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目的探讨抗甲状腺药物(antIthyroId drugs,ATD)停药时间对Graves病患者甲状腺24小时摄131I率(24-h RAIU)及131I治疗效果的影响。方法 266例Graves病患者分为3组,未服药组60例,他巴唑组(MMI)137例,丙基硫氧嘧啶组(PTU组)69例。用药组按131I治疗前停药时间分为3-7d组、8-14d组、15-30d组。所有患者131I治疗前进行甲状腺RAIU及FT3、FT4的测定,131I治疗后随访6-24个月。结果 MMI组和PTU组各停药时间段24-h RAIU与未服药组无明显差异(P>0.05),而两组FT3及FT4值均低于未服药组(P<0.001)。MMI各停药时间组及停用PTU 8-30d者131I疗一次治愈率与未服药组比较无显著差异(P>0.05);但停用PTU 3-7d组其治愈率明显低于未服药组(P<0.05)。结论131I治疗前停用ATD至少3-7d甲状腺24-h RAIU已明显升高,FT3及FT4水平仍然较低,是适合131I治疗的最佳停药时间。131I疗前应用PTU会降低131I治疗疗效,MMI对131I疗效果影响不大。建议对131I疗前服用PTU的Graves病患者停药时间较短时应考虑增加131I的治疗剂量。
Objective To investigate the effects of anti-thyroid drugs (ATD) withdrawal time on thyroid 24-hour 131I (24-h RAIU) and 131I treatment in patients with Graves’ disease. Methods Two hundred and sixty-six patients with Graves’ disease were divided into three groups: 60 patients without medication, 137 patients with methimazole and 69 patients with propylthiouracil (PTU). Drug treatment group before treatment by 131I withdrawal time is divided into 3-7d group, 8-14d group, 15-30d group. All patients before 131I treatment of thyroid RAIU and FT3, FT4 determination, 131I treatment followed up 6-24 months. Results There was no significant difference between the MMI group and the PTU group in the 24-h RAIU and the untreated group (P> 0.05). The FT3 and FT4 values in the two groups were lower than those in the untreated group (P <0.001). There was no significant difference in the once cure rate of 131I treatment between MMI discontinuation group and PTU withdrawal 8-30d group (P> 0.05); however, the cure rate of PTU 3-7d group was significantly lower than that of non-medication group (P <0.05). Conclusions At least 3-7 days of ATD before 131I treatment is stopped, the thyroid 24-h RAIU has been significantly increased, FT3 and FT4 levels remain low, which is the best stopping time for 131I treatment. 131I application of PTU before treatment will reduce the therapeutic effect of 131I, MMI 131I treatment effect is not affected. Proposed 131I treatment of patients with Graves disease before taking PTU withdrawal should be considered to increase the therapeutic dose of 131I.