摘要
目的了解131碘(^(131)I)治疗甲状腺功能亢进症(甲亢)后,早期口服左甲状腺素钠片对早发甲状腺功能减退症(甲减)的影响及临床价值。方法选取2015年7月至2016年7月该院甲状腺专科门诊收治的采用^(131)I治疗的格雷夫斯甲亢患者209例,按照抛币法将正面分为研究组(92例),反面分为对照组(117例)。研究组于一次性^(131)I治疗后第31天起口服左甲状腺素钠片25μg/d,连续30 d后停药;对照组只予以^(131)I治疗。分别测定并比较2组患者治疗后3、6、12个月游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、促甲状腺激素(TSH)、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化酶抗体(TPoAb)、促甲状腺受体抗体(TRAb)水平。结果研究组患者治疗后3、6、12个月FT_3、FT_4水平均稍高于对照组,但差异均无统计学意义(P>0.05);治疗后12个月TSH水平明显低于对照组,差异有统计学意义(P<0.05)。研究组患者治疗后3个月复查甲亢发生率稍高于对照组,但差异无统计学意义(P>0.05);6、12个月复查甲亢发生率与对照组比较,差异均无统计学意义(P>0.05)。研究组患者治疗后3、6个月早发甲减发生率均低于对照组,尤其是治疗后12个月早发甲减发生率明显低于对照组,差异均有统计学意义(P<0.05)。研究组患者治疗后3、6、12个月复查TPoAb、TgAb水平均明显低于对照组,差异均有统计学意义(P<0.05);治疗后3个月复查TRAb阴性率明显高于对照组,差异有统计学意义(P<0.05),治疗后6、12个月复查TRAb阴性率与对照组比较,差异均无统计学意义(P>0.05)。结论早期口服小剂量左甲状腺素钠片可减轻受到辐射的甲状腺组织进一步损伤而降低早发甲减发生率。
Objective To understand the effect and clinical value of early oral levothyroxine sodium tablets on early h-ypothyroidism after^131I treating hyperthyroidism. Methods Totall 209 cases of Graves hyperthyroidism treated by^131I in thethyroid department of this hospital from July 2015 to July 2017 were selected and divided into the study group（92 cases）andcontrol group（117 cases）according to the front side and reverse side by throwing coins method. The study group began to orallytake levothyroxine sodium tablets 25 μg/d on 31 d after once^131I treatment for continuous 30 d and got drug withdrawal;whilethe control group was given only^131I treatment. The levels of FT3,FT4,TSH,TgAb,TPoAb and TRAb at 3,6,12 months aftertreatment were detected and compared. Results The FT3 and FT4 levels at 3,6,12 months after treatment in the study groupwere slightly higher than those in the control group,the difference had no statistical significance（P〉0.05）;the TSH level at 12 months after treatment in the study group was significantly lower than that in the control group,the difference was statisticallysignificant（P〉0.05）.The hyperthyroidism occurrence rate at 3 months after treatment in the study group was slightly higherthan that in the control group,which showed no statistical difference（P〈0.05）;the hyperthyroidism occurrence rate at 6,12 months reexamination had no statistical difference between the study group and control group（P〉0.05）.The occurrence rate ofearly onset hypothyroidism after 3,6 months treatment in the study group was lower than that in the control group,especiallywhich at after 12 month treatment in the study group was significantly lower than that in the control group,the difference wasstatistically significant（P〈0.05）.The TPoAb and TgAb levels at 3,6,12 months after treatment in the study group were signifi-cantly lower than those in the control group,the difference was statistically significant（P〈0.05）;the TRAb negative rate at 3 months after treatment in the study group was significantly higher than that in the control group and the difference was statisti-cally significant（P〈0.05）,the TRAb negative rate at 6,12 months after treatment had no statistical difference between thestudy group and control group（P〉0.05）. Conclusion Early orally taking a small dose of levothyroxine sodium tablets can alle-viate the further injury of irradiated thyroid tissue,thus reduces the occurrence rate of early onset hypothyroidism.
作者
谢志君
尤真明
李立
XIE Zhijun;YOU Zhenming;LI Li(Department of Thyroid,Chongqing Municipal Wansheng Economic and Technological Development District People＇s Hospital,Chongqing 400800,China)
出处
《现代医药卫生》
2018年第18期2792-2794,2797,共4页
Journal of Modern Medicine & Health
基金
重庆市卫生和计划生育委员会基金项目(2015ZBXM076)
作者简介
谢志君（1972-）,本科,副主任医师,主要从事内分泌（核医学）临床工作
