甲亢低骨量患者131I治疗后干预治疗效果的评价

目的:研究甲亢低骨量患者131I治疗后干预治疗的效果.方法:对100例甲亢低骨量患者,随机分为两组:A组50例,131I治疗后口服钙尔奇D及罗盖全治疗;B组50例,131I治疗后骨质自然恢复.另设C组50例为正常对照组.于131I治疗前、治疗后3、6及12个月测定A、B两组骨密度(BMD),观察其骨质变化并评价治疗效果.结果:(1)A组随治疗时间延长BMD逐渐升高,具有一定的规律性,腰椎(L2-4)骨密度3个月提高明显(t=-2.111,P=-0.04)且12个月时达到与C组无统计学差异(t=-2.290,P=0.202).(2)B组3个月时腰椎BMD有所降低,12个月时升高明显(股骨颈t=-2.327,P=0.043;腰椎(L2-4)t=-2.798,P=0.000).(3)6个月时两组腰椎骨密度改善幅度出现统计学差异(t=-2.416,P=0.018),12个月时差异显著(t=-3.259,P=-0.002).结论:131I联合钙尔奇D与罗盖全治疗甲亢低骨量患者,其恢复时间及疗效均用131I治疗,能有效防止骨量的进一步下降及减少骨质疏松症的发生.     

甲亢低骨量患者~(131)I治疗后干预治疗效果的评价（英文）

目的:研究甲亢低骨量患者131I治疗后干预治疗的效果。方法:对100例甲亢低骨量患者,随机分为两组:A组50例,131I治疗后口服钙尔奇D及罗盖全治疗;B组50例,131I治疗后骨质自然恢复。另设C组50例为正常对照组。于131I治疗前、治疗后3、6及12个月测定A、B两组骨密度(BMD),观察其骨质变化并评价治疗效果。结果:(1)A组随治疗时间延长BMD逐渐升高,具有一定的规律性,腰椎(L2-4)骨密度3个月提高明显(t=-2.111,P=0.04)且12个月时达到与C组无统计学差异(t=-2.290,P=0.202)。(2)B组3个月时腰椎BMD有所降低,12个月时升高明显(股骨颈t=-2.327,P=0.043;腰椎(L2-4)t=-2.798,P=0.000)。(3)6个月时两组腰椎骨密度改善幅度出现统计学差异(t=-2.416,P=0.018),12个月时差异显著(t=-3.259,P=0.002)。结论:131I联合钙尔奇D与罗盖全治疗甲亢低骨量患者,其恢复时间及疗效均用131I治疗,能有效防止骨量的进一步下降及减少骨质疏松症的发生。     

罗盖全联合钙尔奇D治疗甲亢低骨量患者的疗效

为了探讨罗盖全联合钙尔奇D在治疗甲亢低骨量患者中的应用价值,本研究将100例甲亢低骨量患者随机分为两组,A组50例,碘131 (131I)治疗后服用钙尔奇D和罗盖全; B组50例,碘131 (131I)治疗后骨质自然恢复,C组20例为正常对照组。碘131(131I)治疗前及治疗后3个月、6个月和12个月时,测量各组骨密度的变化情况,评估治疗疗效。研究结果表明,A组的骨密度随着治疗时间延长而逐渐增加,腰椎(L2-4)治疗12个月后与C组相比无显著性差异(p0.05);B组腰椎(L2-4)在3个月后有所下降,12个月后明显增加(p=0.001);6个月后两组腰椎骨密度差异有统计学意义(p=0.023),12个月后差异更加明显(p=0.001)。本研究结果初步得出结论:碘131 (131I)联合钙尔奇D和罗盖全治疗的甲亢低骨量患者恢复时间和疗效优于单纯碘131 (131I)治疗,可有效防止骨量进一步减少,减少骨质疏松症的发生。     

碘-131联合胰岛素泵治疗2型糖尿病伴发甲亢的近远期疗效及对骨代谢指标的影响

目的:探讨碘-131(~(131)I)联合胰岛素泵治疗2型糖尿病(T2DM)伴发甲亢的近远期疗效及对骨代谢指标的影响。方法:选取2016年5月至2018年5月我院收治的T2DM伴发甲亢患者125例为研究对象,按照随机数字表法分为A组(n=42)、B组(n=42)和C组(n=41)。其中A组给予~(131)I联合胰岛素泵治疗,B组给予~(131)I联合二甲双胍治疗,C组给予胰岛素泵联合甲硫咪唑治疗。比较三组患者治疗后近远期的临床疗效、治疗前后血糖指标、甲状腺功能指标、骨代谢指标以及不良反应发生情况。结果:治疗后,A组临床近期、远期疗效总有效率高于B组和C组,复发率低于B组、C组(P0.05)。治疗后三组患者促甲状腺素(TSH)水平高于治疗前,且A组高于B组,游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、总三碘甲状腺原氨酸(TT_3)、总甲状腺素(TT_4)水平低于治疗前,且A组低于B组、C组(P0.05)。治疗后三组患者空腹血糖(FPG)、餐后2小时血糖(2h PG)和糖化血红蛋白(Hb A1c)水平低于治疗前,且A组低于B组、C组(P0.05)。治疗后三组患者骨钙素(BGP)、降钙素(CT)、I型前胶原N端肽(PINP)、β-胶原降解产物(β-CTX)、磷酸酶(ALP)水平低于治疗前,且A组低于B组、C组(P0.05)。治疗期间三组患者不良反应发生率比较无统计学差异(P0.05)。结论:采用~(131)I联合胰岛素泵治疗T2DM伴发甲亢患者安全有效,可改善患者甲状腺功能及骨代谢指标,降低血糖水平。     

唑来膦酸联合钙尔奇D治疗糖尿病性骨质疏松的临床疗效研究

目的:观察唑来膦酸联合钙尔奇D治疗糖尿病性骨质疏松症的临床疗效。方法:将120例糖尿病性骨质疏松患者随机分为实验组和对照组,实验组60例予唑来膦酸联合钙尔奇D治疗,对照组60例予钙尔奇D治疗。连续治疗12个月后,比较两组患者的骨密度、疼痛评分及不良反应的发生情况。结果:治疗12个月后,实验组患者的股骨颈、股骨粗隆和腰椎正位的骨密度均较对照组明显升高,差异有统计学意义(P0.05);VAS疼痛评分较对照组显著降低(P0.05)。治疗过程中,两组均无严重的不良反应发生。结论:唑来膦酸联合钙尔奇D治疗糖尿病性骨质疏松临床效果优于钙尔奇D单药治疗。     

TRAb在Graves病~(131)I治疗中的临床价值

目的:探讨促甲状腺激素受体抗体(TRAb)在Graves病131I治疗中的临床价值。方法:回顾性分析我院经131I治疗的186例Graves病患者,与70例健康对照组分别于131I治疗前及治疗后3、6、12和18月采用电化学发光免疫分析法(ECLA)动态检测血清TRAb、FT3、FT4、TSH浓度变化,进行统计分析,并计算TRAb的阳性率。结果:70例健康对照组TRAb水平1.09±0.45 IU/L,186例Graves病131I治疗前血清TRAb水平9.95±7.18 IU/L,明显高于健康对照组,两组比较有显著的统计学意义(t=-10.306,P0.001)。131I治疗3月后TRAb水平14.81±10.37 IU/L,明显高于治疗前(t=-5.26,P0.001);131I治疗6月后TRAb水平12.33±8.73 IU/L开始下降,治疗12月后TRAb水平3.14±0.87 IU/L明显降低;治疗18月后TRAb水平1.19±0.45 IU/L与健康对照组比较差异无统计学意义(t=-1.588,P=0.113)。Graves病131I治疗前TRAb阳性率为93.5%,治疗后3、6、12、18个月TRAb阳性率分别为93.5%、79.6%、27.4%和8.6%。结论:Graves病131I治疗中检测TRAb水平具有指导治疗、判断疗效、预测复发等重要的临床价值。     

阿仑膦酸钠与钙尔奇D分别联合二甲双胍治疗2型糖尿病合并骨质疏松症的疗效对比研究

摘要 目的：对比阿仑膦酸钠与钙尔奇D分别联合二甲双胍治疗2型糖尿病（T2DM）合并骨质疏松症的疗效。方法：选取我院于2016年4月~2019年1月期间收治的109例T2DM合并骨质疏松症患者,根据乱数表法将患者分为钙尔奇D组（n=54,钙尔奇D）和阿仑膦酸钠组（n=55,阿仑膦酸钠）。比较两组患者临床疗效、血糖指标、骨代谢相关指标、腰椎L2~L4及股骨颈的骨密度值。结果：阿仑膦酸钠组治疗1个月后的临床总有效率为83.64%（46/55）,高于钙尔奇D组的62.96%（34/54）（P<0.05）。两组治疗1个月后腰椎L2~ L4、股骨颈的骨密度值均升高,且阿仑膦酸钠组高于钙尔奇D组（P<0.05）。两组治疗1个月后骨钙素（BGP）升高,且阿仑膦酸钠组高于钙尔奇D组（P<0.05）;血清I型胶原C末端肽（s-CTX）、碱性磷酸酶（BAP）、人抗酒石酸酸性膦酸酶 5b（TRAP-5b）则降低,且阿仑膦酸钠组低于钙尔奇D组（P<0.05）。两组治疗1个月后空腹血糖（FPG）、糖化血红蛋白（HbA1c）均降低（P<0.05）,但两组治疗1个月后组间比较无统计学差异（P>0.05）。两组不良反应发生率对比无统计学差异（P >0.05）。结论：与钙尔奇D联合二甲双胍治疗比较,阿仑膦酸钠联合二甲双胍治疗T2DM合并骨质疏松症患者,疗效显著,可有效改善骨代谢指标及骨密度,且不影响降糖效果,具有一定的临床应用价值。     

仙灵骨葆胶囊治疗骨质疏松疼痛患者的疗效及其对骨密度及骨代谢的影响

目的:探讨仙灵骨葆胶囊治疗骨质疏松疼痛患者的疗效,并分析其对骨密度及骨代谢的影响,为临床用药提供依据。方法:研究对象为我院2015年6月-2017年7月期间收治的60例骨质疏松症疼痛患者。根据治疗方案的不同将患者均分为对照组和观察组各30例。对照组患者采用常规西医治疗,观察组在对照组基础上加用仙灵骨葆胶囊治疗,两组均治疗6个月。治疗前及治疗6个月后(治疗后)采用视觉模拟量表(VAS)评分对患者的疼痛程度进行评价。评价并比较两组疗效。分别于治疗前、治疗后对所有患者腰椎、股骨颈骨密度以及血清N端中段骨钙素(N-MID)、骨钙素(BGP)以及I型胶原羧基末端交联肽(β-CTX)进行检测。结果:治疗后,观察组患者VAS评分明显低于对照组(P0.05),且观察组总有效率为93.33%(28/30),高于对照组的73.33%(22/30)(P0.05)。治疗后,两组患者腰椎、股骨颈骨密度均明显增加,且观察组患者腰椎骨密度明显高于对照组(P0.05)。治疗后,两组患者β-CTX水平均明显降低,BGP水平均明显升高,且观察组β-CTX水平明显低于对照组,而BGP水平明显高于对照组(P0.05),两组患者治疗前后N-MID水平均无明显变化(P0.05)。结论:仙灵骨葆胶囊治疗骨质疏松症疼痛患者疗效显著,能够减轻疼痛并改善骨密度及骨代谢。     

仙灵骨葆胶囊的骨关节炎治疗疗效观察

目的:观察仙灵骨葆胶囊与钙尔奇D治疗骨关节炎的临床疗效。方法:将符合要求的64例患者随机分成2组,治疗组33人,口服钙尔奇D加仙灵骨葆胶囊治疗;对照组31人口服钙尔奇D治疗,共治疗12周。观察对比治疗组疗效显著高于对照组;结果:治疗组有效率100%;对照组:70.97%;2组比较,差异有非常显著性意义(P0.01),治疗组疗效优于对照组。治疗后治疗组骨密度提高,临床症状体征均明显改善,2组比较,差异均有非常显著性意义(P0.01)。结论:仙灵骨葆胶囊增加骨密度,提高骨关节炎的治疗疗效,并安全无不良反应,临床应用很有价值。     

骨质疏松兔松质骨微观结构和微观成分的时间序贯性变化

目的:研究去势手术建立骨质疏松兔模型中松质骨微观结构和微观成分的时间序贯性变化。方法:40只新西兰白兔随机分为假手术组(sham组,n=20)和骨质疏松组(OP组,n=20)。OP组兔子给予去势手术处理,sham组给予假手术处理。分别于术后的0周、4周、6周、8周,利用DXA测量腰椎骨密度(每组每个时间点选择5只动物)。之后处死动物,采集腰椎标本。利用Micro-CT、FTIR、腰椎轴向压缩试验得到松质骨的微观结构、微观成分(骨矿盐晶体和胶原)和宏观力学参数。利用t检验比较同一时间点两组之间的相关参数。结果:OP组BMD逐渐下降,松质骨微观结构逐渐疏松,微观组成属性逐渐改变,宏观力学强度均逐渐下降。FTIR在4周时即检测到OP组腰椎骨矿盐和胶原基质比(P=0.046)、骨矿盐结晶度(P=0.018)、胶原交联比(P=0.006)发生显著性改变,早于BMD和微观结构的变化。OP组腰椎宏观生物力学强度在第8周时达到最低点(P=0.001)。结论:去势手术后,腰椎松质骨骨矿盐晶体和胶原属性最早发生变化,松质骨微观成分和微观结构的改变是导致椎体强度明显改变的原因。FTIR技术可以较早的检测到骨质疏松发生过程中骨组织微观成分的改变。     

Ultrasonographic thyroid volume as a reliable prognostic index of radioiodine-131 treatment outcome in Graves' disease hyperthyroidism.

OBJECTIVE: We studied the relationship between thyroid volume, thyroid function and immunological markers of Graves' disease (GD) to determine prognostic factors of treatment response to low-dose radioiodine-131 (131I). MATERIAL AND METHODS: A prospective study of 40 patients with GD hyperthyroidism treated with 131I (141 +/- 85MBq) and 10 GD patients who went spontaneously into remission (controls). Free T4, total T3 and basal TSH levels, TSH-receptor antibodies (TRAb) and anti-thyroid peroxidase antibodies (TPOAb) were studied. Thyroid volume was determined by ultrasonography. Logistic regression models were used to predict the probability of final thyroid status. Receiver-operating characteristics (ROC) curves and Hosmer Lemeshow tests were used to evaluate the final statistical models. RESULTS: Of 40 patients treated with 131I, 16 became euthyroid, 12 hyperthyroid and 12 hypothyroid at 12 months. Median thyroid volume was reduced from 24.8 ml before to 8.5 ml at 12 months (p<0.001). In 10 control patients, the median reduction was from 16.6 ml to 11.3 ml (p=0.029). Thyroid volume reduction was lower in the hyperthyroid than in the euthyroid group, but higher in the hypothyroid group. Thyroid volume at baseline and at 3 months predicted hyperthyroidism outcome with a cut-off of 45 ml and 24.4 ml, respectively (odds ratio 1.074, p=0.003, ROC curve 0.78 and odds ratio 1.182, p=0.012, ROC curve 0.86 respectively). Thyroid volume at 6 months differentiated the hyperthyroid group with a cut-off of 17 ml. Thyroid volume at 3 and 6 months with a cut-off of 8.5 ml and 9.3 ml respectively, predicts permanent hypothyroidism outcome (odds ratio 0.768 and 0.685, p=0.012 and p=0.008, ROC curve 0.89 and 0.88, respectively). Changes in thyroid echogenicity and TRAb and TPOAb levels did not show any predictive value in the follow-up after 131I therapeutic outcome. CONCLUSION: The study shows that the ultrasonographic thyroid volume at 3 and 6 months after low-dose 131I treatment for GD hyperthyroidism could be a reliable prognostic factor of thyroid function outcome in the first year after treatment, and also reveals that the changes in the thyroid echogenicity and in the immunological markers of GD have no prognostic value.     

Effect of parathyroidectomy on bone mineral density in hemodialysis patients with secondary hyperparathyroidism: possible usefulness of preoperative determination of parathyroid hormone level for prediction of bone regain.

PURPOSE: To examine longitudinal changes of bone mineral density (BMD) after parathyroidectomy (PTx) in patients undergoing maintenance hemodialysis (HD) with severe secondary hyperparathyroidism (HPT) to determine which factor contributes most to bone changes. METHODS: Fifteen Japanese HD patients who had been refractory to medical therapy were subject to PTx with autotransplantation. We measured BMD by dual energy X-ray absorptiometry (DXA) at the lumbar spine (L2 - 4 BMD) and the distal 1/3 region of the radius (1/3R BMD) at 1, 3, 6, 12, 24, and 36 months after PTx. RESULTS: Baseline Z-score of BMD was markedly low at 1/3R (- 3.07) and slightly low at L2 - 4 (-0.59) in this group. A significant increase in L2 - 4 BMD was observed as early as one month after PTx, which was sustained afterwards. Annual percent changes in L2 - 4 and 1/3R BMD were + 15.6 % and + 6.4 %, respectively. The annual percent changes in BMD at both sites were positively associated with preoperative intact PTH levels (L2 - 4; r = 0.642, p = 0.010, 1/3R; r = 0.884, p < 0.001) and total alkaline phosphatase (ALP) levels (L2 - 4; r = 0.663, p = 0.007, 1/3R; r = 0.858, p < 0.001). Stepwise multiple regression analysis revealed that serum levels of intact PTH and ALP were the best predictors of both percentage and net changes in radial BMD with high determination coefficients (r 2 > 0.8). CONCLUSION: Successful PTx following appropriate supplementation with vitamin D and calcium provides a marked increase in lumbar BMD and a modest increase in radial BMD in HD patients with secondary HPT. Preoperative levels of PTH and ALP are useful for predicting postoperative changes in bone mass.     

131I对男性甲状腺功能亢进症血清性激素及甲状腺球蛋白水平影响研究

目的:探讨~(131)I对男性甲状腺功能亢进症患者血清性激素及甲状腺球蛋白水平的影响。方法:收集我院收治的男性甲状腺功能亢进症患者74例,随机分为对照组和实验组,每组各37例,对照组患者给予他巴唑口服,20-30 mg/次,每日口服1次。实验组患者在对照组基础上给予~(131)I治疗。治疗结束后,检测并比较两组患者血清游离三碘甲状腺素(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、睾酮(T)、雌二醇(E2)、甲状腺球蛋白(TG)水平的变化以及临床疗效。结果:与治疗前相比,两组患者血清FT3、FT4、T、E2、TG水平均显著下降,TSH水平明显升高(P0.05);与对照组相比,实验组患者血清FT3、FT4、T、E2、TG水平较低,TSH水平以及临床治疗有效率较高(P0.05)。结论:~(131)I能够显著降低男性甲状腺功能亢进症血清FT3、FT4、T、E2、TG水平,升高TSH水平,临床效果较好。     

Prevalence of hyperthyroidism after exposure during childhood or adolescence to radioiodines from the chornobyl nuclear accident: dose-response results from the Ukrainian-American Cohort Study

Relatively few data are available on the prevalence of hyperthyroidism (TSH concentrations of <0.3 mIU/liter, with normal or elevated concentrations of free T4) in individuals exposed to radioiodines at low levels. The accident at the Chornobyl (Chernobyl) nuclear plant in Ukraine on April 26, 1986 exposed large numbers of residents to radioactive fallout, principally to iodine-131 ((131)I) (mean and median doses = 0.6 Gy and 0.2 Gy). We investigated the relationship between (131)I and prevalent hyperthyroidism among 11,853 individuals exposed as children or adolescents in Ukraine who underwent an in-depth, standardized thyroid gland screening examination 12-14 years later. Radioactivity measurements taken shortly after the accident were available for all subjects and were used to estimate individual thyroid doses. We identified 76 cases of hyperthyroidism (11 overt, 65 subclinical). Using logistic regression, we tested a variety of continuous risk models and conducted categorical analyses for all subjects combined and for females (53 cases, n = 5,767) and males (23 cases, n = 6,086) separately but found no convincing evidence of a dose-response relationship between (131)I and hyperthyroidism. There was some suggestion of elevated risk among females in an analysis based on a dichotomous dose model with a threshold of 0.5 Gy chosen empirically (OR = 1.86, P = 0.06), but the statistical significance level was reduced (P = 0.13) in a formal analysis with an estimated threshold. In summary, after a thorough exploration of the data, we found no statistically significant dose-response relationship between individual (131)I thyroid doses and prevalent hyperthyroidism.     

Effects of long-term treatment with GH in the bone mineral density of adults with hypopituitarism and GH deficiency and after discontinuation of GH replacement.

BACKGROUND: Only few previous studies have assessed the effects of long-term growth hormone (GH) replacement therapy on bone mineral density (BMD) in adult patients with GH deficiency. The aim of this study was to investigate the effects of long-term GH therapy on bone metabolism and BMD. MATERIAL AND METHODS: At the start of the study, 20 adults with GH deficiency were randomized to receive either GH, 0.25 IU x kg per week, or placebo. After 6 months, patients in the placebo group were switched to GH therapy, and they received GH for a further 18 months. Of the 20 patients, 14 were male and 6 female with GH deficiency of adult-onset. The mean age of the patients at the start of the study was 40.3+/-10.9 years and the duration of GH deficiency was 10.6+/-6.4 years. Patients deficient in pituitary hormones other than GH had been receiving stable replacement doses of appropriate hormones for at least 6 months before the start of the study. Rates of bone metabolism were assessed by measuring calcium, phosphate, alkaline phosphatase, calciuria, phosphaturia and osteocalcin. BMD was measured by dual X-ray absorptiometry. Body composition was calculated from measurements of bioelectrical impedance. RESULTS: Before GH treatment, BMD in the femoral neck was lower in patients than in controls. The rate of bone resorption markers increased significantly after 6 months and remained stable during the whole treatment period. BMD significantly increased in L2-L4 after 12 months of treatment with an increase of Z-score. The total BMD increase was 4.5+/-6.5%. BMD in the femoral neck increased after 12 months with an increase of Z-score after 18 months. The total increase was 10.4+/-18%. The total BMD increase was not different among patients with or without basal osteopenia. In both groups BMD in L2-L4 and in the femoral neck remained stable after 12 months without GH treatment. Sex, age, BMI and the time in which GH deficiency started, before or after the end of the peak of BMD, did not correlate with BMD. The BMD values and their response to GH treatment did not correlate with other associated deficiencies, and we did not find differences among BMD increase and GH dose, levels of insulin-growth factor-I, insulin growth factor binding protein-3, and parameters of body composition. CONCLUSIONS: The results of the study support previous ones that BMD is subnormal in adults with GH deficiency; that GH replacement therapy stimulates bone turnover with initial biochemical changes; and that in the long term, this stimulation results in a significant augmentation in BMD that continues to increase after 2 years and remains stable after 12 months of GH withdrawal.     

碘131 与抗甲状腺药物治疗甲亢的临床疗效比较

目的:探讨碘131(I131)和抗甲状腺药物治疗甲亢的临床疗效对比,为临床提供参考依据。方法:选择2012年1月至2014年10月我院甲状腺功能亢进患者218例,按照随机数字表法分为观察组和对照组,每组各109例患者,观察组采用碘131治疗,对照组采用抗甲状腺药物治疗。比较治疗12个月后两组患者的临床疗效、复发率和并发症,采用酶联免疫吸附法检测治疗前后血清甲状腺激素水平。结果:治疗12个月后,观察组的有效率为92.66%明显高于对照组的69.72%,观察组的复发率为2.75%明显低于对照组的13.76%,差异均有统计学意义(P0.01)。观察组的心脏病、肝功能受损及血象降低等不良反应的发生率为7.34%明显低于对照组32.11%,差异有统计学意义(P0.01)。治疗后两组患者的血清甲状腺素(T4)、游离三碘甲状原氨酸(FT3)、三碘甲状原氨酸(T3)、促甲状腺激素(TSH)、游离甲状腺素(FT4)水平较治疗前降低,且观察组的降低幅度优于对照组,差异均有统计学意义(P0.05)。结论:碘131治疗甲亢可提高临床疗效,降低复发率,不良反应轻,可降低血清甲状腺激素水平,,值得推广应用。     

Radioactive Iodine Therapy Without Recent Antithyroid Drug Pretreatment For Hyperthyroidism Complicated By Severe Hyperbilirubinemia Due To Hepatic Dysfunction: Experience Of A Chinese Medical Center

Objective: The objective of this work is to report our experience with ¹³¹I therapy without recent antithyroid drug (ATD) pretreatment for refractory severe hyperthyroidism complicated by hyperbilirubinemia due to hepatic dysfunction.Methods: Five patients with refractory severe hyperthyroidism were treated with ¹³¹I at 90 to 120 μCi/g-thyroid (total activity, 6.2 to 10.1 mCi). The patients previously had received ATD treatment from 2 months to 12 years and discontinued ATDs from 2 months to 4 years before ¹³¹I treatment due to treatment failure or severe jaundice. Prior to ¹³¹I therapy, the patients were asked to take a low-iodine diet and were treated with bisoprolol fumarate, digoxin, furosemide, S-adenosylmethionine, polyene phosphatidylcholine, and plasma exchange as supportive treatment for related clinical conditions. Four of the patients also received lithium carbonate in conjunction with their ¹³¹I treatment. The patients were followed for 4 to 9 years after ¹³¹I therapy.Results: After ¹³¹I treatment, jaundice disappeared completely within 3 to 4 months in all patients, and liver function tests returned to normal. Concurrent atrial fibrillation and heart failure, leukopenia and thrombocytopenia, or thrombocytopenia and left cardiac enlargement improved remarkably in 3 patients during the follow-up period. Three to 45 months after ¹³¹I treatment, hypothyroidism was noted in the patients and they were treated with L-thyroxine replacement therapy.Conclusion:¹³¹I therapy without recent ATD pretreatment for refractory severe hyperthyroidism complicated by serious jaundice appears to be safe and effective, with good long-term results. It may be the preferred therapy for such patients and should be used as early as possible.Abbreviations:ATD = antithyroid drugFT₄ = free thyroxinePTU = propylthiouracilRAIU = radioactive iodine uptakeTSH = thyroid-stimulating hormone     

Radioiodine treatment of multinodular non-toxic goitre.

OBJECTIVE--To investigate the long term effect of radioactive iodine on thyroid function and size in patients with non-toxic multinodular goitre. DESIGN--Consecutive patients with multinodular non-toxic goitre selected for radioactive iodine treatment and followed for a minimum of 12 months (median 48 months) after an intended dose of 3.7 MBq/g thyroid tissue corrected to a 100% uptake of iodine-131 in 24 hours. PATIENTS--69 patients with a growing multinodular non-toxic goitre causing local compression symptoms or cosmetic inconveniences. The treatment was chosen because of a high operative risk, previous thyroidectomy, or refusal to be operated on. MAIN OUTCOME MEASUREMENTS--Standard thyroid function variables and ultrasonically determined thyroid volume before treatment as well as 1, 2, 3, 6, and 12 months after treatment and then once a year. RESULTS--56 patients were treated with a single dose of 131I, 12 with two doses, and one with four doses. In 45 patients treated with one dose and remaining euthyroid the median thyroid volume was reduced from 73 (interquartile range 50-106) ml to 29 (23-48) ml at 24 months in the 39 patients in whom this was measured during follow up. The median reduction was 40 (22-48) ml (60% reduction, p < 0.0001), half of which occurred within three months. Patients treated with two doses as well as those developing hypothyroidism and hyperthyroidism had a significant reduction in thyroid volume. Eleven patients developed hypothyroidism (cumulative five year risk 22%, 95% confidence interval 4.8% to 38.4%). Side effects were few: three cases of hyperthyroidism and two cases of radiation thyroiditis. Only one patient was dissatisfied with the result; she was referred for operation six months after treatment. CONCLUSIONS--A substantial reduction in thyroid volume accompanied by a low incidence of hypothyroidism and few side effects makes the use of radioactive iodine an attractive alternative to surgery in selected cases of non-toxic multinodular goitre.