[1]冯菲,赵德善.131I治疗青少年儿童甲状腺功能亢进症[J].国际放射医学核医学杂志,2009,33(3):171-174,183.[doi:10.3760/cma.j.issn.1673-4114.2009.03.011]
　FENG Fei,ZHAO De-shan.The treatment of hyperthyroidism in adolescents and children with 131I[J].International Journal of Radiation Medicine and Nuclear Medicine,2009,33(3):171-174,183.[doi:10.3760/cma.j.issn.1673-4114.2009.03.011]
点击复制

131I治疗青少年儿童甲状腺功能亢进症(/HTML)
分享到：

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

卷:
33
期数:
2009年第3期
页码:
171-174,183
栏目:
核素治疗
出版日期:
1900-01-01

文章信息/Info

Title:
The treatment of hyperthyroidism in adolescents and children with 131I
作者:
冯菲;  赵德善
山西医科大学第一医院核医学科, 太原 030001
Author(s):
FENG Fei;  ZHAO De-shan
Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan 030001, China
关键词:
甲状腺功能亢进症; 青少年; 儿童; 碘放射性同位素; 近距离放射疗法
Keywords:
Hyperthyroidism; Iodine radioisotopes; Brachytherapy Adolescents; Children
DOI:
10.3760/cma.j.issn.1673-4114.2009.03.011
摘要:
甲状腺功能亢进症(甲亢)是青少年和儿童常见的内分泌疾病,影响青少年和儿童各个系统的发育成熟,特别是骨骼系统和神经系统,其自然缓解率低,需要采取积极、安全、有效的治疗方法。抗甲状腺药物(ATD)、甲状腺次全切除术和131I治疗是治疗青少年和儿童甲亢的三种方法。ATD常为内科医师的首选,但其治疗缓解率较低,服药时间长,停药后复发率高,并且其不良反应在青少年和儿童比成年人多见;甲状腺切除术的成功率和并发症与手术医师的技术水平有极大的关系,且术后颈部会留有瘢痕;131I用于甲亢治疗已经有60余年,数千名青少年和儿童患者接受过此治疗,到目前为止未发现治疗后甲状腺癌及其他恶性肿瘤的发病率、患者的生育率、流产率和后代畸形率等与普通人群有明显差别,其治疗缓解率高,不良反应少,可以作为对ATD效果不佳、有服药禁忌证或服药后出现不良反应的青少年和儿童甲亢治疗的首选。131I治疗甲亢后最常见的转归是甲减,可给予甲状腺激素替代治疗,但因青少年和儿童对甲状腺激素的依赖性大,对射线的敏感性强,宜采用小剂量131I以达到理想控制。
Abstract:
Hyperthyroidism in adolescents and children is a common endocrinium disorder, which disturbs the development of diverse body systems, especially of skeletal and central nervous systems. The patients with hyperthyroidism have a lower long-term, spontaneous remission of the disease. The majority of adolescents and children patients with hyperthyroidism have to receive an effective, safe therapy. Currently, there are three methods for treating hyperthyroidism. They include in antithyroid drugs (ATD), surgery and radioactive iodine (131I) therapy. ATD always is the first line way to these patients with hyperthyroidism for endocrinologist yet. But the remission rate of hyperthyroidism for ATD is lower, the remission of hyperthyroidism also need spend longer time, and side effects of ATD are more common in adolescents and children than in adult. The success ratio and complications of surgery are mainly depended on the technic of surgeons, 131I has been used as the treatment of hyperthyroidism for more than six decades. So far, there are still no enough evidences to show that the incidence of thyroid cancer and other malignant diseases, the patients’ fertility rate, rate of abortion and malformation of descendants in hyperthyroidism patients following 131I were marked difference with that in other people. The remission rate of hyperthyroidism following 131I was higher and its side effects were less. 131I therapy can be the first choice to adolescents and children with hyperthyroidism who are no suitable to ATD therapy. Hypothyroidism is most often one outcome of pediatric patients with hyperthyroidism after 131I therapy. Hence, the patients with hypothyroidism have to receive the replacement treatment of thyroxine. Since the development of adolescents and children are more dependent on thyroxine and adolescents and children are more sensitive to the radioactive rays than adults, it is more suitable to get ideal control with a relative lower dosage of 131I to adolescents and children with hyperthyroidism.

参考文献/References:

[1] Lazar L, Kaher-Leiboviei O, Pertzelan A, et al. Thyrotoxicosis in prepubertal children compared with pubertal and postpuberlal patients. J Clin Endocrinol Metab, 2000, 85(10):3678-3682.
[2] Weetman AP. Graves’ hyperthyroidism:how long should antithyroid drug therapy be continued to achieve remission?. Nat Clin Pract Endocrinol Metab, 2006, 2(1):2-3.
[3] Rivkees SA, Sklar C, Frecmark M. Clinical review 99:The management of Graves’ disease in children, with special emphasis on radioiodine treatment. J Clin Endncrinol Metab. 1998, 83(11):3767-3776.
[4] Sugino K, Ito K, Mimura T, et al. Surgical treatment of Craves’ disease in children. Thyorid, 2004, 14(6):447-452.
[5] Toohey RE, Stabin MG. Comparative analysis of dosimelry parameters for nuclear medicine. ORISE Re:port 99-1064, 1999:Proceedings of the Sixth International Radiopharmaceutical Dosimetry Symposium. Gatlinburg. 1996:532-547.
[6] Boice Jr JD. Radiation-induced thyroid cancer-what’s new?. J Natl Cancer Inst, 2005, 97(10):703-705.
[7] Boice Jr JD. Thyroid disease 60 years after Hiroshima and 20 years after Chernobyl. JAMA, 2006, 295(9):1060-1062.
[8] Davis S, Kopecky KJ, Hamilton TE, et al. Thyroid neoplasia, autoimmune thyroiditis, and hypothyroidism in persons exposed to iodine 131 from the hanford nuclear site. JAMA, 2004, 292(21):2600-2613.
[9] Read CH Jr, Tansey M J, Menda Y. A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves’ patients. J Clin Endocrinol Metab. 2004, 89(9):4229-4233.
[10] Dickman PW, Holm LE, Lundell G, et al. Thyroid cancer risk after thyroid examination with 131I:a population-based cohort study in Sweden. Int J Cancer, 2003, 106(4):580-587.
[11] Krassas GE, Laron Z. A questionnaire survey concerning the most favourable treatment for Graves’ disease in children and adolescents. EurJ Endocrinol, 2004, 151(1):155-156.
[12] 赵德善,孔繁振,司宏伟,等.儿童和青少年甲状腺功能亢进症的131Ⅰ治疗.中华内分泌代谢杂志,2006,22(6):566-568.
[13] De-Shan Zhao, Fei Feng, Fan-Zhert Kong, et al. Radioiodine treatment of hyperthyroidism in pediatric patients[J/OL]. J Nucl Med, 2009, 50(Supplement 2):1387[2009-00-00]. http://jnumedmtg.snmjournals.org/cgi/content/meeting_abstract/50/2_MeetingAbstracts/1387.
[14] Bartley GB, Fatourechi V, Kadrmas EF, et al. The incidence of Graves’ ophthalmopathy in Olmsted County, Minnesota. Am J Ophthalmol, 1995, 120(4):511-517.
[15] Wiersinga WM. Thyroid associated ophthalmopathy:pediatric and endocrine aspects. Pediatr Endocrinol Rev, 2004, 1(Suppl 3):513-517.
[16] Krassas GE, Gogakos A. Thyroid-associated ophthalmopathy in juvenile Graves’ disease-clinical, endocrine and therapeutic aspects. J Pediatr Endocrinol Metab, 2006, 19(10):1193-1206.
[17] Iarsen PR, Davies TF, Hay ID. The thyroid gland//Wilson JD, FosterD W, Kronenberg HM, et al. Williams text book of endocrinology. 9th, Philadelphia:WB Saunders, 1998:447-448.

相似文献/References:

[1]梁雯丽,郑艳,李娜,等.Graves甲亢患者131I治疗后早期TRAb及TSAb变化的研究分析[J].国际放射医学核医学杂志,2016,40(1):13.[doi:10.3760/cma.j.issn.1673-4114.2016.01.003]
　Liang Wenli,Zheng Yan,Li Na,et al.Analysis of the changes in early TRAb and TSAb after 131I treatment for patients with Graves hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(3):13.[doi:10.3760/cma.j.issn.1673-4114.2016.01.003]
[2]田琦,蒋宁一,郑丽.265例精细个体化131I治疗Graves甲亢的疗效观察[J].国际放射医学核医学杂志,2016,40(4):259.[doi:10.3760/cma.j.issn.1673-4114.2016.04.004]
　Tian Qi,Jiang Ningyi,Zheng Li.Therapeutic effect of fine individual 131I treatment on Graves disease hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(3):259.[doi:10.3760/cma.j.issn.1673-4114.2016.04.004]
[3]王越,晋建华,李思进,等.甲状腺24h摄碘率与131I治疗Graves甲亢疗效相关性研究[J].国际放射医学核医学杂志,2015,39(6):442.[doi:10.3760/cma.j.issn.1673-4114.2015.06.002]
　Wang Yue,Jin Jianhua,Li Sijin,et al.Correlation between thyroid 24 h of radioactive iodine uptake and clinical efficacy of 131I therapy for Graves’ hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(3):442.[doi:10.3760/cma.j.issn.1673-4114.2015.06.002]
[4]张丽花,蒋宁一.131I治疗Graves甲亢合并肝功能损害或血细胞减少的优势与风险[J].国际放射医学核医学杂志,2015,39(6):483.[doi:10.3760/cma.j.issn.1673-4114.2015.06.010]
　Zhang Lihua,Jiang Ningyi.The advantage and risk of 131I treatment in hyperthyroidism combined with liver injury or blood cell reduction[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(3):483.[doi:10.3760/cma.j.issn.1673-4114.2015.06.010]
[5]杨宝军.131I治疗甲亢合并特发性血小板减少性紫癜一例[J].国际放射医学核医学杂志,2015,39(6):511.[doi:10.3760/cma.j.issn.1673-4114.2015.06.017]
[6]郭坤,高蕊,于燕,等.表皮生长因子受体基因表达与甲状腺功能亢进症131I治疗预后的关系[J].国际放射医学核医学杂志,2015,39(1):4.[doi:10.3760/cma.j.issn.1673-4114.2015.01.003]
　Guo Kun,Gao Rui,Yu Yan,et al.The relationship between epidermal growth factor receptor mRNA expression and the efficacv of 131I treatment in hyperthyroidism patients[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(3):4.[doi:10.3760/cma.j.issn.1673-4114.2015.01.003]
[7]郑艳,赵德善,付松海,等.儿童和青少年Graves甲亢患者131Ⅰ治疗剂量的分析研究[J].国际放射医学核医学杂志,2013,37(2):69.[doi:10.3760/cma.j.issn.1673-4114.2013.02.002]
　ZHENG Yan,ZHAO De-shan,FU Song-hai,et al.The dose analysis of 131Ⅰ treatment in pediatric patients with Graves hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2013,37(3):69.[doi:10.3760/cma.j.issn.1673-4114.2013.02.002]
[8]张瑞国,秦岚,张又萍,等.初诊Graves甲亢合并肝损害及其影响因素的临床分析[J].国际放射医学核医学杂志,2013,37(5):283.[doi:10.3760/cma.j.issn.1673-4114.2013.05.008]
　ZHANG Rui-guo,QIN Lan,ZHANG You-ping,et al.Clinical study of hepatic dysfunction and its correlative factors in newly diagnosed patients with Graves hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2013,37(3):283.[doi:10.3760/cma.j.issn.1673-4114.2013.05.008]
[9]黄春玲,查金顺,蒋婷吟.甲状腺功能亢进症患者血浆中TNF-α1和IL-2水平的临床分析[J].国际放射医学核医学杂志,2012,36(2):92.[doi:10.3760/cma.j.issn.1673-4114.2012.02.008]
　HUANG Chunling,ZHA Jin-shun,JIANG Ting-yin.The clinical analysis of the TNF-α1 and IL-2 levels in patients with hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2012,36(3):92.[doi:10.3760/cma.j.issn.1673-4114.2012.02.008]
[10]牟联超,李先映,石彩虹.131I治疗青少年Graves病58例临床分析[J].国际放射医学核医学杂志,2010,34(5):299.[doi:10.3760/cma.j.issn.1673-4114.2010.05.013]
　MU Lian-chao,LI Xian-ying,SHI Cai-hong.Analyze of 131I therapy on 58 youngsters with Graves’ disease[J].International Journal of Radiation Medicine and Nuclear Medicine,2010,34(3):299.[doi:10.3760/cma.j.issn.1673-4114.2010.05.013]

备注/Memo

备注/Memo:
收稿日期:2008-12-23
通讯作者:赵德善,E-mail:deshanzh@hotmail.com
更新日期/Last Update: 1900-01-01