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《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:: 35
期数:: 2011年第2期

页码:: 93-99

栏目:: 临床核医学

出版日期:: 1900-01-01

文章信息/Info

Title:: Application of lithium carbonate on radioiodine treatment of Graves’ hyperthyroidism

作者:: 查金顺¹; 黄春玲¹; 蒋婷吟¹; 蒋艳²; 1. 362000 泉州, 福建医科大学附属第二医院核医学科;
2. 362000 泉州, 福建医科大学附属第二医院图书馆

Author(s):: ZHA Jin-shun¹; HUANG Chun-ling¹; JIANG Ting-yin¹; JIANG Yan²; Department of Nuclear Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China

关键词:: 格雷夫斯病; 碘放射性同位素; 近距离放射疗法; 碳酸锂; 化学疗法; 辅助

Keywords:: Graves disease; Iodine radioisotopes; Brachytherapy; Lithium carbonate; Chemotherapy; adjuvant

DOI:: 10.3760/cma.j.issn.1673-4114.2011.02.007

摘要:: ¹³¹I治疗Graves甲状腺功能亢进症(甲亢)的有效性取决于其在甲状腺内的滞留时间,且受治疗前抗甲状腺药物使用、肿大甲状腺容积和甲状腺24 h摄碘率等因素的影响。锂具有阻止有机碘和甲状腺激素自甲状腺内释出的作用而不影响甲状腺对¹³¹I的摄取,因此,¹³¹I治疗Graves甲亢前后辅以短程、小剂量碳酸锂,具有提高甲状腺摄碘率、延长¹³¹I在甲状腺内的有效半衰期的作用。使用碳酸锂辅助¹³¹I治疗Graves甲亢可增加甲状腺的受照剂量,从而减少有效半衰期短的患者服用¹³¹I的最和全身放射性照射量,并改善甲亢治愈率。¹³¹I辅以碳酸锂短程治疗因甲状腺毒症得到快速控制并避免了因¹³¹I治疗前抗甲状腺药物停用、不能耐受或无效的患者短期甲状腺毒症的恶化,和防止¹³¹I治疗后血清甲状腺激素水平短期升高,而被认为是有益的。另外,就快速控制甲亢而言,不管甲状腺肿的大小,碳酸锂均可增强¹³¹I治疗的有效性,同时也可提高巨大甲状腺肿患者甲亢的永久控制率。由于碳酸锂有助于预防放射性碘相关的血清游离甲状腺激素浓度的升高并可加强甲状腺毒症的控制,这对年长、严重甲亢、有心血管疾病或其他严重非甲状腺疾病基础的高危患者来说特别重要,因为,即便是甲状腺毒症的一个短暂恶化,也可能导致严重的后果。¹³¹I治疗Graves甲亢前后辅以小剂量碳酸锂治疗安全有效。

Abstract:: Effectiveness of radioiodine for Graves’ hyperthyroidism depends on retention time of ¹³¹I in the thyroid, and may be effected by several factors, including previous treatment with antithyroid drugs,goiter volume, 24 h thyroidal radioactive iodine uptake and so on. A short course of therapy with low dose of lithium carbonate increased retention of ¹³¹I in the thyroid and prolong the intrathyroidal effective half-life of ¹³¹I before and after ¹³¹I therapy in patients with Graves’ disease, because of the actions that lithium blocks the release of organic iodine and thyroid hormone from the thyroid gland without affecting thyroidal radioactive iodine uptake. Therefore, using lithium as adjunct to radioiodine therapy increases the radiation dose delivered to the thyroid, to result in reduced the activity required and whole-body radiation dose in patients with very short effective half-life, and so improve the cure rate of hyperthyroidism. A short course of lithium carbonate therapy can be considered a useful adjunct to ¹³¹I therapy for obtaining a more rapid control of thyrotoxicosis and avoiding its transient exacerbation because of methimazole withdrawal prior to ¹³¹I administration or in patients who cannot tolerate or do not respond to antithyroid drugs, and for helping to prevent the radioiodineassociated increase in serum free thyroid hormone concentrations. In addition, lithium carbonate enhances the effectiveness of ¹³¹I therapy, in terms of prompter control of hyperthyroidism in patients with small or large goiters. At the same time, lithium also may increases the rate of permanent control of hyperthyroidism in patients with large goiters. In summary, in the short-term lithium plays an important role as an adjunct to ¹³¹I,since it helps to prevent the ¹³¹I-associated increase in serum free thyroid hormone concentrations and allows a more prompt control of thyrotoxicosis. This is of particular importance in highrisk patients, such as the elderly,those with severe hyperthyroidism, underlying cardiovascular disorders, or other severe nonthyroidal illness for whom even a transient exacerbation of the thyrotoxicosis may be dangerous. Treatment with a relatively low dose of lithium before and after ¹³¹I therapy offers a safe and effective alternative means of controlling thyrotoxicosis in patients with Graves disease.

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备注/Memo

备注/Memo:: 收稿日期:2010-12-21。
通讯作者:查金顺,Email:zjs630805@126.com

更新日期/Last Update: 1900-01-01

《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

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