摘要:目的探讨放射性131I代替手术治疗甲状腺功能亢进(甲亢)伴巨大甲状腺肿的可能性.方法 82例甲亢,女51例,男31例,平均年龄35岁(11~75).均有典型甲亢临床表现及生化异常.131I疗后随访3~38个月,根据有无结节分为两组,一组为43例弥漫性巨大甲肿伴甲亢,另一组为39例结节性巨大甲肿伴甲亢.应用触诊结合核素甲状腺显像确定甲状腺重量.本组核素显像未发现冷结节.根据治疗史、甲状腺大小、甲状腺摄131I率、症状体征及病程等确定服131I剂量.76例患者(92.7%)为Ⅲ°甲状腺肿,甲状腺肿估重150~200克者67例,201~300克者13例,400~500克者2例.一次131I疗者71例(86.6%),两次131I疗者10例(12.2%),三次131I疗者1例(1.2%),平均首剂服131I量为1452.62±726.31MBq(39.26±19.63mCi),范围为518~4810MBq(14~130mCi).平均首剂每克甲状腺组织投131I量为5.25±1.18MBq(142.89±32.29μCi),范围为2.18~7.40MBq(59~200μCi).结果至随访时止,24例(29.3%)完全缓解,19例(23.2%)部分缓解,39例(47.6%)甲状腺功能减退(甲减),其中永久性甲减8例(9.7%);一过性甲减11例(13.4%);17例(20.7%)因随访时间不足一年尚不能确定为一过性或永久性甲减.43例(52.4%)131I疗后其巨大甲肿完全消退,34例(41.5%)为Ⅰ°甲肿,2例(2.4%)为Ⅱ°甲肿,Ⅲ°甲肿者仅1例(1.2%).结论 131I是治疗甲亢伴巨大甲肿的安全有效的治疗方法,如果核素显像不伴冷结节,本法可以代替手术治疗.%Objectives This retrospective analysis is to study the effects of radioiodine in hyperthyroidism with large goitre and observe the possibility to take the place of surgery. Methods 82 patients (pts) with hyperthyroidism including 51 female and 31 male, age ranging from 11 to 75 years old (mean 35.43±12.14), were treated with 131I. All patients presented with typical clinical and biochemical hyperthyroidism and were followed up for 3~38 months after 131I treatment. Patients were categorized into 2 diagnostic groups: Graves disease (43 pts) and toxic multinodular goitres (39pts). Gland weights were estimated by palpation and scintigraphy. Cold nodule had not been found in scintigraphy in all pts. The dose in mCi administered were determined according to therapeutic history, thyroid weight (g), rate of uptake 131I, patient's symptoms and course of disease, etc. 76 pts (92.7%) had III degree goitre. Goitre weight was stratified into 150~200 g (67 pts), 201~300 g (13 pts) and 400~500 g (2pts). 71 pts (86.6%) were given one dose of 131I, 10pts (12.2%) two doses, one patient had three doses. The mean first dose was 39.26±19.63mCi (14~130 mCi).The mean first μCi/g was 142.89±32.29μCi (59~200).Results 24 pts (29.3%) had complete remission (euthyroid), 19 pts (23.2%) had partial resolution. 39(47.6%) pts had hypothyroidism (HP) including 8 permanent HP, 11 transient HP,3 subclinical HP and 17 indeterminate HP. The later group had HP that could not be decided to be transient or permanent because the time of following up was less than one year. After 131I therapy, goitres of 43 pts (52.4%) became 0 degree, 34 pts (41.5%) became I degree, 4 pts (4.9%) had II degree and only one pt still had a III degree goitre.Conclusions 131I therapy is a safe and effective method for treating hyperthyroidism with large goitre. If the large goitre does not have cold nodule in scintigraphy, 131I treatment may replace surgery.