| Objectives:Based on the survival analysis of a large sample of 3946 patients with Graves disease, the purpose of this study was to investigate the related factors of times for recovery, improvement, relapse, and hypothyroidism after 131I therapy and to provide scientific bases for clinical therapeutic regimen and prognosis.Methods:A total of 3946 patients(2670 females, 1276 males, ratio of 2.1,average age 41.12±10.94 years)with Graves disease treated with 131I between the years 1959～2007 were followed up for a minimum of 3 months, a maximum of 37.4 years, and averaged 4.15±4.36 years. According to laboratory examination and patients'clinical manifestation, the terminal events of 131I therapy included recovery, improvement, relapse and hypothyroidism. Terminal times of follow-up were:①time of terminal event firstly occurred;②time of the latest follow-up;③time of research's termination. Life table method, log-rank test and a stepwise Cox's proportional hazard regression model were used to describe the survival function, to perform univariate analyses for categorical variables, and to identify significant factors related to the four terminal events, respectively. All statistical analyses were performed by using the statistical software SPSS (version 13.0).Results:①Recovery: The cumulative probability of recovery were 82% at 1 year, 66% at 2 years, 52% at 3 years, 40% at 4 years, 34% at 5 years, 26% at 6 years, and 18% at 7 years. The median recovery time was 2.83 years. The protective factors were thyroid weight, ATD species and whether or not to accompany periodic paralysis. The hazard factors were dosage and texture. The dosage of 131I had the largest influence.②Improvement: The cumulative probability of improvement were 96% at 1 year, 81% at 2 years, 66% at 3 years, 48% at 4 years, 40% at 5 years, and 26% at 6 years. The median survival time was 3.5 years. The protective factors were thyroid weight, time of caplendus ATD and whether or not to accompany hepatic damage. The hazard factors were dosage and frequency. The frequency of 131I had the largest influence.③Hypothyroidism: The cumulative probability of hypothyroidism were 17% at 1 year, 23% at 2 year, 26% at 3 year, 28% at 4 year, 30% at 5 years, 32% at 6 year, 36% at 7 year, 40% at 8 year, 42% at 9 year, 45% at 10 years, and 66% at 15 years. The median hypothyroidism time was 11.17 years. The hazard factors were dosage of 131I, species and time of caplendus ATD. The protective factors were gender, 24-th 131I uptake. The dosage of 131I had the largest influence.④Relapse: The cumulative probability of relapse were 2% at 1 year, 3% at 2 years, 4% at 3 years, 5% at 4 years, 5% at 5 years, 6% at 6 years, 6% at 7 years,6% at 8 years, 7% at 9 years, and 7% at 10 years. The hazard factors were course of disease, cure history of preradiotherapy, thyroid weight, ATD species and frequency. The protective factors were dosage of 131I. Treatment history before radiotherapy had the largest influence.Conclusions:For recovery, the cumulative probability was 82% at 1 year and the median recovery time was 2.83 years. The dosage of 131I had the largest influence; The cumulative probabilities of hypothyroidism were 2%～6% increased per year with 66% at 15 years and the median hypothyroidism time was 11.17 years. The dosage of 131I had the largest influence; The cumulative probability of relapse was 7% at 10 years which increased 0%～1% per year within 10 years and treatment history before radiotherapy had the largest influence. 131I therapy is a relative ideal treatment for Graves disease, but the influence of factors related to its outcomes should be considered. Key words: radioiodine-131; Graves disease; survival analysis...
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