0.034)是影响131I成功治疗的因素.结论 131I治疗Graves病后3年,甲亢缓解率高,但甲减发生率也高.大部分早发甲减患者仍持续甲减,少数甲状腺功能恢复正常或甲亢复发.ATD治疗和有效半衰期是影响131I成功治疗的重要因素.     

High pre-therapy [99mTc]pertechnetate thyroid uptake, thyroid size and thyrostatic drugs: predictive factors of failure in [131I]iodide therapy in Graves' disease

BACKGROUND AND OBJECTIVE: Several factors may interfere with the success rate of radioiodine therapy (RIT) in Graves' disease. Our aim was to evaluate, retrospectively, some of these factors in the outcome of RIT. METHODS: Patient gender, age at diagnosis, ophthalmopathy, disease duration, thyroid size, drug used as clinical treatment, thionamide withdrawal period during RIT preparation, FT4, TSH and [99mTc]pertechnetate thyroid uptake prior to RIT were studied as potential interference factors for RIT success. Eighty-two Graves' disease patients were submitted to RIT after thionamide treatment failure. Prior to RIT, 67 patients were receiving methimazole and 15 propylthiouracil. Thirty-three patients received thionamides during RIT; in 49 patients the medication was withdrawn for 2-30 days. [99mTc]pertechnetate thyroid uptake was determined before RIT. Fixed doses of 370 MBq of [131I]iodide were administered to all patients. RESULTS: Eleven patients became euthyroid; 40 became hypothyroid and 31 remained hyperthyroid. There was no association between outcome and age at diagnosis, gender, ophthalmopathy, pre-RIT FT4, TSH, antithyroid antibodies or thyrostatic drug. Multiple logistic regression showed higher probability of treatment success in patients with thyroid mass <53 g (odds ratio (OR)=8.9), with pre-RIT thyroid uptake <12.5% (OR=4.1) and in patients who withdrew thionamide before RIT (OR=4.9). CONCLUSIONS: Fixed doses of 370 MBq of radioiodine seem to be practical and effective for treating Graves' disease patients with [99mTc]pertechnetate uptake <12.5% and thyroid mass <53 g. This treatment is clearly not recommended for patients with large goitre. In contrast to what could be expected, patients with a high pre-RIT thyroid uptake presented a higher rate of RIT failure.     

131I治疗对Graves眼病转归的影响

目的 分析131I治疗后Graves甲状腺功能亢进症(甲亢)疗效与Graves眼病转归的相关关系,探讨131I治疗对Graves眼病转归的影响.方法 652例Graves甲亢合并Graves眼病的患者,均按照常规程序一次性给予治疗量的131I.服用131I前测量患者眼球突出度,并详细记录眼部症状和特征.治疗结束后定期随...     

甲状腺激素治疗亚临床甲状腺功能减退症对血脂水平影响的荟萃分析

目的 使用荟萃分析方法汇总随机对照试验,评估甲状腺激素对亚临床甲状腺功能减退症（SCH）患者血脂水平的影响。 方法 以“thyroxine”、“ levothyroxin”及“levothyroxine”为关键词检索了2015年7月前包括Cochrane Library、PubMed、Medline、Google Scholar及Embase等在内的数据库中有关甲状腺激素替代治疗SCH的随机对照试验文献,所有数据均为连续型变量,采用Cochrane提供的RevMan 5.2软件进行统计学分析,依据Cochrane质量评价标准进行文献质量评估。当研究间存在异质性时（I2 > 50%）,采用随机效应模型进行荟萃分析;否则采用固定效应模型进行荟萃分析。 结果 最终纳入7篇随机对照试验文献,共319例患者。纳入的7篇文献方法学整体质量较好。共进行4组荟萃分析评价甲状腺激素对血脂的影响,4组研究之间无统计学异质性[总胆固醇（TC）:I2=42%,P=0.11;甘油三酯（TG）:I2=0,P=0.92;低密度脂蛋白胆固醇（LDL-C）:I2=34%,P=0.18;高密度脂蛋白胆固醇（HDL-C）:I2=0,P=0.96],均采用固定效应模型进行荟萃分析。荟萃分析结果显示,甲状腺激素及安慰剂对血浆中血脂水平的影响程度如下:TC（平均差:-0.18;95% CI:[-0.40,0.03];P=0.09）、TG（平均差:-0.02;95% CI:[-0.17,0.13];P=0.78）、LDL-C（平均差:-0.23;95% CI:[-0.44,-0.33];P=0.02）、HDL-C（平均差:-0.06; 95% CI:[-0.14,0.02];P=0.14）。 结论 对于SCH患者,在进行外源性甲状腺激素治疗后,血浆LDL-C水平得到改善,而血浆TC、TG、HDL-C水平未见明显变化。     

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.     

Low failure rate of fixed administered activity of 400 MBq 131I with pre-treatment with carbimazole for thyrotoxicosis: the Gateshead Protocol

BACKGROUND: Thyrotoxicosis is associated with significant morbidity, therefore adequate control of the disease is paramount. The outcome of treatment of thyrotoxicosis using radioiodine shows variable failure rates depending, amongst other things, on the administered activity of radioiodine and the use of anti-thyroid drugs. Thus, management should follow an evidence based protocol, which has a low failure rate. METHOD: We prospectively analysed the outcome of treatment using our Gateshead protocol of a fixed administered activity of radioiodine therapy (400 MBq) given to 201 patients (including 140 with Graves' disease, 48 with toxic multinodular goitre (TMNG) and 13 with toxic nodule) followed up for a median period of 12 months (range, 6-77 months). Carbimazole was discontinued in patients rendered euthyroid 16 days prior to radioiodine. No routine anti-thyroid drugs or thyroxine were given following radioiodine unless hypothyroidism or thyrotoxicosis occurred. RESULTS: Following the Gateshead protocol led to a failure rate of 6.5% (eight females with Graves' disease, four females with TMNG and one female with toxic nodule), 29% euthyroidism and 64% hypothyroidism. The rates of hypothyroidism for women and for men were: in Graves' disease 77% and 79%, in TMNG 29% and 75%, in toxic nodule 42% and 0%, respectively. CONCLUSIONS: Our observations show that withholding an antithyroid drug in excess of just over 2 weeks prior to administering a fixed administered activity of radioiodine in patients with thyrotoxicosis leads to the lowest reported failure rate, irrespective of the underlying cause. One possible mechanism for this could be the avoidance of drug induced radio-resistance.     

131I治疗甲状腺功能亢进症的影响因素

甲状腺功能亢进症131I治疗剂量的确定受甲状腺吸碘率、有效半衰期、甲状腺质量、抗甲状腺药物等众多因素影响,131I治疗的预后情况是这些因素共同作用的结果.     

Determination of the optimal minimum radioiodine dose in patients with Graves' disease: a clinical outcome study

The study was performed under the auspices of the International Atomic Energy Commission, Vienna, Austria, with the aim of determining the optimal minimum therapeutic dose of iodine-131 for Graves' disease. The study was designed as a single-blinded randomised prospective outcome trial. Fifty-eight patients were enrolled, consisting of 50 females and 8 males aged from 17 to 75 years. Each patient was investigated by clinical assessment, biochemical and immunological assessment, thyroid ultrasound, technetium-99m thyroid scintigraphy and 24-h thyroid ¹³¹I uptake. Patients were then randomised into two treatment groups, one receiving 60 Gy and the other receiving 90 Gy thyroid tissue absorbed dose of radioiodine. The end-point markers were clinical and biochemical response to treatment. The median follow-up period was 37.5 months (range, 24-48 months). Among the 57 patients who completed final follow-up, a euthyroid state was achieved in 26 patients (46%), 27 patients (47%) were rendered hypothyroid and four patients (7%) remained hyperthyroid. Thirty-four patients (60%) remained hyperthyroid at 6 months after the initial radioiodine dose (median dose 126 MBq), and a total of 21 patients required additional radioiodine therapy (median total dose 640 MBq; range 370-1,485 MBq). At 6-month follow-up, of the 29 patients who received a thyroid tissue dose of 90 Gy, 17 (59%) remained hyperthyroid. By comparison, of the 28 patients who received a thyroid tissue dose of 60 Gy, 17 (61%) remained hyperthyroid. No significant difference in treatment response was found (P=0.881). At 6 months, five patients in the 90-Gy group were hypothyroid, compared to two patients in the 60-Gy group (P=0.246). Overall at 6 months, non-responders to low-dose therapy had a significantly larger thyroid gland mass (respective means: 35.9 ml vs 21.9 ml) and significantly higher levels of serum thyroglobulin (respective means: 597.6 µg/l vs 96.9 µg/l). Where low-dose radioiodine treatment of Graves' disease is considered, a dose of 60 Gy will yield a 39% response rate at 6 months while minimising early hypothyroidism. No significant advantage in response rate is gained by using a dose of 90 Gy. For more rapid therapeutic effect at the expense of an increased rate of hypothyroidism, doses in excess of 120 Gy may be required. Ultrasound determination of thyroid mass and measurement of serum thyroglobulin levels may be predictive of those patients who will be less responsive to low-dose therapy.