Trakya Üniversitesi Nükleer Tıp Anabilim dalındaki hipertiroidi hastalarının 10 yıllık radyoaktif iyot tedavisi sonuçları
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Tarih
2002
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info:eu-repo/semantics/openAccess
Özet
Tîrotoksikoz FT3, FT4 veya her ikisinin serum konsantrasyonunun arttığı ve TSH'nın suprese olduğu durumlarla sonuçlanan hipermetabolizmanın yol açtığı klinik sendromdur. En sık rastlanan tipleri Graves hastalığı, toksik adenom ve toksik MNG'dır. Antitiroid ilaçlar, cerrahi ve radyoaktif iyot hipertiroidinin tedavisinde kullanılan yöntemlerdir. Hiçbir yöntem ideal değildir. Tedavi sonrası hipotiroidi ve yineleyen hipertiroidi riski taşırlar. Radyoaktif iyot tedavisi başlangıç veya yineleyen hastalığı olanlarda giderek artan sıklıkta kullanılır hale gelmektedir. Yetersiz doza bağlı hipertiroidinin kontrolünde gecikme ve uzun süreli takiplerde giderek artan hipotiroidi insidensi iki temel dezavantajıdır. Bizim çalışmamızda 1991-2001 yılları arasında T.Ü.T.F. Nükleer Tıp Anabilim dalında hipertiroidi nedeniyle takip edilen ve radyoaktif iyot tedavisi uygulanan 105 hasta retrospektif olarak incelendi. Sonuçlar hipertiroid, ötiroid ve hipotiroidi olarak değerlendirildi. 30'u erkek ve 75'i kadından oluşan 105 hasta diffüz guatr (Graves hastalığı), toksik nodüler guatr (hiperaktif adenom), toksik multinodüler guatr, multinodüler guatr, nodüler guatr olarak sınıflandırıldı. Hastaların 80'ine tek doz, 25'ine ise ikinci doz ve bunlardan sadece birine üçüncü doz uygulandı. Tek doz sonunda hastaların ötiroid olanlar %26.7, hipotiroid olanlar %20.9, hipertiroid kalanlar %52.4'tür. 25 hastaya ikinci doz uygulandığında ise, %30.5'u ötiroid ve %28.6'sı hipotiroid hale gelmiş olup, %40.9'u hipertiroid kalmıştır. İki doz sonucu hipotiroid hale gelen 30 hastanın (%28.6) 25'sı tiroksin tedavisi almakta olup, 4'ü subklinik hipotiroidiktir. Tiroksin replasman tedavisi hastaların 49 büyük çoğunluğuna ilk yıl içinde başlanmıştır. Birinci doz sonrası tiroksin tedavisine başlama süresi en erken 3. ay iken, tek doz ile hipotiroidi olan 22 hastanın 15'ine ilk yılda tedavi başlandı. İkinci doz sonucu hipotiroidi olan 8 hastanın en erken 2. ayda olmak üzere, 6'sına ilk yılda tedavi başlandı. Tek doz ile bu hastaların %47.6 'inin hipertiroidisi kontrol edilirken, ikinci dozda bu oran %59.1'ye yükselmiştir. Sonuç olarak; radyoaktif iyot tedavisinin sonucunda meydana gelen hipotiroidi komplikasyondan ziyade, hedeflenen bir sonuçtur ve kontrolü hipertiroidinin ilaçla kontrolünden daha kolaydır. Böylece hastaların takibini kolaylaşır ve doktoru ziyaret sıklığı azalır.
Thyrotoxicosis means of the clinical syndrome of hypermetabolism that results when the serum concentrations of free thyroxine (T4), free triiodinethyronine (T3), or both are increased and serum thyrotropin (TSH) is suppressed. Among the causes of thyrotoxicosis, Graves' disease, toxic adenoma and toxic multinodular goitre are most common. Three forms of therapy are available: antithyroid drugs, surgery and radioactive iodine. None of these is ideal and all share the same complications of recurrent hyperthyroidism and permanent hypothyroidism after treatment. Radioiodine is increasingly being recommend for the treatment of thyrotoxicosis, either as primary therapy or as treatment of a relapse that has followed a course an antithyroid drug. It has two main disadvantages a possible delay in control if an insufficient dose of radioiodine has been given and a cumulative incidence of hypothyroidism that necessitates long-term follow-up. In order to assess radioiodine therapy outcome in thyrotoxic patients, we performed a retrospective analysis of 105 patients over a 10-year period encompassing 1991 to 2001 in Trakya University Medical Faculty, Department of Nuclear Medicine. Clinical outcomes assessed included persistent hyperthyroidism, hypothyroidism and euthyroidism. 51 105 patients were enrolled, consisting of 75 females and 30 males. Patients divided into Graves' disease, toxic adenoma, toxic multinodular goitre, nodular goitre and multinodular goitre. Among patients treated with radioiodine, 80 received single dose, 25 received 2 doses, only one patient 3. doses. After radioiodine with single dose for hyperthyroidism, 26.7% were euthyroid, 52.4% were still hyperthyroid and 20.9% become hypothyroid. Among patients treated with second dose radioiodine 30.5% were euthyroid, 40.9% were still hyperthyroid and 28.6% become hypothyroid. Of 29 hypothyroid patients (28.6%) after second dose of radioiodine therapy, 25 patients receive thyroxine replacement and remaining 4 were still subclinicals biochemically hypothyroid. In 15 of 25 hypothyroid patients, thyroxine replacement had been started within first year after first dose of radioiodine therapy. In 8 patients who became hypothyroid after second dose, thyroxin replacement was started within first year (in one patients at second month) In our patient group; the hypothyroidism rate was 20.9% after single dose, and 28.6% after second dose. As a result hypothyroidism occurring after radioiodine therapy should be considered as a target rather than a complication, and its control is much more easier the control of hyperthyroidism. So the follow up the patients and their visits to the hospital decrease with then.
Thyrotoxicosis means of the clinical syndrome of hypermetabolism that results when the serum concentrations of free thyroxine (T4), free triiodinethyronine (T3), or both are increased and serum thyrotropin (TSH) is suppressed. Among the causes of thyrotoxicosis, Graves' disease, toxic adenoma and toxic multinodular goitre are most common. Three forms of therapy are available: antithyroid drugs, surgery and radioactive iodine. None of these is ideal and all share the same complications of recurrent hyperthyroidism and permanent hypothyroidism after treatment. Radioiodine is increasingly being recommend for the treatment of thyrotoxicosis, either as primary therapy or as treatment of a relapse that has followed a course an antithyroid drug. It has two main disadvantages a possible delay in control if an insufficient dose of radioiodine has been given and a cumulative incidence of hypothyroidism that necessitates long-term follow-up. In order to assess radioiodine therapy outcome in thyrotoxic patients, we performed a retrospective analysis of 105 patients over a 10-year period encompassing 1991 to 2001 in Trakya University Medical Faculty, Department of Nuclear Medicine. Clinical outcomes assessed included persistent hyperthyroidism, hypothyroidism and euthyroidism. 51 105 patients were enrolled, consisting of 75 females and 30 males. Patients divided into Graves' disease, toxic adenoma, toxic multinodular goitre, nodular goitre and multinodular goitre. Among patients treated with radioiodine, 80 received single dose, 25 received 2 doses, only one patient 3. doses. After radioiodine with single dose for hyperthyroidism, 26.7% were euthyroid, 52.4% were still hyperthyroid and 20.9% become hypothyroid. Among patients treated with second dose radioiodine 30.5% were euthyroid, 40.9% were still hyperthyroid and 28.6% become hypothyroid. Of 29 hypothyroid patients (28.6%) after second dose of radioiodine therapy, 25 patients receive thyroxine replacement and remaining 4 were still subclinicals biochemically hypothyroid. In 15 of 25 hypothyroid patients, thyroxine replacement had been started within first year after first dose of radioiodine therapy. In 8 patients who became hypothyroid after second dose, thyroxin replacement was started within first year (in one patients at second month) In our patient group; the hypothyroidism rate was 20.9% after single dose, and 28.6% after second dose. As a result hypothyroidism occurring after radioiodine therapy should be considered as a target rather than a complication, and its control is much more easier the control of hyperthyroidism. So the follow up the patients and their visits to the hospital decrease with then.
Açıklama
Anahtar Kelimeler
Hipertiroid, İyot Tedavisi
