~(131)碘治疗弥漫性甲状腺功能亢进远期并发甲状腺功能减退的临床及实验室观察

本文总结我院64例~(131)碘治疗弥漫性甲亢的随访结果,男性17例,女性47例,年龄从31～63岁。随访项目包括TT_4、TT_3、TSH、TRH兴奋试验、MCA、TGA、血清胆固醇、甘油三酯及ECG等。甲减的诊断及分型按Evered标准加以修改。远期甲减发病率:2～5年随访为25％,6～10年随访为50％,11～15年随访为58.8％,总的发病率为52.1％。甲减组和非甲减组甲状腺重量及接受~(131)碘的毫居里数未见统计差别;亚临床型甲减及轻型甲减之间除TT_3外,TT_4,TSH均值未见有意义差别。最后,作者就甲减的发病率、亚临床甲减的诊断和治疗、~(131)碘治疗弥漫性甲亢发生甲减的机理进行了讨论。

A STUDY ON LATE HYPOTHYROIDISM AFTER IODINE-131 THERAPY FOR GRAVES' DISEASE

This article presents the results of a long term follow up of iodine-131 therapy for Graves' disease in 64 patients. Among them, 17 were males, 47 females, ages ranged from 31 to 63 years old. Items of study included TT3, TT4, TSH, TEH stimulation test, MCA, TGA, serum cholesterol, triglyceryl, ECG as well as clinical manifestations. The diagnosis of hypothyroidism and its typing were made according to Evered's criteria with minor modifications. The incidence of late hypothyroidism 2-6 yrs 6-10 yrs, 11-15 yrs, 16-20 yrs and 22 yrs after iodine-131 the therapy was 3/12,6/12, 10/17, 5/6 and 1/1 respectively. A total incidence of late hypothyroidism was 52.1% (25/48). There was no significant difference statistically in the weight of the thyroid or the dose of the iodine-131 used between the hypothyroid and euthyroid groups. No significant difference in mean value of TT4 or TSH was found between the mild and subclinioal hypothyroid groups.The incidence and mechanism of hypothyroidism after iodine-131 therapy for Graves' disease, the diagnosis and treatment of subclinical hypothyroidism were briefly discussed.