甲状腺疾病的放射性核素治疗ppt课件.ppt

戒烟很重要 在激素联合131I 治疗期间宜辅以指导患者饮食和生活习惯,尤其告知患者戒烟。 Bartalena L, Baldeschi L, Dickinson A, et al. Consensus statement of the European Group on Graves′ orbitopathy(EUGOGO) on management of GO. Eur J Endocrinol, 2008, 158: 273-285. 2.Pinchera A 1998 Relation between therapy for hyperthyroidism and the course of Graves ophthalmopathy. N Engl J Med. 338:73-78 3.Thyroid-associated ophthalmopathy after treatment for Graves’ hyperthyroidism with antithyroid drugs or iodine-131. J Clin Endocrinol Metab 2009;94:3700-7 一项大型的随机对照研究显示放射碘治疗GD与GO进展的风险升高相关（与ATDs相比RR=5.8），且这种风险能够被糖皮质激素联合治疗抵销2 。 研究提示主动吸烟者接受放射碘治疗后1年随访中GO发生或恶化的发生率最高(23-40%) 2 。 多项研究都一致认为：吸烟对放射碘治疗患者GO存在有害的影响。这种风险是与每日吸烟数量成比例的，既往吸烟患者的风险仍明显低于目前吸烟患者。 1.Pfeilschifter J, Ziegler R 1996 Smoking and endocrine ophthalmopathy: impact of smoking severity and current vs lifetime cigarette consumption. Clin Endocrinol (Oxf). 45:477-481 文献报道 131I治疗加重突眼病情在吸烟者中更明显3 高度关注甲减 众多研究表明治疗后出现的持续、未处理的甲状腺功能减退症是GO进展的有害因素。 131I治疗后早期使用左旋甲状腺素预防甲减发生（血清甲状腺激素正常后即给予），这类患者GO极少出现恶化(0%-2%)。 Tallstedt L, Lundell G, Blomgren H, Bring J 1994 Does early administration of thyroxine reduce the development of Graves ophthalmopathy after radioiodine treatment? Eur J Endocrinol. 130:494-497. Perros P, Kendall-Taylor P, Neoh C, Frewin S, Dickinson J 2005 A prospective study of the effects of radioiodine therapy for hyperthyroidism in patients with minimally active graves ophthalmopathy. J Clin Endocrinol Metab. 90:5321-5323. 治疗甲亢几个主要观点 (一)131I治疗甲亢的目的 尽早治愈甲亢（甲减或甲功正常）、缩短甲亢持续时间而不是避免甲减的发生，已成为公认的131I治疗目标要求。 Saara Metso, et al. Long-term follow-up study of radioiodine treatment of Hyperthyroidism. Clinical Endocrinology (2004) 61, 641–648. Joyce Sy, et al. Usage of a fixed dose of radioactive iodine for the treatment of hyperthyroidism: one-year outcome in a regional hospital in Hong Kong. Hong Kong Med J 2009;15:267-73. Robert A, et al. Optimal iodine-131 dose for eliminating hyperthyroidism in Graves’ disease. J Nucl Med 1991,32:411-416. 大剂量131I比小剂量131I治疗能更快实现甲亢治愈，从而降低甲