儿童及青少年甲亢131I治疗临床探讨.docVIP

儿童及青少年甲亢131I治疗临床探讨 　　[摘要] 目的：探讨儿童或青少年甲亢131I治疗的适应证、临床疗效及副作用等问题。方法：对58例8~20岁的儿童或青少年甲亢131I治疗后随访5年以上的病例资料进行回顾性分析，以评价131I治疗儿童或青少年甲亢的适应证、临床疗效、副作用等问题。结果：58例儿童或青少年甲亢患者采用131I治疗的原因分析，30例因服用内科抗甲状腺药物（Antithyroid drug，ATD）治疗效果不佳，8例不能坚持ATD治疗，12例因ATD治疗后出现白细胞减少、皮肤过敏、肝功能受损等副作用，8例因甲状腺肿大明显（Ⅲ度肿大）而直接采用131I治疗。58例患者131I治疗后完全治愈45例（治愈率77.6%），好转12例（20.7%），无效1例（1.7%），总有效率为98.3%（57/58），发生永久性甲减10例（17.2%）。所有患者治疗后均未出现明显近期副作用，随访5年以上无发生甲状腺癌、白血病及其他癌症的病例。对其中12例已生育患者调查，后代均健康，无致畸现象发生。结论：131I治疗儿童或青少年甲亢疗效肯定、相对安全，无明显近期和远期副作用，对ATD治疗效果不佳、不能坚持ATD治疗、ATD治疗后出现明显副作用或甲状腺肿大特别明显的青少年甲亢患者，131I治疗是值得推荐的方法。 　　[关键词] 青少年甲亢；131I；治疗 　　[中图分类号] R581 [文献标识码] B [文章编号] 1673-7210（2011）11（b）-171-02 　　 　　Clinical study of children or adolescent hyperthyroidism after iodine-131 therapy 　　LIU Shihong1, DUAN Dong2 　　1.Department of Nuclear Medicine, the Peoples Hospital of Tongliang County, Chongqing 402560, China; 2.Department of Nuclear Medicine, the First Hospital of Chongqing Medical University, Chongqing 400016, China 　　[Abstract] Objective: To probe into the indication, clinical curative effect and side effect of children or adolescent hyperthyroidism with 131I therapy. Methods: 58 cases (age range from 8-20 years) treated with 131I for Graves disease over 5 years follow-up were retrospective studied, and the indication, clinical curative effect and side effect of the treatment with 131I were discussed. Results: The reasons to select 131I therapy of all patients were analyzed, 30 of them had no good therapeutic effect with antithyroid drugs (ATD), 8 of them couldt adhere to the treatment with ATD, 12 of them presented side effect (including skin allergy, decreasing of leukocyte and impairing of liver function) after ATD treatment, and 8 cases had obviously goitrous (degree Ⅲ) and used the treatment of 131I. Over 5 years follow-up, 45 cases (77.6%) were once cured among the 58 patients, improvement in 12 cases (20.7%), hypothyroidism in 10 cases (17.2%), and ineffective in 1 case (1.7%). There were no early side effect a