甲状腺吸碘率对Graves甲亢患者抗甲状腺药物治疗后选择停药时机的价值  

Value of thyroid iodine uptake rate in evaluating the timing of withdrawal after Graves hyperthyroidism treatment

作　　者：冯少仁 张青[3] 黄清梅 胡娜 刘志强 Feng Shaoren;Zhang Qing;Huang Qingmei;Hu Na;Liu Zhiqiang(Department of Nuclear Medicine,Xinyu People's Hospital,Xinyu 338025,China;Department of Endocrinology,Xinyu People's Hospital,Xinyu 338025,China;Department of Nuclear Medicine,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]新余市人民医院核医学科,江西新余338025 [2]新余市人民医院内分泌科,江西新余338025 [3]南昌大学附属第一医院核医学科,江西南昌330006

出　　处：《临床荟萃》2019年第8期730-733,共4页Clinical Focus

摘　　要：目的探讨甲状腺吸碘率对Graves甲亢患者经甲巯咪唑治疗后选择停药时机的价值。方法2015年3月至2018年4月间48例Graves甲亢患者经甲巯咪唑正规治疗2年,患者甲亢症状消失,血清检测游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、超敏促甲状腺激素(sTSH)、促甲状腺素受体抗体(TRAb)恢复正常,准备停药。所有患者暂停药5天行甲状腺24小时吸碘率检测,根据24小时吸碘率检测结果将患者分成两组,吸碘131正常组和吸碘131升高组。吸碘131正常组15(15/48)例停服抗甲亢药;吸碘131升高组33(33/48)例再分为停药组和用药组。用药组12(12/33)例继续服抗甲亢药直至24小时吸碘率正常才停药,停药组21(21/33)例停服抗甲亢药。吸碘131正常组和吸碘131升高组均于停药9个月后随访,观察两组甲亢复发率,并分析复发危险因素。结果吸碘131正常组甲亢复发5(5/15)例,用药组甲亢复发3(3/12)例,共复发8(8/27)例;停药组甲亢复发17(17/21)例。停药组甲亢复发例数高于吸碘131正常组、用药组例数之和。吸碘131正常组+用药组甲亢复发率与停药组比较,差异有统计学意义(P<0.05)。复发危险因素有TRAb强阳性、甲状腺肿大Ⅲ度、停药前甲状腺24小时吸碘率升高、年龄小于25岁。结论甲状腺24小时吸碘率检测对Graves甲亢患者经甲巯咪唑治疗后选择停药时机有价值;Graves甲亢患者经甲巯咪唑治疗后选择停药时应全面考虑,除甲亢症状、体征消失外,还应进行血清检测FT3、FT4、sTSH、TRAb及甲状腺24小时吸碘率检测,三者相结合可降低Graves甲亢患者经甲巯咪唑治疗后的复发率。Objective To study the value of iodine uptake rate of thyroid in evaluating the timing of withdrawal of Graves hyperthyroidism after treatment with methimazole. Methods Forty-eight cases of Graves hyperthyroidism were treated regularly by methimazole for two years from March 2015 to April 2018,the symptoms of hyperthyroidism disappeared,serum free triiodothyronine(FT3),free thyroxine(FT4),super sensitivity thyroid stimulating hormone(sTSH) and thyrotropin prceptor antibody(TRAb) levels returned to normal.24 hours iodine uptake rate of thyroid of all cases were tested suspension of drugs after five days.The cases were divided into two groups according to the results of 24 hours iodine intake rate,iodine^131 intake normal group and elevated group.15 cases (15/48) of intake iodine-^131 normal group stopped taking anti-hyperthyroidism drug at the same time.33 cases(33/48) of intake iodine-^131 the elevated group were divided into the discontinuation group and the medication group,12 cases(12/33) of the medication group continued anti-hyperthyroidism drugs until the normal rate of iodine intake.21 cases(21/33) of the drug withdrawal group were stopped taking anti-hyperthyroidism drugs.Two groups of cases were followed up after nine months,the recurrence rate of hyperthyroidism was observed and the risk factors of recurrence were analyzed in two groups. Results There were 5 cases (5/15) of recurrence of hyperthyroidism in iodine-^131 intake normal group,There were 3 cases(3/12) of recurrence of hyperthyroidism in medication group,There were 8 cases (8/27) of recurrence in two groups.17 cases(17/21) were recurrence of hyperthyroidism in discontinuation group.The recurrence case of hyperthyroidism in discontinuation group was higher than iodine -^131 intake normal group and medication group altogether.Comparison of recurrence rate of hyperthyroidism between iodine- 131 normal group and medication group,the recurrence rate of hyperthyroidism in two groups was statistically significant ( P < 0.05 ).The risk factors of recu

关 键 词：甲状腺功能亢进症 甲巯咪唑 碘 

分 类 号：R581.1[医药卫生—内分泌]