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目的 探讨131I治疗青少年及儿童格雷夫斯甲状腺功能亢进症(Graves甲亢)的疗效及安全性.方法 89例青少年及儿童Graves甲亢患者行131I治疗.给药剂量采用公式法计算(2.59～4.44 MBq/g),参考病程、甲状腺质量和最高摄碘率进行修正.均采用一次性空腹口服,有合并症的给予相应处理.治疗后3、6、12个月随访,以后每年随访1次.前瞻性随访观察所有患者131I治疗后的治愈率、甲减率、甲状腺良恶性肿瘤发生情况、生长发育情况及后代健康情况.结果 随访至今的患者共80例,失访9例(10.1％).131I治疗剂量范围为177.6～555.0 MBq,平均剂量为203.5 MBq.随访至12个月,131I治疗青少年及儿童Graves甲亢痊愈率82.50％,有效率98.75％,无效率1.25％;随着时间的推移甲减发生率逐渐升高,15年甲减累计发生率为35％.所有治疗患者生长发育均正常,均育有后代,后代智力及发育均正常.随访病例中无甲状腺癌、白血病等疾病发生.结论 131I治疗青少年及儿童Graves甲亢安全且疗效好,不良反应少,值得临床推广应用.

Objective To investigate the therapeutic effects and safety of 131I treatment on children and adolescents with Graves disease.Methods In this study,89 children and adolescents with Graves hyperthyroidism cases were treated using 131I.131I was given at a dosage of 2.59 to 4.44 MBq per gram of thyroid tissue and calibrated according to the course of disease,thyroid weight,and the highest iodine rate.The treatment was via oral medication on an empty stomach once a day.All cases were required to undergo a proper medical follow-up at the end of 3,6,and 12 months after treatment and once a year later.The cure,hypothyroidism rates and incidence rates of benign and malignant thyroid tumors and the health of their offspring were studied.The safety of radioiodine treatment for children and adolescents' growth,development were also evaluated.Results Follow-up was conducted on 80 cases,with 30 males and 50 females,aged from 6 to 19 (12.2±2.3) years;nine patients were lost to follow-up (10.1％).The maximum dose of 131I ranged from 177.6 to 555 MBq per patient;the mean dose was 203.5 MBq.After one year of radioiodine treatment,the cure rate was 82.50％,and the effective rate was 98.75％;no efficiency is very low (1.25％).As time passed,the incidence of hypothyroidism increased,reaching 35％within 15 years.All cured patients had normal growth and produced offspring whose intelligence and development were normal.No one was diagnosed with thyroid carcinoma or leukemia in his/her medical follow-ups.Conclusions Using 131I for treating children and adolescents with Graves hyperthyroidism was effective and safe.The minimal side effects make it worthy of wide application in clinics.