优甲乐联合甲状腺片替代治疗对^131碘致早发甲减的临床意义

目的探讨优甲乐联合甲状腺素片替代治疗甲亢患者^131碘治疗后早发甲减的疗效及对永久性甲减的控制效果。方法经临床和实验室甲状腺激素水平测定，明确诊断的^131碘致早发甲减患者96例，随机分成（A、B和C）3组，每组32例，分别采用甲状腺素片、优甲乐和两者联合治疗，各组患者均在替代治疗后第2、4、6和8周行血清FT3、FT4、TSH测定，并根据病情调整药物剂量，12周后停药3周再行甲状腺激素水平测定和SPECT甲状腺显像。结果治疗后FT3、FT4和TSH全部恢复正常者3组分别为：31.13％、34．3％和59．4％，C组明显高于A组和B组（P〈0．05）；SPECT显像正常者C组为71．9％，明显高于A组的37．5％（P〈0．01）和B组43．8％（P〈0．05）；高FT3血症发生率A组明显高于B组和C药组（P〈0．05）；高FT4血症的发生率B组和C组明显高于A组（P〈0．05）。结论对^131碘致早发甲减的替代治疗，甲状腺素片和优甲乐联合使用可能更有利于早期稳定下丘脑-垂体-甲状腺轴，使甲状腺细胞得到保护而影响早发甲减的预后恢复，降低永久性甲减的发生率。

Effect of ievothyroxine sodium combined with thyroid tablets on hypothyroidism patients due to use of 131 iodine

Objective To investigate therapeutic effect of Euthyrox combined with thyrine on early onset hypothyroidism patients due to use of 131I therapy. Methods There 96 patients early onset hypothyroidism patients due to 131I therapy, diagnosed clinically were randomly divided into group A treated with thyroxine,group B treated with euthyrox and group C treated with thyroxine and euthyrox, each group consisted of 32cases. The levels of serum FT3, FT4 and TSH were determined 2,4,6 and 8 weeks after treatment. Twelve weeks after treatment the level of thyroid hormone was determined and visualized thyroid by SPECT 3 weeks after treatment. Results The rates of patients returned to normal in the three groups in the levels of FT3,FT4,TSH were 31.3% ,34.3% and 59.4% respectively. The rate of group C was obviously higher than that of other two groups (P<0.05). The rate of normal SPECT thyroid visualization in group C was 71.9%, significantly higher than that of group A (37.5%,P<0.01) and group B:(3.8%,P<0.05). The rate of hyper-FT3-emia in group A is higher than group B and C (P<0.05). The rate of hyper-FT4-emia is on the contrary. Conclusion The substitute treatment of hypothyroidsm patients with euthyrox in combination with thyrine is beneficial to stabilize the functional axle of hypothalamus-appendices suprasphenoidalis -thyroid, thus protect the thyroid cell, and then improve prognosis of early onset hypothyroidism due to use 131I therapy,reduce the occurrence rate of permanent hypothyroidism.