讲课治疗甲亢.pptVIP

2021/3/26 * 关于预治疗 对甲亢伴有并发症患者,建议将并发症控制在相对稳定时,采用131I治疗; 对重症甲亢，可考虑先用抗甲状腺药物短程治疗，病情缓解后再行131I治疗;（指严重高代谢症状，而不包含严重并发症“高危”患者） 对一般适应证患者，没有提及或强调在131I治疗前需要预治疗。 几个主要观点 “共识” 一般情况下,131I治疗前停服MMI2～7d, PTU 2～4周。 2021/3/26 * Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials. Walter MA,et al. BMJ. 2007 Mar 10;334(7592):514 Abstract OBJECTIVE: To determine the effect of adjunctive antithyroid drugs on the risk of treatment failure, hypothyroidism, and adverse events after radioiodine treatment. DESIGN: Meta-analysis. DATA SOURCES: Electronic databases (Cochrane central register of controlled trials, Medline, Embase) searched to August 2006 and contact with experts. Review methods Three reviewers independently assessed trial eligibility and quality. Pooled relative risks for treatment failure and hypothyroidism after radioiodine treatment with and without adjunctive antithyroid drugs were calculated with a random effects model. RESULTS: We identified 14 relevant randomised controlled trials with a total of 1306 participants. Adjunctive antithyroid medication was associated with an increased risk of treatment failure (relative risk 1.28, 95% confidence interval 1.07 to 1.52; P=0.006) and a reduced risk for hypothyroidism (0.68, 0.53 to 0.87; P=0.006) after radioiodine treatment. We found no difference in summary estimates for the different antithyroid drugs or for whether antithyroid drugs were given before or after radioiodine treatment. CONCLUSIONS: Antithyroid drugs potentially increase rates of failure and reduce rates of hypothyroidism if they are given in the week before or after radioiodine treatment, respectively. Pretreatment with propylthiouracil but not methimazole reduces the therapeutic efficacy of iodine-131 in hyperthyroidism. Imseis RE, Vanmiddlesworth L, Massie JD, Bush AJ, Vanmiddlesworth NR. J Clin Endocrinol Metab. 1998 Feb;83(2):685-7 Abstract Ninety-three hyperthyroid patients were treated wit