甲状腺功能亢进症的放射性碘治疗

佳琪 杨(承德医学院研究生学院，中国;保定市第一中心医院，中国;)
贺松 李(保定市第一中心医院，中国;)
沛璇 姚(承德医学院研究生学院，中国;)
曼 唐(保定市第一中心医院，中国;)
永昌 席(保定市第一中心医院，中国;)

摘要

本文综述了近年来甲状腺功能亢进症放射性碘（RAI）治疗的研究进展。RAI 作为甲亢主要治疗方式之一，在治愈率和复发率上显著优于抗甲状腺药物（ATDs），但易导致永久性甲状腺功能减退，且可能增加 Graves 眼病风险。剂量策略方面，固定剂量与个体化计算剂量存在争议，美国和欧洲甲状腺协会指南立场不同，两种方案成功率相近，但计算剂量可减少辐射暴露。长期安全性研究显示，RAI 可能增加脑血管事件及继发性恶性肿瘤风险，虽绝对风险低，但需重视长期管理。目前 RAI 治疗正从单纯追求治愈转向个体化风险 - 获益评估，未来需更多研究明确长期影响及优化方案。

关键词

甲亢；放射性碘治疗；抗甲状腺药物

参考

许波进, 彭文芳, 黄珊. 2022版《中国甲状腺功能亢进症和其他原因所致甲状腺毒症诊治指南》解读[J/OL]. 外科理论与实践, 2023, 28(6): 512-519.

何双涛, 张进安. 甲状腺功能亢进的三种治疗方法选择[J/OL]. 上海医药, 2016, 37(2): 11-13, 23.

CHEN D Y, JING J, SCHNEIDER P F, et al. Comparison of the long-term efficacy of low dose 131I versus antithyroid drugs in the treatment of hyperthyroidism[J/OL]. Nuclear Medicine Communications, 2009, 30(2): 160-168[2025-08-06].

WANG J, QIN L. Radioiodine therapy versus antithyroid drugs in Graves’ disease: a meta-analysis of randomized controlled trials[J/OL]. The British Journal of Radiology, 2016, 89(1064): 20160418[2025-08-06].

MA C, XIE J, WANG H, et al. Radioiodine therapy versus antithyroid medications for Graves’ disease[J/OL]. Cochrane Database of Systematic Reviews, 2016, 2016(2)[2025-08-06].

AZIZI F. A New Perspective in the Management of Graves’Hyperthyroidism[J/OL]. International Journal of Endocrinology and Metabolism, 2020, 18(Suppl)[2025-08-06].

KENDALL-TAYLOR P, KEIR M J, ROSS W M. Ablative radioiodine therapy for hyperthyroidism: long term follow up study.[J/OL]. BMJ, 1984, 289(6441): 361-363[2025-08-06].

Blair A L T , Lowe D C , Hadden D R ,et al.Long term follow up of patients treated for hyperthyroidism with low dose radioactive iodine.[J].Ulster Medical Journal, 1980, 49(1):71.

SMITH R N, WILSON G M. Clinical trial of different doses of 131-I in treatment of thyrotoxicosis.[J/OL]. BMJ, 1967, 1(5533): 129-132[2025-08-06].

Li JF, Xie LJ, Qin LP, et al. Development of hypothyroidism over 13 years of follow-up of patients with hyperthyroidism after radioiodine therapy. Hell J Nucl Med. 2022;25(1):26-31.

RADHI H. Efficacy of a single fixed 131I dose of radioactive iodine for the treatment of hyperthyroidism[J/OL]. Endocrinology and Disorders, 2019, 3(2): 01-12[2025-08-06].

WONG K K, SHULKIN B L, GROSS M D, et al. Efficacy of radioactive iodine treatment of graves’ hyperthyroidism using a single calculated 131I dose[J/OL]. Clinical Diabetes and Endocrinology, 2018, 4(1): 20[2025-08-06].

FANNING E, INDER W J, MACKENZIE E. Radioiodine treatment for graves’ disease: a 10-year Australian cohort study[J/OL]. BMC Endocrine Disorders, 2018, 18(1): 94[2025-08-06].

LESLIE W D, WARD L, SALAMON E A, et al. A Randomized Comparison of Radioiodine Doses in Graves’ Hyperthyroidism[J/OL]. The Journal of Clinical Endocrinology & Metabolism, 2003, 88(3): 978-983[2025-08-06].

Bydder S .Controversy in thyroid disease.[J].Journal of the Royal College of Physicians of London, 2000, 34(6):502.

DE ROOIJ A, VANDENBROUCKE J P, SMIT J W A, et al. Clinical outcomes after estimated versus calculated activity of radioiodine for the treatment of hyperthyroidism: systematic review and meta-analysis[J/OL]. European Journal of Endocrinology, 2009, 161(5): 771-777[2025-08-06].

VAN ISSELT J W, DE KLERK J M H, LIPS C J M. Radioiodine treatment of hyperthyroidism: fixed or calculated doses; intelligent design or science?[J/OL]. European Journal of Nuclear Medicine and Molecular Imaging, 2007, 34(11): 1883-1884[2025-08-06].

ROSS D S, BURCH H B, COOPER D S, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis[J/OL]. Thyroid, 2016, 26(10): 1343-1421[2025-08-06].

MARIANI G, TONACCHERA M, GROSSO M, et al The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders, Part 1: Hyperthyroidism[J/OL]. Journal of Nuclear Medicine, 2021, 62(3): 304-312[2025-08-06].

MILLER C, AL-JABRI A, O’MURCHADA L, et al. Use of a dosimetry-based RAI protocol for treatment of benign hyperthyroidism optimises response while minimising exposure to ionising radiation[J/OL]. Clinical Endocrinology, 2024, 100(6): 585-592[2025-08-06].

ALLAHABADIA A, DAYKIN J, SHEPPARD M C, et al. Radioiodine Treatment of Hyperthyroidism—Prognostic Factors for Outcome[J].

LA COUR J L, JENSEN L T, VEJ-HANSEN A, et al. Radioiodine therapy increases the risk of cerebrovascular events in hyperthyroid and euthyroid patients[J/OL]. European Journal of Endocrinology, 2015, 172(6): 771-778[2025-08-06].

WONG C L, TAM H K V, FOK C K V, et al. Thyrotoxic Atrial Fibrillation: Factors Associated with Persistence and Risk of Ischemic Stroke[J/OL]. Journal of Thyroid Research, 2017, 2017: 1-11[2025-08-06].

FRANKLYN J A, MAISONNEUVE P, SHEPPARD M C, et al. Mortality after the Treatment of Hyperthyroidism with Radioactive Iodine[J/OL]. New England Journal of Medicine, 1998, 338(11): 712-718[2025-08-06].

PENG C C H, LIN Y J, LEE S Y, et al. MACE and Hyperthyroidism Treated With Medication, Radioactive Iodine, or Thyroidectomy[J/OL]. JAMA Network Open, 2024, 7(3): e240904[2025-08-06].

EVRON J M, ESFANDIARI N H, PAPALEONTIOU M. Cancer incidence and mortality following treatment of hyperthyroidism with radioactive iodine[J/OL]. Current Opinion in Endocrinology, Diabetes & Obesity, 2020, 27(5): 323-328[2025-08-06].

HALL P, BERG G, BJELKENGREN G, et al. Cancer mortality after iodine-131 therapy for hyperthyroidism[J/OL]. International Journal of Cancer, 1992, 50(6): 886-890[2025-08-06].

SPARANO C, MOOG S, HADOUX J, et al. Strategies for Radioiodine Treatment: What’s New[J/OL]. Cancers, 2022, 14(15): 3800[2025-08-06].

METSO S, JAATINEN P, HUHTALA H, et al. Increased Cardiovascular and Cancer Mortality after Radioiodine Treatment for Hyperthyroidism[J/OL]. The Journal of Clinical Endocrinology & Metabolism, 2007, 92(6): 2190-2196[2025-08-06].

DOI: http://dx.doi.org/10.12345/yzlcyxzz.v8i8.30655