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독성미만성갑상선종환자에서 방사성옥소(放射性沃素)()투여후(投與後) 발생(發生)하는 영구적갑상선기능저하증(永久的甲狀腺機能低下症) Permanent Hypothyroidism after Radioactive Iodine(131I) Treatment in Diffuse Toxic Goiter

대한핵의학회지 1977년 11권 1호 p.39 ~ 48
박선양, 이정상, 이홍규, 고창순, 이문호,
소속 상세정보
박선양 ( Park Seon-yang ) 
서울대학교 의과대학 내과학교실

이정상 ( Lee Jung-Sang ) 
서울대학교 의과대학 내과학교실
이홍규 ( Lee Hong-Kyu ) 
서울대학교 의과대학 내과학교실
고창순 ( Koh Chang-Soon ) 
서울대학교 의과대학 내과학교실
이문호 ( Lee Mun-Ho ) 
서울대학교 의과대학 내과학교실

Abstract


Radioactive iodine(RAD, principally 131I, effectively controls hyperthyroidism in the majority of patients. The subsequent development of hypothyroidism, however, has been of increasing concern since it was first pointed out by Chapman and Maloof in 1955. And the steady increase of late hypothyroidism during the passage of time was known with its relation with dosage of RAI.
The authors have investigated the development-of hypothyroidism in 935 patients with diffuse toxic goiter(DTG) who were treated with RAI(131I) at the Seoul National University Hospital from 1960 to 1977 to reveal its relation with the number of RAI treatments, dosage of RAI, age of patients and exophthalmos with the following results.
1) The incidence of hypothyroidism by year after RAI therapy among 631 patients with DTG who were treated with single RAI regimen was 7.4%(1 year), 11.8%(2 year), 16.2%(3 year), 22.1%(4 year) and 25.5%(5 year), and that among 163 patients given multiple RAI treatments was 8.6%(1 year), 10.4%(2 year), 13.3%(3 year), 29.1%(4 year), and 54.1%(5 year) respectively showing much higher yearly increments from 4 years after RAI treatment´ in comparison with the former.
2) Among 550 patients in the lower dose group treated with single RAI regimen less than 5.0 mCi (Mean±S.D.: 4.3±0.6mCi), the incidence of hypothyroidism by year after RAI treatment was 6.8%(1 year), 11.4%(2 year), 15.4%(3 year), while among 81 patients in the higher dose group given single RAI treatment not less than 5.5 mCi (Mean±S.D.: 6.3±0.5mCi) it was 12.0%(1 year), 15.4%(2 year) and 20.4%(3 year) respectively. However, the duration till euthyroid state after RAI therapy in the two groups was 5.1±3.6 months and 4.8±2.8 months respectively showing no statistically signficant difference (p>0. 1).
4) The incidence of hypothyroidism after RAI treatment in patients younger than 30 years of age was 4.3%(1 year) and 7.7%(2 year); in patients from 30 years to 49 years of age, 5.8 %(1 year) and 11.1%(2 year);in those older than 50 years, 11.0%(1 year) and 14.4
% (2 year). The data revealed rising incidence of hypothyroidism with increase of patients´ age.
4) Arrcrg 116 rati(rts with excFhtl:aimcs the incidence cf hypothyroidism by year after RAI trea´rr_ent was 7.1%(1 year) and 12.1%(2 year) while that among 184 patients without exophthalmcs was 7.2%(1 year) and 12.2%(2 year) respectively.
- With the above data the authors cculd ccr_ciude that the hypothyroidism in patients with DTG who were treated by RAI cevelcped mere frequently than reported by others in Korea till now, and increased with the passage cf time, the yearly increments frcm 4 years after RAI treatment increasing markedly in the m.ultirle icFe gicup, and the incidence cculd be reduced by decreasing the administered RAI ccse r.ct irerersirg t1e duration till euthyrcid state after RAI therapy.

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