ABSTRACT
[Abstract] Objective To evaluate the safety and long-term results of131I therapy without antithyroid drug (ATD) pretreatment for patients with severe hyperthyroidism (SH). Methods Clinical data of 637 patients with SH, admitted in the Department of Nuclear Medicine, the former 307th Hospital of Chinese PLA from Jan. 1975 to Dec. 2014, treated with131I without ATD pretreatment and followed up for more than one year, were recruited in present study. SPSS 20.0 software was used to analyze the therapeutic efficacy, serum levels of thyroid hormone (TH) and thyroid therapeutic activity, etc. Results Based on the clinical characteristics, the 637 patients were divided into seven groups: severe thyroid dysfunction, thyrotoxic heart disease, complicated with severe liver dysfunction, complicated with large goiter, complicated with huge goiter, complicated with severe cytopenia, and complicated with thyrotoxic periodic paralysis, etc. Five hundred and Forty cases (84.8%) were cured, 53 cases (8.3%) with complete remission, and 44 cases (6.9%) with incomplete remission. Hypothyroidism was noted in 363 cases (57.0%). No significant clinical worsening was found in 637 patients after131I therapy. The thyroid hormones (TH) level returned to normal within 12 months after131 I therapy in 510 patients (80.1%). The efficacy of131I therapy was closely correlated to the administered activity of131I. The dose of131 I therapy was 2.59 to 11.11MBq per gram of thyroid with an average of (3.82±0.80)MBq, and the total131I activity administrated for the individuals was 85.1-3496.5MBq with an average of (447.7±407.0)MBq. The cure rate after one dose of131I therapy was 81.8%. The serum TH level was decreased significantly in patients with severe jaundice by lithium carbonate prescribed shortly before and after131I therapy. The131I therapy instead of surgical treatment is safe and effective for those patients complicated with huge goiter and heart disease and unsuitable for surgery.131I therapy does not affect fertility, and there have been 57 patients who have given birth of 59 healthy babies. Conclusion131I therapy without ATD pretreatment is safe and effective for patients with SH. Based on comprehensive treatment, the individualized131I therapy for such patients should be considered as early as possible.