蒋宁一_共识解读2011.pptVIP

查资料。 * 查资料 * * 研究报道：并发有甲状腺功能亢进性心脏病的患者应用放射碘治疗作为单一方案治疗后并不使心脏症状加重。 Thyrocardiac Disease and Its Management with Radioactive Iodine I131 Clement Delit;Solomon Silver;Stephen B. Yohalem;Robert L. Segal. Abstract Hyperthyroidism was treated with I131 in 1,603 cases. These included cases of diffuse toxic goiter and nodular goiter with hyperthyroidism. There were 187 patients with congestive heart failure, 30 with angina pectoris, and 32 with combined angina pectoris and congestive failure. In addition, there were 107 patients with atrial fibrillation but without congestive failure or angina. Radioiodine was the only treatment used for the hyperthyroid state. The cardiac status was strikingly improved in all groups studied. The number of treatments and incidence of myxedema was almost the same for the cardiac and noncardiac patients. The total administered dose averaged 7.0 millicuries for the entire series and 11.5 for the cardiac patients. The recurrence rate was less than 1%. The authors believe that I131 is the treatment choice for thyrocardiac disease. 2、甲亢合并肝功能损害 治疗原则：及时有效地控制甲亢,同时辅以保肝治疗。 确诊甲亢伴肝损害时,应首选一次临床治愈或甲减。 即使是肝损害严重者,在加强护肝保肝、拮抗应激、抑制免疫的同时,仍可考虑用 治疗。 经治疗后,绝大多数Graves甲亢肝损害在甲状腺激素水平恢复正常后肝功能可逐渐恢复。 3、甲亢合并白细胞、粒细胞或血小板减少 治疗Graves甲亢所用的131I剂量水平不会导致白细胞、粒细胞或血小板减少； 应积极进行131I 治疗,同时给予对症、支持 、升白细胞药物治疗,定期检查血常规; 建议血液科医生会诊,联合制定治疗方案; 甲亢合并血白细胞、粒细胞或血小板减少及粒细胞缺乏症者采用 治疗明显优于抗甲状腺药物或手术治疗 。 黄勤,邹大进,潘文舟. 治疗伴白细胞减少Graves病的临床观察. 中华内分泌代谢杂志, 2006, 16: 184-185. 4、甲状腺相关眼病 甲亢伴GO患者是否采用131I治疗？ 学术界一直存在争议。 大量文献报道：可以采用131I治疗。强烈推荐接受糖皮质激素联合治疗。 内分泌《指南》： 轻度、稳定期的中-重度→单独应用131I ； 进展期→加用泼尼松。(我们认同此观点) 131I治疗法对GO的影响 131I治疗法是甲状腺眼病的高危因素之一。 GO明确的危险因素包括甲亢的131I治疗、吸烟、治疗前T3高水平、治疗前TRAb高水平和放射碘治疗后甲减。 （多篇文献报道） 2. 131I治疗后眼病的恶化往往是短暂的，可以采用糖皮质激素抵销。（ N Engl J Med. 1998 Jan 8;338(2):73-8.Relation between therapy for hyperthyroidism and the course of Graves ophthalmopathy.） ATA316-317 甲亢治疗方法 例数 改善% 无变化% 恶化% 甲巯咪唑 148 2 95 3 13