甲狀腺疾病的放射性核素治療

1、 第三軍醫(yī)大學(xué)一院第三軍醫(yī)大學(xué)一院 內(nèi)分泌科內(nèi)分泌科131碘 到 病 除131I治療后治療后前位前位后位后位治療前治療前前位前位后位后位中華醫(yī)學(xué)會核醫(yī)學(xué)分會普查結(jié)果中華醫(yī)學(xué)會核醫(yī)學(xué)分會普查結(jié)果甲亢年治療量超過萬人甲亢年治療量超過萬人次以上的省份有：次以上的省份有：廣東廣東 25110，四川四川 15526，廣西廣西 12629，湖北湖北 11691，吉林吉林 10650，甲亢年治療量較多的單甲亢年治療量較多的單位有：位有：核工業(yè)核工業(yè)416醫(yī)院醫(yī)院 8235解放軍解放軍321醫(yī)院醫(yī)院 5000枝江市人民醫(yī)院枝江市人民醫(yī)院 3778梅州市人民醫(yī)院梅州市人民醫(yī)院 3714解放軍解放軍303醫(yī)院醫(yī)院

2、 3260哈爾濱醫(yī)大二院哈爾濱醫(yī)大二院 3260李亞明教授提供李亞明教授提供按我國甲亢患病率按我國甲亢患病率1%計算，接受計算，接受131I治療的患者為治療的患者為3.62%。153Sm/89Sr治療骨轉(zhuǎn)移癌治療骨轉(zhuǎn)移癌125I/ 103Pd粒子治療惡性腫瘤粒子治療惡性腫瘤32P膠體腔內(nèi)治療膠體腔內(nèi)治療原發(fā)性骨髓原發(fā)性骨髓增生性疾病增生性疾病放射免疫治療放射免疫治療冠脈內(nèi)照射治冠脈內(nèi)照射治療血管再狹窄療血管再狹窄 核素放射治療 治好了我治好了我老爸的甲亢！老爸的甲亢！具體使用劑量可根據(jù)甲狀腺攝碘率、甲狀腺具體使用劑量可根據(jù)甲狀腺攝碘率、甲狀腺估重、病情等因素，按經(jīng)驗(yàn)公式加以計算。估重、病情等因

3、素，按經(jīng)驗(yàn)公式加以計算。 計劃甲狀腺吸收劑量（計劃甲狀腺吸收劑量（Gy）131I ITp（d）甲狀腺重（甲狀腺重（g）37 131I治療量（治療量（Bq）= 1.2131I ITeff（d）甲狀腺甲狀腺131I I最高攝取率（最高攝取率（%） 按甲狀腺吸收劑量計算按甲狀腺吸收劑量計算: : 一般為一般為6080Gy(600015000rad) TpTp物理半衰期物理半衰期 TeffTeff有效半衰期有效半衰期 1.21.2為為37KBq(137KBq(1 Ci)Ci)131131I I給予甲狀腺組織的輻射吸收劑量（給予甲狀腺組織的輻射吸收劑量（GyGy）具體使用劑量可根據(jù)甲狀腺攝碘率、甲狀腺具

4、體使用劑量可根據(jù)甲狀腺攝碘率、甲狀腺估重、病情等因素，按經(jīng)驗(yàn)公式加以計算。估重、病情等因素，按經(jīng)驗(yàn)公式加以計算。 計劃每克甲狀腺攝取計劃每克甲狀腺攝取131I I活度（活度（Bq或或 Ci ）甲狀腺重（甲狀腺重（g） 131I治療量（治療量（Bq）= 甲狀腺甲狀腺131I I最高攝取率（最高攝取率（%） 按每克甲狀腺攝取活度計算按每克甲狀腺攝取活度計算: 一般為一般為70120 Ci 131I /g 該公式假設(shè)該公式假設(shè)TeffTeff（有效半衰期）按有效半衰期）按5 5天計算；天計算； 若若TeffTeff與此差別太大，可將計算結(jié)果乘以與此差別太大，可將計算結(jié)果乘以5/Teff 5/Teff

5、 加以矯正。加以矯正。131I治療甲亢安全性良好治療甲亢安全性良好惡性腫瘤惡性腫瘤總發(fā)病率總發(fā)病率低于普通人群低于普通人群惡性腫瘤標(biāo)化發(fā)病率（SIR）注：SIR, Standardised Incidence Ratio，標(biāo)化發(fā)病率 P=0.0001Jayne A Franklyn, et al. Cancer incidence and mortality after radioiodine treatment for hyperthyroidism: a population-based cohort study. Lancet 1999; 353: 211115.74177417例應(yīng)用例

6、應(yīng)用131I131I治療的甲亢患者（治療的甲亢患者（7207372073人人* *年隨訪）年隨訪）131I治療甲亢安全性良好治療甲亢安全性良好惡性腫瘤惡性腫瘤死亡率死亡率與普通人群無異與普通人群無異標(biāo)化惡性腫瘤死亡率（SMR ）回顧性研究，35593例甲亢患者，分別接受131I、手術(shù)、抗甲狀腺藥物治療。其中65%的患者接受131I治療。評估這些甲亢患者尤其是應(yīng)用131I治療后的癌癥死亡率。 特殊情況特殊情況 甲狀腺危象甲狀腺危象 Graves眼病眼病治療轉(zhuǎn)歸治療轉(zhuǎn)歸 多數(shù)甲亢性心臟病患者經(jīng)131I治療，甲狀腺功能正常后，其心臟功能完全或部分恢復(fù)正常； 如甲亢性心臟病病程長、甲狀腺腫大明顯者，1

7、31I緩解甲亢性心臟病的療效較差。強(qiáng)調(diào)131I治療后終生隨診的重要！及時糾正甲減！研究報道：并發(fā)有甲狀腺功能亢研究報道：并發(fā)有甲狀腺功能亢進(jìn)性心臟病的患者應(yīng)用放射碘治進(jìn)性心臟病的患者應(yīng)用放射碘治療作為單一方案治療后并不使心療作為單一方案治療后并不使心臟癥狀加重。臟癥狀加重。Thyrocardiac Disease and Its Management with Radioactive Iodine I131Clement Delit;Solomon Silver;Stephen B. Yohalem;Robert L. Segal.AbstractHyperthyroidism was tre

8、ated with I131 in 1,603 cases. These included cases of diffuse toxic goiter and nodular goiter with hyperthyroidism. There were 187 patients with congestive heart failure, 30 with angina pectoris, and 32 with combined angina pectoris and congestive failure. In addition, there were 107 patients with

9、atrial fibrillation but without congestive failure or angina. Radioiodine was the only treatment used for the hyperthyroid state. The cardiac status was strikingly improved in all groups studied. The number of treatments and incidence of myxedema was almost the same for the cardiac and noncardiac pa

10、tients. The total administered dose averaged 7.0 millicuries for the entire series and 11.5 for the cardiac patients. The recurrence rate was less than 1%. The authors believe that I131 is the treatment choice for thyrocardiac disease.ATA316-317甲亢治療方法 例數(shù) 改善% 無變化無變化% 惡化% 甲巰咪唑 148 2 95 3 131I 150 0 85

11、 15 131I + 潑尼松 145 35 65 0GO惡化率惡化率Bartalena et al N Engl J Med 1989, 321:1349Bartalena 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

12、 hyperthyroidism and the course of Graves ophthalmopathy. N Engl J Med. 338:73-78338:73-783.Thyroid-associated ophthalmopathy after treatment for Graves hyperthyroidismwith antithyroid drugs or iodine-131. J Clin Endocrinol Metab 2009;94:3700-7一項(xiàng)大型的隨機(jī)對照研究顯示放射碘治療一項(xiàng)大型的隨機(jī)對照研究顯示放射碘治療GD與與GO進(jìn)展進(jìn)展的風(fēng)險升高相關(guān)（與的

13、風(fēng)險升高相關(guān)（與ATDs相比相比RR=5.8），且這種風(fēng)險），且這種風(fēng)險能夠被能夠被糖皮質(zhì)激素糖皮質(zhì)激素聯(lián)合治療抵銷聯(lián)合治療抵銷2 。研究提示主動吸煙者接受放射碘治療后研究提示主動吸煙者接受放射碘治療后1年隨訪中年隨訪中GO發(fā)生或惡化的發(fā)生率最高發(fā)生或惡化的發(fā)生率最高(23-40%) 2 。多項(xiàng)研究都一致認(rèn)為：吸煙對放射碘治療患者多項(xiàng)研究都一致認(rèn)為：吸煙對放射碘治療患者GO存在存在有害的影響。這種風(fēng)險是與每日吸煙數(shù)量成比例的，有害的影響。這種風(fēng)險是與每日吸煙數(shù)量成比例的，既往吸煙患者的風(fēng)險仍明顯低于目前吸煙患者。既往吸煙患者的風(fēng)險仍明顯低于目前吸煙患者。1.Pfeilschifter J, Z

14、iegler R 1996 Smoking and endocrine ophthalmopathy: impact of smoking severity and current vs lifetime cigarette consumption. Clin Endocrinol (Oxf). 45:477-48145:477-481文獻(xiàn)報道文獻(xiàn)報道131I治療加重突眼病情在吸煙者中更明顯治療加重突眼病情在吸煙者中更明顯3Tallstedt L, Lundell G, Blomgren H, Bring J 1994 Does early administration of thyroxin

15、e 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 ophthalm

16、opathy. J Clin Endocrinol Metab. 90:5321-5323.Saara Metso, et al. Long-term follow-up study of radioiodine treatment of Hyperthyroidism. Clinical Endocrinology (2004) 61, 641648.Joyce Sy, et al. Usage of a fixed dose of radioactive iodine for the treatment of hyperthyroidism: one-year outcome in a r

17、egional 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.大劑量131I比小劑量131I治療能更快實(shí)現(xiàn)甲亢治愈更快實(shí)現(xiàn)甲亢治愈，從而降低甲亢相關(guān)的死亡率。131I治療是安全的，但是大多數(shù)患者會發(fā)生治療后甲減，需要個體化劑量的甲狀腺激素終生替代治療。這種療法既解決了甲亢的治療問題，也最大限度降低了

18、甲減相關(guān)性疾病發(fā)生率6 美國內(nèi)分泌醫(yī)師學(xué)會（AACE）甲亢及甲減臨床指南甲亢并發(fā)癥嚴(yán)重危害患者健康甲亢并發(fā)癥嚴(yán)重危害患者健康131I治療甲亢療效好治療甲亢療效好P0.01發(fā)生率（%）治愈時間（月）Chen DY, et al. Comparison of the long-term efficacy of low dose 131I versus antithyroid drugs in the treatment of hyperthyroidism. Nucl Med Commun. 2009 Feb;30(2):160-8.前瞻性、隨機(jī)研究，納入前瞻性、隨機(jī)研究，納入2021例甲亢患者，

19、分別接受抗甲狀腺藥物或例甲亢患者，分別接受抗甲狀腺藥物或131I治療，平均隨訪治療，平均隨訪98個月。個月。*#131131I I治療甲亢療效顯著治療甲亢療效顯著131131I I治療甲亢治愈時間快治療甲亢治愈時間快*P=0.000#P=0.001幾個主要觀點(diǎn)幾個主要觀點(diǎn)過去認(rèn)為：甲減是過去認(rèn)為：甲減是131I治療的并發(fā)癥或副作用等。治療的并發(fā)癥或副作用等。現(xiàn)在觀點(diǎn)：甲減是治療的一種轉(zhuǎn)歸或是期望的結(jié)局?，F(xiàn)在觀點(diǎn)：甲減是治療的一種轉(zhuǎn)歸或是期望的結(jié)局。131I治療甲亢后治療甲亢后甲減發(fā)生率高，甲減發(fā)生率高，早發(fā)晚發(fā)早發(fā)晚發(fā)有所不同有所不同1.131I治療Graves甲亢專家共識2.Aftab M

20、Ahmad, et al. Objective estimates of the probability of developing hypothyroidism following radioactive iodine treatment ofThyrotoxicosis. European Journal of Endocrinology (2002) 146 767775.3.131I治療甲狀腺功能亢進(jìn)癥遠(yuǎn)期觀察。中華核醫(yī)學(xué)雜志，1984，4：7-11國外資料國外資料國內(nèi)資料國內(nèi)資料晚發(fā)甲減晚發(fā)甲減發(fā)生率與發(fā)生率與131I治療劑量無關(guān)治療劑量無關(guān)晚期甲減發(fā)生率（%）Leslie, W.D

21、,(2003) A randomized comparison of radioiodine doses in Graves hyperthyroidism. Journal of Clinical Endocrinology and Metabolism, 88, 978983.低固定劑量：235 MBq高固定劑量：350 MBq低調(diào)節(jié)劑量：2.96 MBq (80Ci)/g 甲狀腺，經(jīng)24h131I攝取率調(diào)節(jié)高調(diào)節(jié)劑量：4.44 MBq(120Ci)/g 甲狀腺，經(jīng)24h131I攝取率調(diào)節(jié) 甲亢治療后發(fā)生甲低甲亢治療后發(fā)生甲低與甲狀腺細(xì)與甲狀腺細(xì)胞轉(zhuǎn)換速度和甲胞轉(zhuǎn)換速度和甲狀腺的增殖能力狀

22、腺的增殖能力有關(guān)。而不是有關(guān)。而不是131131I I劑量。劑量。永久性甲低永久性甲低不同于早發(fā)甲不同于早發(fā)甲低，它低，它不是輻射不是輻射的直接結(jié)的直接結(jié)果果與自身與自身免疫過程免疫過程有關(guān)有關(guān)與甲亢與甲亢的自然病的自然病程有關(guān)程有關(guān)相比甲亢相比甲亢甲減的治療更容易，危害程度更輕甲減的治療更容易，危害程度更輕陳漢華. 131 碘治療甲狀腺功能亢進(jìn)癥7170例療效總結(jié).柳州醫(yī)學(xué).2008 年第21 卷第3 期廖學(xué)權(quán)等.甲狀腺功能減退癥的內(nèi)分泌治療.中國醫(yī)藥導(dǎo)報. 2010 年5 月第7 卷第13 期郭根武等. 碘-131治療甲狀腺功能亢進(jìn)癥治療效果分析. 中國輻射衛(wèi)生,2009,18(3)優(yōu)甲樂

23、優(yōu)甲樂支持放射性碘治療甲亢導(dǎo)致甲減支持放射性碘治療甲亢導(dǎo)致甲減Thyroid Function and Mortality in Patients Treated for HyperthyroidismJayne A. Franklyn, Michael C. Sheppard, Patrick MaisonneuveJAMA. 2005 Jul 6;294(1):71-80RESULTS: In 15,968 person-years of follow-up, 554 died vs 487 expected deaths (standardized mortality ratio SMR

24、, 1.14; 95% confidence interval CI, 1.04-1.24, P=.002). Increased risks of all-cause and circulatory deaths vs age- and period-specific mortality were observed in follow-up in those not requiring, or prior to, T(4) therapy. These increased risks were not observed during follow-up on T(4) therapy (ci

25、rculatory disease SMR prior to T(4), 1.33; 95% CI, 1.14-1.53 vs SMR, 0.91; 95% CI, 0.70-1.17 during T(4). Patients receiving T(4) had decreased risk of mortality vs risk in the period not requiring, or prior to, T(4) therapy (all-cause mortality hazard ratio HR, 0.65; 95% CI, 0.54-0.79; circulatory

26、mortality HR, 0.65; 95% CI, 0.48-0.87). Increased all-cause mortality vs the background population was observed in the period prior to T(4) therapy in follow-up associated with low, normal, and high serum thyrotropin. The SMR for ischemic heart disease increased slightly when analyzed by serum thyro

27、tropin, high serum thyrotropin being the highest SMR (low thyrotropin SMR, 1.06; 95% CI, 0.75-1.45; normal thyrotropin SMR, 1.17; 95% CI, 0.76-1.71; high thyrotropin SMR, 1.48; 95% CI, 0.86-2.37). Comparison within the cohort showed that mild hypothyroidism prior to T(4) therapy was associated with

28、increased risk of mortality from ischemic heart disease vs biochemical euthyroidism (HR, 2.08; 95% CI, 1.04-4.19).CONCLUSIONS: Patients treated with radioiodine for hyperthyroidism had increased mortality vs age- and period-specific mortality in England and Wales, a finding no longer evident during

29、T(4) therapy. This supports treating hyperthyroidism with doses of radioiodine sufficient to induce overt hypothyroidism. The association within the cohort of mortality from ischemic heart disease with subclinical hypothyroidism suggests T(4) replacement should be considered should this biochemical

30、abnormality develop after radioiodine therapy.結(jié)果認(rèn)為放射性碘治療后甲減結(jié)果認(rèn)為放射性碘治療后甲減接受接受T4治療的患者死亡率與背治療的患者死亡率與背景人群相似。景人群相似。131I治療治療GD出現(xiàn)出現(xiàn)甲減，替代治療甲減，替代治療對存活無影響。對存活無影響。甲減的替代治療是安全、簡便的。甲減的替代治療是安全、簡便的。但在內(nèi)科學(xué)界尚不能完全接受此觀點(diǎn)，但在內(nèi)科學(xué)界尚不能完全接受此觀點(diǎn)，有些內(nèi)科醫(yī)生經(jīng)常有些內(nèi)科醫(yī)生經(jīng)常“告誡告誡”患者，患者，“不不要接受要接受131I治療，甲減比甲亢更難治治療，甲減比甲亢更難治”等。等。在有關(guān)在有關(guān)131I治療后甲減引

31、起的醫(yī)療糾紛治療后甲減引起的醫(yī)療糾紛中，有些就是因?yàn)閮?nèi)科醫(yī)生的中，有些就是因?yàn)閮?nèi)科醫(yī)生的“忠告忠告”而引發(fā)的。而引發(fā)的。應(yīng)該溝通，達(dá)成共識。應(yīng)該溝通，達(dá)成共識。一般情況下，一般情況下，131I治療前停服治療前停服MMI27d, PTU 24周周。Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials.Walter MA,et al. BMJ. 2007 Mar 10;334(7592):514 Abstra

32、ct OBJECTIVE: To determine the effect of adjunctive antithyroid drugs on the risk of treatment failure, hypothyroidism, and adverse events after radioiodine treatment.DESIGN: Meta-analysis.DATA SOURCES: Electronic databases (Cochrane central register of controlled trials, Medline, Embase) searched t

33、o August 2006 and contact with experts. Review methods Three reviewers independently assessed trial eligibility and quality. Pooled relative risks for treatment failure and hypothyroidism after radioiodine treatment with and without adjunctive antithyroid drugs were calculated with a random effects

34、model.RESULTS: We identified 14 relevant randomised controlled trials with a total of 1306 participants. Adjunctive antithyroid medication was associated with an increased risk of treatment failure (relative risk 1.28, 95% confidence interval 1.07 to 1.52; P=0.006) and a reduced risk for hypothyroid

35、ism (0.68, 0.53 to 0.87; P=0.006) after radioiodine treatment. We found no difference in summary estimates for the different antithyroid drugs or for whether antithyroid drugs were given before or after radioiodine treatment.CONCLUSIONS: Antithyroid drugs potentially increase rates of failure and re

36、duce rates of hypothyroidism if they are given in the week before or after radioiodine treatment, respectively.Pretreatment with propylthiouracil but not methimazole reduces the therapeutic efficacy of iodine-131 in hyperthyroidism.Imseis RE, Vanmiddlesworth L, Massie JD, Bush AJ, Vanmiddlesworth NR

37、.J Clin Endocrinol Metab. 1998 Feb;83(2):685-7 AbstractNinety-three hyperthyroid patients were treated with 1 dose of iodine-131 (131I) during the past 10 years. Thirty-three were pretreated with propylthiouracil (PTU), 22 with methimazole (MMI), and 38 received no antithyroid drugs (ATD). ATD were

38、discontinued 5-55 days before 131I therapy in three fourths of the cases and more than 4 months before therapy in one fourth of the cases. The frequency of cures in the 3 groups, 6-8 months after radioiodine therapy, was retrospectively studied. The cure rate among those who discontinued PTU for 5-5

39、5 days before 131I was significantly reduced (24%), compared with those who discontinued MMI for the same duration (61%) or those who received no ATD (66%). When PTU was discontinued for more than 4 months, the cure rate was similar to those who received no ATD. It is concluded that if ATD are used

40、as initial therapy for hyperthyroidism, then PTU (but not MMI) may reduce the therapeutic efficacy of subsequent 131I. The reduction in cure rate was observed even when PTU was discontinued for as long as 55 days before 131I therapy. To our knowledge, this is the first report to compare, in one stud

41、y, the effects of pretreatment with PTU and MMI on 131I therapy. 抗甲狀腺藥物可能增抗甲狀腺藥物可能增加首次劑量放射碘治加首次劑量放射碘治療失敗的幾率療失敗的幾率這種現(xiàn)象發(fā)生在使這種現(xiàn)象發(fā)生在使用用PTU的患者中，的患者中，而在使用而在使用MMI治療的治療的患者中并未有此現(xiàn)患者中并未有此現(xiàn)象發(fā)生象發(fā)生u131I治療前治療前 過去認(rèn)為：甲狀腺激素水平降至正常。過去認(rèn)為：甲狀腺激素水平降至正常。 現(xiàn)在傾向：甲狀腺激素水平偏高可用。攝現(xiàn)在傾向：甲狀腺激素水平偏高可用。攝131I率保持率保持在較高水平，有利于在較高水平，有利于131I的攝

42、取。的攝取。u131I服藥后服藥后 過去觀點(diǎn)：使用過去觀點(diǎn)：使用131I治療后，不再用治療后，不再用ATD。 現(xiàn)在觀點(diǎn)：服用現(xiàn)在觀點(diǎn)：服用131I后，短期少量的后，短期少量的ATD輔助治療效輔助治療效果更好。果更好。uATD藥物類中賽治對藥物類中賽治對131I吸收、排泄的影響較小。吸收、排泄的影響較小。u提倡聯(lián)合治療，綜合治療。提倡聯(lián)合治療，綜合治療。觀念更新觀念更新適應(yīng)證適應(yīng)證對兒童應(yīng)該用甲巰咪唑治療對兒童應(yīng)該用甲巰咪唑治療1-2年，對年，對10歲以上的少歲以上的少年而言放射治療、手術(shù)或抗甲狀腺藥物都可以選擇。年而言放射治療、手術(shù)或抗甲狀腺藥物都可以選擇。Radioiodine Therap

43、y for HyperthyroidismRadioiodine Therapy for HyperthyroidismDouglas S. Ross, M.D. N Engl J Med 2011;364:542-50Douglas S. Ross, M.D. N Engl J Med 2011;364:542-50131131I I治療在很小的治療在很小的兒童兒童(5(5歲歲) )中應(yīng)避免中應(yīng)避免。131131I I劑量經(jīng)劑量經(jīng)計算所得計算所得10 mCi150 Ci150 Ci，可接受可接受131131I I 治療。治療。若恰當(dāng)使用，放射碘在兒科若恰當(dāng)使用，放射碘在兒科GD患者是有效的治

44、療手患者是有效的治療手段。段。Rivkees SA, Sklar C, Freemark M 1998 Clinical review 99: The management of Graves disease in children,with special emphasis on radioiodine treatment. J Clin Endocrinol Metab. 83:3767-3776Levy WJ, Schumacher OP, Gupta M 1988 Treatment of childhood Graves disease. A review with emphasis

45、 on radioiodine treatment. Cleve Clin J Med. 55:373-382.國外學(xué)者觀點(diǎn)國外學(xué)者觀點(diǎn)經(jīng)經(jīng)131I治療的青少年患者，成年后生育情況與普通人群無異治療的青少年患者，成年后生育情況與普通人群無異研究結(jié)論：接受高劑量131I治療的青少年患者，其生育功能未受任何影響。Salil D. Sarkar, et al. Subsequent fertility and birth histories of children and adolescents treated with 131I for thyroid cancer. J Nuci Med,197

46、6,17:460-464.40例20歲及以下經(jīng)131I治療的青少年患者，電話隨訪成年后生育情況。A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves patients.Read CH Jr, Tansey MJ, Menda Y. J Clin Endocrinol Metab. 2004 Sep;89(9):4227-8. AbstractThis report details the 26- and 36-yr outcomes o

47、f 116 patients under the age of 20 yr with Graves disease who were treated with radioiodine between 1953 and 1973. Contacted by telephone and mail in 1991-1992, 107 of them supplied personal historical data, and their physicians furnished interval histories, physical examinations, and laboratory dat

48、a. This was repeated in 2001-2002, with 98 of them being contacted. At the time of treatment, the patients ages ranged between 3 yr, 7 months and 19 yr, 9 months. Six were less than 6 yr of age, 11 were between 6 and 11 yr, 45 were between 11 and 15 yr, and 45 were between 16 and 19 yr. The average length of fo