The Study Of Correlation And Retrospection In The Therapeutic Effect Of ～(131)I Therapy For 500 Graves' Hyperthyroidism Patients

Background: Hyperthyroidism is one of the most common endocrine diseases. Graves' hyperthyroidism accounts for 85% of all hyperthyroidism patients, especially, under the age of 40. Its incidence rate presents an increasing tendency. Therapeutic methods of Graves' hyperthyroidism include surgery, anti-thyroid drug (ATD), radioactive iodine-131(¹³¹I) therapy. Because ¹³¹I therapy has many advantage, such as, simple, safe, convenient, economic, effective, fewer side effect, it has been accepted by more and more patients and doctors. In fact, ¹³¹I therapy has become an ideal method. However since its curative effect is influenced by many factors, like age, course, serum thyroid horomones level, ¹³¹I dosage and individual sensitivity, there are difficulties to some extent in clinic practice. Regarding the above questions, many studies have been done and some achievements have been made. In order to optimize ¹³¹I dosage, increase cure rate and decrease hypothyroidism incidence further, studies are needed.Pupose: 1. Find the relationship between early hypothyroidism and late hypothyroidism after ¹³¹I therapy for Graves' hyperthyroidism, and their incidence rates respectively.2. Through follow-up, observe the influenctial factors on early hypothyroidism and late hypothyroidism, analyze them and understand the predictabilities of them.3. Observe the different curative effects between old patients and the middle -aged or young patients.4. Study the influence of different kinds of ATD on ¹³¹I therapy.5. Comprehensively analyze multiple influenced factors on ¹³¹I treatment andtry to provide references for decreasing late hypothyroidism.6. Apply the result into clinic practices and guide treatment.Method: 1. 500 Graves' hyperthyroidism patients (15-74 years, 144 male patients, 356 female patients) were hospitalized for their first 131I therapy. They all stopped eating those foods (sea weed, sea fish, ect) and taking drugs (tapazole, propythiouracil, liquor iodi compostus, propantheline, ect) which can influence thyroid13 ^uptake.2. According to 131I therapeutical procedure, the followings are carried out: serological examination, routine medical examination, thyroid effctive half-life (EHL) test, thyroid weight estimation, thyroid ECT examination, 131I therapeutical dosage determination, taking the determined 131I by patients, follow-up arrangement, appraising 131I curative effctiveness.3. Sort out the above data and statistically analyze them.Results: l.Incidece rates of early hypothyroidism and late hypothyroidism after 131I therapy are 33.20% and 6.6% respectively. About 22.2% cases with late hypothyroidism are developed after early hypothyroidism. There are significant differences between their incidence rates(/=ll 1.826, P<0.001), but there is no significant difference between their occurances(^?=0.829, P=0.363>0.05).2. Through analyzing the multiple influenced factors, we obtained the logistic regression equation of early hypothyroidism:Y=-3.503-2.339X4+0.213X8+0.229X9+0.319Xi3.The influential factors of early hypothyroidism after 131I therapy include: disease course, the highest thyroid uptake ratio of I3II,EHL, thyroid mitochondria antibody (TMA), ect. The course of the disease is protective factor but the highest thyroid uptake ratio of 131I, EHL and TMA are risk factors. The higher risk factors are more possible early hypothyroidiamoccur. The total accuracy of using logistic regression equation on determining early hypothyroidism is 69.4%. From ROC curve, we find out that disease course and the highest thyroid uptake ratio of 131I have predicted the early hypothyroidism is more accurate prediction on early hypothyroidism.3. From analying the multiple factors of late hypothyridism, we find out: the total accuracy of using logistic regression equation on determining late hypothyroidism is 93.8%. Femle, recurrent after ATD treatment, with heavier thyroid weight will have lower possiblity of late hypothyroidism. But patients with longer EHL, higher titer of TMA will have higher possiblity. From ROC curve, we find out that EHL has more accurate prediction on late hypothyroidism.4. Age is considered an independent factor, its influence on 131I therapeutic effect is that the recovery rate and improvement rate are lower in the old group, but the incidence of hypothyroidism is higher in the old group.5. ATD treatment before 131I therapy will not influence the curative effect, we find no significant differences between ATD continuous group and ATD withdrawal, let alone a particular kind of ATD group.6. The cure rate, improvement, invalid, hypothyroidiam and total effective rate of 131I therpy are 70.6%, 21.0%, 1.8%, 6.6%, 98.2% respectively. Patients with samller thyroid weight, shorter EHL, lower TMA titer and negative TSI will have higher 131I effective rate.Conclusion: 131I therapy is an ideal treatment for Graves' hyperthyroidism, which have many advantages. The higher thyroid uptake ratio of 131I, EHL and TMA titre are the more possible early hypothyroidiam occur. At the same time, EHL, TMA, TSI and thyroid weight also can influence 131I curative effect and the incidence of late hypothyroidism. The disease course is protective factor, but the highest thyroid uptake ratio of 131I, EHL and TMA are risk factors. Because of the multiple factors'influences on 131I curative effect and hypothroidism, we should comprehensively consider these influential factors from different aspects so as to individualize therapeutic plan.