目的 探討131I治療非毒性甲狀腺腫(NTG)的治療劑量、適應征、治療效果。方法 35例臨床確診的NTG患者，5例曾手術治療、15例經甲狀腺片治療腫大甲狀腺縮小不明顯有氣道壓迫症狀、3例老年患者、5例合併心肺疾患不能手術、7例拒絕手術。均經不同劑量131I治療，131I劑量為2.96-70.3MBq(80∼190uCi)/g，隨訪觀察12~36月，超聲測定甲狀腺大小，觀察甲狀腺變化情況。結果 35例NTG經131I治療後12月甲狀腺重量由治療前86.5±20.3g 縮小到治療後40.34±13.6g (p<0.001)，平均縮小57.0%10.6％。 隨訪期間所有病員治療後甲狀腺均有縮小(8.6％∼76.8％)。所有病員治療後無明顯不適，壓迫症狀明顯改善，僅1例出現頸部輕度腫大。隨訪期間3例出現甲低症狀，經補充甲狀腺片得到了及時改善。結論 131I治療非毒性甲狀腺腫是一種安全、簡便、有效的方法。特別適合於合併心肺疾患的老年人、非毒性甲狀腺腫大術後復發、甲狀腺腫大氣道壓迫明顯、禁忌手術或拒絕手術者。
The clinical evaluation of iodine-131 therapy in non-toxic goiter
Chen Yue, Zhang Chunyin, Sun Xiaoyang, et al. Department of Nuclear Medicine, Luzhou Medical College. Luzhou, 646000, China.
Objective To study the Iodione-131 dose, indications and effect of radioiodine treatment of non-toxic goiter (NTG). Methods 35 patients with large non-toxic goiters were treated with 131I. 5 had previous thyroidectomy with goiter recurrence, 15 had symptoms of respiratory obstruction after thyroxin treatment without adequate effect, 3 were older patients who were at high operative risk, 5 had cardiopulmonary disease, 7 refused surgery. 131I was given at a dose of 2.96-70.3MBq/g total thyroid mass corrected to a 100% 131I uptake in 24 hours. Thyroid size was measured by sonography during 12~36 months follow-up. Results In 35 patients treated with 131I the thyroid mass was reduced from 86.5 ±20.3g to 40.3 ±13.6g at 12 months (p<0.001). The average reduction was 57.0% ±10.6%. All patients had a reduction in thyroid volume. Side effects were few: only one case of radiation thyroiditis. 3 patients developed hypothyroidism which was easily managed by thyroxin treatment. Conclusions A substantial reduction in thyroid volume can be achieved in 131I therapy for NTG. 131I therapy for NTG appears to be an acceptable, cost-effective, simple therapy for large NTG, especially for older patients who are at high operative risk, have had previous thyroidectomy with goiter recurrence, contraindications to or refusal of surgery. (Asian J Nucl Med 2001;1:37-39)
Key Words : Iodine-131 ; Non-toxic goiter ; Therapy
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