| Background:Graves hyperthyroidism is also called Graves diseases. It accounts for85%of all causes of hyperthyroidism, especially, under the age of40. Therapeutic methods for Graves hyperthyroidism include surgery, anti-thyroid drug (ATD), and radioactive iodine-131(131I) therapy. Because131I therapy has many advantage, such as, simple, safe, convenient, economic, effective, fewer side effects, it has become an ideal method. However since its theraputic effect is influenced by many factors, like age, course, serum thyroid horomones level, total131I dosage and individual sensitivity, there are difficulties to some extent in clinic practice. And Graves hyperthyroidism patients often combined with complications of ophthalmopathy, liver function injury, leukopenia and etc. Regarding the above questions, many studies have been done and some achievements have been made. In order to optimize131I dosage, increase cure rate and reduce complications, further studies are needed.Objectives:1. Statistically analyze the curative effect of Graves hyperthyroidism after131I therapy.2. Comprehensively analyze multiple influencial factors on131I treatment and try to provide references for decreasing late hypothyroidism.3. Through follow-up, observe the influencial factors on precocious hypothyroidism, late hypothyroidism and the weight decreasing rate of thyroid, analyze these factors and try to assess their predictabilities.4. Observe the curative effects of Graves hyperthyroidism combined with ophthalmopathy, liver function injury and leucopenia.5. Apply the result into clinic practices and guide treatment.Method:1.2125cases Graves hyperthyroidism patients received131I therapy. They all stopped eating the foods and taking drugs which can influence thyroid131I uptake.2. According to131I therapeutical procedure, the followings are carried out: serological examination, routine medical examination, blood routine, liver function, thyroid effctive half-life(EHL) test, thyroid weight estimation, thyroid ECT examination,131I therapeutical dosage determination, taking the determined131I orally, follow-up arrangement, appraising131I curative effctiveness.3. Sort out the above data and statistically analyze them.Results:1. The clinical recovery rate, improvement rate, invalid rate, hypothyroidism rate, cure rate and total effective rate of the2125cases after more than half a year of131I therpy are56.7%,23.1%,4.1%,16.1%,72.8%and95.9%respectively. The clinical recovery rate, improvement rate, invalid rate, hypothyroidism rate, cure rate and total effective rate of those1832cases who accepted single time131I therapy are54.6%,24.9%,4.4%,16.1%,70.7%and95.6%respectively. The clinical recovery rate, improvement rate, invalid rate, hypothyroidism rate, cure rate and total effective rate of those293cases who accepted multiple times131I therapy are69.6%,11.6%,2.4%,16.4%,86.0%and97.6%respectively. The cure rate of those who accepted more than two times of131I treatment was higher than those who accepted single time of131I treatment. But the hypothyroidism rate between them has no significant statistical difference.2. Age, weight of thyroid and dose of131I per gram of thyroid are the three factors that influence on1311therapeutic effect in all of the analytical methods. From the optimal scale regression analysis and the logistic regression analysis, we can find out:younger age, lighter thyroid mass and larger dose of131I per gram of thyroid will get better curative effect. Other factors in different analytical methods have different conclusions.3. The incidence of precocious hypothyroidism of the research date is32.2%. Maximum131I uptake rate and ATD treatment duration are the two factors that influence precocious hypothyroidism after131I therapy. From the logistic regression analysis, we can find out:lower maximum131I uptake rate, longer ATD treatment duration will have higher possibility of precocious hypothyroidism. Other factors in different analytical methods have different conclusions.4. The incidence of late hypothyroidism of this research is17.6%. Mass of thyroid, EHL and titer of TGA are the factors that influence on late hypothyroidism after131I therapy. From the logistic regression analysis, we can find out:lighter mass of thyroid, longer EHL and higher titer of TGA will have higher possibility of late hypothyroidism. Other factors in different analytical methods have different conclusions.5. Mass of thyroid, EHL and total dose of131I are the factors that influence on volumetric reduction degree of thyroid after1311therapy. From the optimal scale regression analysis, we can find out:lighter mass of thyroid, longer EHL and larger total dose of131I will have significantly volumetric reduction degree of thyroid. Other factors in different analytical methods have different conclusions.6. The cure rate of hepatic function injury is79.2%. The curative rate of patients with mild hepatic function injury was significantly higher than with medium and severe hepatic function injury. The curative rate of hepatic function injury type with mainly enzyme rise is statistically better than other two types of hepatic function injury. There was a significant correlated association between outcomes of hepatic function recovery and hyperthyroidism therapeutic efficacy.7. The total effective rate of hyperthyroidism with exophthalmos is71.6%, The curative rate of patients with mild exophthalmos is better than with moderate to severe exophthalmos, there is a significant association between outcomes of exophthalmos and Graves disease therapeutic efficacy. For patients with active exophthalmos glucocorticoids therapy can obtain satisfactory effect.8. The cure rate of leukopenia is91.7%. WBC counts in65cases didn’t return to normal level which remain in the range of (3.0-4.0)×109/L (however before treatment WBC counts are in the range of1.7～2.4×109/L). There is a significant correlated association between outcomes of leukopenia and hyperthyroidism therapeutic efficacy.Conclusion:131I therapy is an ideal treatment for Graves hyperthyroidism, which have many advantages. Age, mass of thyroid and dose of131I per gram of thyroid are the more important factors that influence therapeutic effect of131I therapy. At the same time, the higher thyroid uptake ratio of131I, EHL, TMA and TRAb can also influence131I curative effect, the incidence of late hypothyroidism and volumetric reduction degree of thyroid. There are many factors which may influence the131I treatment of Graves hyperthyroidism, and there are interactions among the multiple factors, so we should comprehensively consider these influencial factors from different aspects so as to individualize therapeutic plan. For those combined with ophthalmopathy, hepatic function injury and leukopenia,131I therapy is also an effective means, and there is a significant correlated association between outcomes of those complications and hyperthyroidism therapeutic efficacy. |
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