Analysis Of The Efficacy Of ¹³¹I For Graves’ Disease And Related Influencing Factors

Background:Diffuse toxic goiter（Graves’disease）is an organ-specific autoimmune disease caused by a combination of environmental and genetic factors and is the most common cause of hyperthyroidism（abbreviated as hyperthyroidism）.The current first-line treatment for Graves’disease includes antithyroid drugs（ATD）,surgical treatment and radionuclide iodine-131(¹³¹I)therapy.ATD has a long treatment period and is prone to relapse after discontinuation of the drug,adverse effects such as drug allergy,granulocyte deficiency,liver damage and vasculitis may occur after taking the drug;surgical treatment is costly and invasive,and there is also a risk of permanent hypoparathyroidism,damage to the recurrent laryngeal nerve and thyroid crisis.¹³¹I treatment is simple,low cost,safe and effective,and is therefore receiving increasing attention and research from endocrinologists and nuclear medicine specialists at home and abroad.However,in clinical practice,the efficacy of ¹³¹I treatment for Graves’disease may be influenced by a number of factors,including age,disease duration,thyroid volume,thyroid hormones,¹³¹I treatment dose,previous ATD use,smoking and so on.But,the results of national and international studies are inconsistent,and the studies that have been conducted only address a single or a few factors.In addition,failure of ¹³¹I therapy remains a common and difficult clinical problem.Therefore,it is important to study and analyse the efficacy of ¹³¹I in the treatment of Graves’disease and the related factors affecting its efficacy in order to improve the success rate of clinical ¹³¹I treatment.Objective:To analyse the efficacy of ¹³¹I treatment for Graves’disease and the related factors affecting its efficacy,and to explore the indicators for predicting failure to heal after ¹³¹I treatment,with the aim of helping the clinic to identify the characteristics of the high-risk group of failure to heal after¹³¹I treatment at an early stage,and providing a theoretical basis for improving the success rate of¹³¹I treatment.Methods:277 patients who attended the Department of Endocrinology and Department of Nuclear Medicine at Huaihe Hospital of Henan University from January 2016 to December 2021 and were diagnosed with Graves’disease and treated with ¹³¹I were selected,and relevant information on all included study populations was collected through the hospital electronic medical record information system,including gender,age,duration of disease,whether smoking,whether hyperthyroid heart disease is combined,number of ¹³¹I treatments,whether ATD has been taken,whether thyroid nodules are combined,thyroid volume,¹³¹I treatment dose,white blood cell count（WBC）,neutrophil count（NEUT）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,gamma-glutamyl transpeptidase（GGT）,free triiodothyronine（FT3）,free thyroxine（FT4）,thyroid stimulating hormone（TSH）,thyroglobulin antibody（Tg Ab）,thyroid peroxidase antibody（TPOAb）,thyrotropin receptor antibody（TRAb）,2-hour radioactive iodine uptake（2h RAIU）,24-hour radioactive iodine uptake（24h RAIU）,etc.According to the efficacy evaluation criteria,the patients were divided into two groups:the cured group（n=202）and the uncured group（n=75）.SPSS23.0 statistical software was applied for data analysis.Independent samples t-test,non-parametric test Mann-Whitney U-test and chi-square test were used to conduct one-way analysis of the relevant information of the two groups of patients,and factors with statistically significant differences in the one-way analysis were included in the multi-factor logistic regression analysis.The subject operating characteristic curve（ROC）was plotted,and the predictive value of the relevant indicators for the occurrence of failure to heal after ¹³¹I treatment was evaluated according to the area under the ROC curve（AUC）,and the cut-off values for the indicators were calculated.p<0.05 The difference is statistically significant.Results:1.Of the 277 patients with Graves’disease treated with ¹³¹I,202 were cured,a cure rate of 72.92%,and 75 were not cured,a failure rate of 27.08%.2.Univariate analysis showed that there were no statistically significant differences in age,¹³¹I treatment dose,WBC,NEUT,ALT,AST,GGT,FT3,TSH,Tg Ab,TPOAb,TRAb,24h RAIU,gender,whether smoking,whether combined with hyperthyroid heart disease,number of ¹³¹I treatments,and whether combined with thyroid nodules in the uncured group compared to the cured group（p>0.05）,and statistically significant differences in disease duration,thyroid volume,FT4,2h RAIU,and whether or not they had taken ATD（p<0.05）.3.Multi-factor logistic regression analysis showed that thyroid volume（OR=1.044,p<0.001）,and having taken ATD（OR=2.233,p=0.014）may be key factors affecting the efficacy of ¹³¹I treatment for Graves’disease.The larger the thyroid volume,the higher the likelihood that a patient with Graves’disease will present untreated with ¹³¹I.Patients with Graves’disease who had taken ATD were more likely to experience non-healing after ¹³¹I treatment than those who had not taken ATD.4.ROC curve analysis showed that the area under the ROC curve for thyroid volume was 0.763（p<0.001）,with a sensitivity of 70.7%and a specificity of 78.2%.The cut-off value for thyroid volume was35.16cm³.Conclusions:1.The cure rate of Graves’disease in this study after ¹³¹I treatment was 72.92%.Thyroid volume and previous ATD use may be the key factors affecting the efficacy of ¹³¹I in the treatment of Graves’disease.2.Thyroid volume can be used as a reference indicator to predict whether failure to heal occurs after ¹³¹I treatment.For patients with a thyroid volume≥35.16 cm³,the conventional ¹³¹I treatment dose may not achieve clinical cure and it is recommended to increase the ¹³¹I treatment dose as appropriate,thus reducing the risk of ¹³¹I treatment failure.