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

doi:10.3969/j.issn.1004-583X.2019.08.012

临床荟萃

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

1.新余市人民医院 a.核医学科；b.内分泌科，江西新余 338025；2.南昌大学附属第一医院核医学科，江西南昌 330006

出版日期:2019-08-20 发布日期:2019-10-09
通讯作者: 冯少仁，Email：fengshaoren1967@163.com

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

1a. Department of Nuclear Medicine; 1b.Department of Endocrinology, Xinyu People's Hospital,
Xinyu 338025, China; 2.Department of Nuclear Medicine, the First Affiliated Hospital
of Nanchang University, Nanchang 330006, China

Online:2019-08-20 Published:2019-10-09
Contact: Corresponding author: Feng Shaoren, Email：fengshaoren1967@163.com

摘要/Abstract

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。

关键词: 甲状腺功能亢进症, 甲巯咪唑, 碘

Abstract: 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 recurrence included strong positive of TRAb, grade Ⅲ goiter, increased iodine uptake rate of thyroid of 24 hours and less than 25 years old. Conclusion The 24 hours iodine uptake rate of thyroid was valuable for evaluating the timing of Graves hyperthyroidism after methimazole treatment; The timing of withdrawal of methimazole after Graves hyperthyroidism being treated with methimazole should consider all aspects. In addition to the disappearance of symptoms and signs of hyperthyroidism, FT3, FT4, sTSH, TRAb and 24hours iodine uptake rate of thyroid should be detected, it can reduce the recurrence rate of Graves hyperthyroidism combinating of the three after methimazole treated.

Key words: hyperthyroidism, methimazole, iodine

冯少仁1a，张青2，黄清梅1b，胡娜1a，刘志强1a. 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[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2019.08.012.

Feng Shaoren1a, Zhang Qing2, Huang Qingmei1b, Hu Na1a, Liu Zhiqiang1a. Value of thyroid iodine uptake rate in evaluating the timing of withdrawal after Graves hyperthyroidism treatment[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2019.08.012.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2019.08.012

https://huicui.hebmu.edu.cn/CN/Y2019/V34/I8/730

[1]	李会芳, 苗霞. 甲状腺激素水平对2型糖尿病肾脏病风险的预测[J]. 临床荟萃, 2023, 38(2): 137-142.
[2]	崔国艳, 郑雯, 张丽伟. 利多卡因联合瑞舒伐他汀治疗不耐受胺碘酮的急性冠状动脉综合征伴急性心律失常的临床疗效[J]. 临床荟萃, 2021, 36(4): 311-314.
[3]	王红梅，张婷，陈静炯，邓江山，徐周伟，付剑亮，赵玉武. 低T3水平与大动脉粥样硬化型脑梗死患者短期预后的关系[J]. 临床荟萃, 2020, 35(6): 517-520.
[4]	曹冲1，傅松波1，汤旭磊1，刘靖芳1，马丽华1，孙蔚明1，牛滢1，井高静1，赵楠1，牛强龙1，杨芳1，李玉娟1，乌丹1，郭慧萍1，王斌莉1，宋佩1. 兰州市城关区居民甲状腺结节与碘营养状况调查[J]. 临床荟萃, 2018, 33(7): 587-590.
[5]	杜绒贵. 老年冠心病患者并发低三碘甲状腺原氨酸综合征时冠状动脉病变特征分析[J]. 临床荟萃, 2017, 32(3): 216-219.
[6]	康亚星，王绵. 甲状腺功能亢进症诊治过程中存在的常见问题[J]. 临床荟萃, 2017, 32(12): 1091-1091.
[7]	曹立平，刘佳，丁静贤，吕文君，王如容. 碳酸锂联合甲巯咪唑对甲状腺功能亢进合并白细胞减少的疗效[J]. 临床荟萃, 2017, 32(1): 78-80.
[8]	吕晓伟,周红. Graves眼病的诊治[J]. 临床荟萃, 2016, 31(3): 241-245.
[9]	张力辉,袁玲玲. 亚临床甲状腺功能亢进症的诊治[J]. 临床荟萃, 2016, 31(3): 237-240.
[10]	冯珏. Graves' 甲状腺功能亢进症的正确诊断与规范化治疗[J]. 临床荟萃, 2016, 31(3): 233-236.
[11]	张荣金,郝咏梅. 弥漫性毒性甲状腺肿患者白细胞减少/缺乏的机制及治疗[J]. 临床荟萃, 2016, 31(3): 246-249.
[12]	李慧,李静. 妊娠甲状腺功能亢进患者抗甲状腺药物治疗[J]. 临床荟萃, 2016, 31(3): 254-257.
[13]	刘志红,王瑞英. 妊娠甲状腺功能亢进症对子代脑发育的影响[J]. 临床荟萃, 2016, 31(3): 258-261.
[14]	王绵. 碘营养状态与甲状腺疾病[J]. 临床荟萃, 2016, 31(3): 272-276.
[15]	陈晓雷;吴文君;徐南飞;马志伟. 病毒性脑炎患者血清甲状腺激素水平测定及临床意义[J]. 临床荟萃, 2015, 30(3): 321-323.

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

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价