Efficacy of clinical immunology intervention for patients with glucocorticoid refractory subacute thy-roiditis / 中华核医学与分子影像杂志

ABSTRACT

Objective To assess the efficacy and clinical value of immunoglobulin combined with interferon ( IFN) α-2b in treatment of patients with glucocorticoid refractory subacute thyroiditis. Methods Thirty-five cases of subacute thyroiditis (12 males, 23 females, age (58.1±12.0) years) from January 2016 to May 2017 were retrospectively analyzed. Patients were resistant to the treatment of glucocorticoid and as-pirin, or were not suitable for that treatment because of accompany diseases. Thirty-four healthy controls (16 males,18 females, age (57.0±10.0) years) were included. Thyroid hormone, C-reactive protein (CRP), erythrocyte sedimentation rate ( ESR) and 24 h iodine uptake rate tests, as well as 99 Tcm O-4 thyroid imaging and thyroid ultrasonography were performed before and after co-administration of immunoglobulin and IFNα-2b. Paired t test or Wilcoxon signed rank test, two-sample t test or Wilcoxon rank test were used for data anal-ysis. Results The levels of free triiodothyronine ( FT3 ) , free thyroxine ( FT4 ) and thyroid stimulating hor-mone ( TSH) 4 weeks after immunology intervention were restored compared with the levels before treatment ( t4.81, 7.76, z=4.60, all P<0.01) and were not significantly different compared with those in the con-trol group ( t0.02, 0.33, z=0.37, all P>0.05) . CRP and ESR were sharply decreased compared to those before treatment (t9.59, 13.78, both P<0.01). The 24 h iodine uptake rate was restored 4 weeks after treatment (t=13.92, P<0.01). The positive result was found in 1 patient (2.9％, 1/35) by 24 h iodine uptake rate test, and 5.7％(2/35) of patients were positive in 99TcmO-4 static imaging and 1 patient(2.9％, 1/35) had positive ultrasonography result. The 3-month follow-up showed that 32 cases were cured and the treatment was effective in all 35 patients. Only 1 case recurred after 12-month follow-up, and the effective rate was 96.9％(31/32, 3 cases were lost to follow-up). Conclusion Immunology intervention is an effective way to treat glucocorticoid refractory subacute thyroiditis and should be applied extensively in clinical treatment.