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。

Clinical study on 131I therapy in Graves disease patients complicated after ATD with increased TSH plus increased 99Tcm uptake at thyroid imaging

Objective To evaluate the usefulness of 131 I therapy in Graves disease patients complicated with increased TSH level and increased 99 Tc m uptake at thyroid imaging after antithyroid drug treatment (ATD). Methods Twenty-seven patients were involved in this study, they were divided into two groups. In one group, including 15 patients, 131 I therapy was given immediately after admission, In the other group, including 12 patients, therapy wasn't given. Both of the groups were followed-up for one year with serial chemiluminescent immunoassay of FT_3, FT_4 and TSH, and 99 Tc m-pertechnium thyroid imaging. Results In the group receiving 131 I therapy immediately, 9 patients had come back to euthyroidism and 3 cases developed into subclinical hypothyroidism, 2 of them were with a series of slightly elevated TSH levels, the remaining one with a series of decreased FT_4 levels and significantly increased TSH levels. 2 cases were still in hyperthyroidism and received a second therapeutic dose. Only one got hypothyroidism. In the group without any therapy, all 12 patients relapsed into hyperthyroidism within four months. Conclusion 131 I therapy should be used for Graves disease patients with a series of high TSH and high uptake of 99 Tc m in the thyroid imaging after ATD.