| Objectives:The purpose of this study was to evaluate the therapeutic efficacy of iodine-131 (131I) on Hashimoto's thyroiditis with a large goiter, investigate the occurrence time and related factors of different outcomes (recovery or improvement) after 131I therapy and to provide scientific reference for clinical therapeutic regimen and prognosis.Methods:A total of 169 patients (from the Third Hospital of Shanxi Medical University; 149 out-patients,20 in-patients; 4 males and 165 females; average age was 38.57±13.26 years) who had Hashimoto's thyroiditis with large goiter and underwent 131I therapy between the years 1997.5±2010.2 were followed up for 3-96 months (13.5±15.9 months). Based on color Dopplar ultrasound, thyroid nuclide scan and Palpation results, the terminal events of 131I therapy in Hashimoto's thyroiditis with goiter were divided into recovery (the goiter was removed completely) and improvement (the goiter was removed incompletely). According to clinical experience and literature documents,the relative influence factors were decided as:sex; age; course of disease before 131I therapy; replacement therapy history before 131I therapy; rigidity and type of goiter; thyroid weight; 24h-Radioactive iodine uptake rate of thyroid; unit dose; the first dose of 131I; the total dose of 131I; frequency. Terminal times of follow-up were:①first occurrence time of terminal event;②last time of the follow-up after 131I therapy;③completion time of the research, if the certain outcome did not appear. Weight of thyroid before and after 131I therapy was compared by using paired t-test. Survival analysis was performed to investigate the two terminal events and the relative impact factors; chi-square test was used for categorical variables, and t-test for quantitative variables. Statistical significance was set at P< 0.05. All statistical analyses were performed by using the statistical software SPSS (version 13.0). Satisfaction degree of the 131I therapy was evaluated by 52 patients who were selected randomly from the total 169 patients.Results:At the end of the terminal times of follow-up,①The average weight of the thyroid gland was 85.18±45.50g (27.0-350.0 g) before the first radio iodine-131 therapy, and it decreased significantly to 24.79±9.27g (20.0-64.0 g) after the last radio iodine-131 therapy (P= 0.001, paired Student's t test). The cumulative probability of recovery was 68.0%. The cumulative probability of improvement was 32.0%. The effective rate of the therapy on goiter was 100%.②Statistically significant differences between the groups were found in unit dose, the total dose of 131I and age, except the thyroid weight and 24h-Radioactive iodine uptake rate of thyroid; Cox regression, course of disease before 131I therapy, unit dose and the frequency of 131I were entered into the regression model, the regression coefficients were-0.696,0.004 and-1.730, respectively. According to the relative ratio (RR) value, the possibility of recovery was reduced by 50.1% the patients whose disease course were more than 4 years compared with those in 0-6 months. With each additional 1 unit of unit dosage, the removal possibility could increase by 4%o. Taking each additional 1 time of 131I, the removal possibility could decease by 82.3%. The median recovery duration was 6 months after the first radio iodine-131 therapy, whereas the median removing period was 15 months if received≥2 times of radioiodine-131 therapy.④Random survey results showed that the satisfaction degree of 131I therapy was 96.2%.Conclusion:The results showed that:radio iodine-131 is an effective therapy on Hashimoto's thyroiditis with a large goiter. Removal of a swollen was influenced by age, duration of iodine, unit dose and serve. The treatment effect is closely related with the unit dose. Various factors, especially the age, duration of the patients as well as the unit dose should be considered when determining the therapeutic doses.
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