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Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2019 January-February;178(1-2):9-18

DOI: 10.23736/S0393-3660.17.03708-1

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Prognostic factors analysis for a calculated dose of 131I therapy in Graves’ disease in China

Wan-Jun ZHAO 1, Qing-Guo LV 2, Yuan FEI 3, Zhen ZHAO 4, Yu-Wei ZHANG 2

1 Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China; 2 Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, China; 3 West China School of Clinical Medicine, Sichuan University, Chengdu, China; 4 Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China



BACKGROUND: The aim of this paper is to share our experience with a calculated dose 131I therapy in Graves’ disease and investigate the prognostic factors influencing the successful outcomes by retrospective review analysis of patients’ records.
METHODS: We retrospectively evaluated 201 patients with diagnosed Graves’ disease treated with 131I therapy. Patients took calculated dose of 131I based on gland size, iodine uptake rate and turnover. With more than 12 months follow-up, clinical characteristics were analyzed, and prognostic factors of successful outcome or hypothyroidism were demonstrated.
RESULTS: After 131I treatment, the rate of hypothyroidism, euthyroidism, partial remission and recurrence was 28.4%, 52.7%, 11.5% and 7.5%, respectively. Duration of disease longer than 1 year (OR=3.561), markedly enlarged thyroid size (OR=2.776), high 24-hour 131I uptake rate (OR=1.948), presence of exophthalmos (OR=2.296) and higher pre-treatment serum fT4 concentration (OR=1.026) were all found to be adverse prognostic factors for successful outcome of 131I therapy. Additionally, abnormal liver function (OR=2.857) and positive TPOAb (OR=1.876) would contribute to the happening of hyperthyroidism in successful outcome, while female (OR=0.457), markedly enlarged thyroid size (OR=0.339) and higher 24-hour 131I uptake rate (OR=0.485) would decrease the happening of hyperthyroidism.
CONCLUSIONS: The adverse prognostic factors of successful outcome of 131I therapy was duration of disease longer than 1 year, markedly enlarged thyroid, high 24 131I uptake rate, presence of exophthalmos, and high pre-treatment serum fT4 concentration. Female sex, markedly enlarged thyroid, and high 24-hour 131I uptake rate would decrease the risk of hypothyroidism.


KEY WORDS: Prognosis - Iodine-131 - Graves disease

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