全民食用加碘盐对甲状腺机能亢进病人药物疗效的影响

目的　了解我国全民食盐加碘 (USI)对甲状腺机能亢进 (甲亢 )病人药物疗效的影响。方法　选择未经治疗甲亢病人 10 1例。分成无碘盐组 4 5例和碘盐组 5 6例 ,开始给予相同剂量丙嘧治疗 ,观察治疗后 1、2、3、6个月用药剂量及检测血清总游离甲状腺素 (TT4)、总三碘甲状腺原氨酸(TT3 )、游离甲状腺素 (FT4)、三碘甲状腺原氨酸 (FT3 )和总三碘甲状腺原氨酸 (TSH)的水平。结果　两组治疗前尿碘含量和甲状腺激素水平的差异都无显著意义 ,无碘盐组治疗后尿碘含量 (14 8μg/L)明显低于治疗前 (2 13μg/L ,P =0 0 0 )。治疗后 ,除 1个月时TT4和TT3 无碘盐组 (15 3nmol/L± 5 0nmol/L ,3 6nmol/L± 1 2nmol/L)明显低于碘盐组 (177nmol/L± 6 4nmol/L ,2 7nmol/L± 1 5nmol/L) ,(P =0 0 4 1,0 0 33) ,其余各个时间的TT4、TT3 、FT4和FT3 在两组之间差异无显著意义 (P>0 0 5 )。治疗 1个月时两组丙嘧剂量差异无显著意义 (P >0 0 5 ) ,治疗 2、3和 6个月时碘盐组的丙嘧剂量 (2 14、189、178mg/d)明显大于无碘盐组 (190、14 7、116mg/d) ,(P =0 0 0 0 )。结论　抗甲状腺药物治疗中服用USI ,可以有效控制甲状腺功能 ,但抗甲状腺药物的治疗剂量明显增加。

Effect of universal salt iodization on the dosage of antithyroid drug

OBJECTIVE: To investigate the effect of universal salt iodization (USI) on antithyroid drug. METHODS: One hundred and one patients with untreated hyperthyroidism were randomly divided into two sex and age-matched groups: group A (n = 45, consuming pure salt without iodine) and group B (n = 56, consuming iodated salt). The same dosage of 300 mg propylthiouracil (PTU) was given to both groups at beginning, the serum TT4. TT3, FT4, FT3, and TSH were measured before and 1, 2, 3, 6 months after PTU treatment, when the serum TT4, TT3, FT4. FT3, and TSH were back to the normal ranges, the dosage of PTU was decreased to maintain the normal levels of serum thyroid hormones. RESULTS: The urine iodine and serum thyroid hormone levels were not significantly different between group A and group B before the treatment (P > 0.05). The urine iodine of group A was significant lower 2 - 3 months after the treatment (148.4 micro g/L) than before the treatment (213.4 micro g/L, P < 0.01). There were not significant differences in serum TT4, TT3, FT4, and FT3 between group A and B before the treatment (all P > 0.05). One month after the treatment the serum TT4 and TT3 in group A were (153 +/- 50) nmol/L and (3.6 +/- 1.2) nmol/L respectively, both significantly lower than those of the group B [(177 +/- 64) nmol/L and (2.7 +/- 1.5) nmol/L respectively, P = 0.041 and 0.033], however, there was no significant difference in other serum thyroid hormones between the group A and group B. The dosage of PTU was not significantly different between group A and B 1 month after the treatment, but became significantly higher in group B than in group A 2, 3, and 6 months after the treatment (214,189, and 178 mg/d respectively vs. 190, 147, and 116 mg/d respectively, and 24, 42, and 62 mg/day more respectively, all P < 0.05). CONCLUSION: Hyperthyroidism can be effectively controlled by PTU while the patients consume iodated salt, but the dosage of PUT needed should be higher than while the patients consume pure salt.