Clinical Study On The Effect Of ¹³¹I On Glycosylated Hemoglobin In Patients With Graves Disease And Abnormal Glucose Metabolism

Objective Objective 1.To observe the changes of thyroid hormone and glycosylated hemoglobin in patients with Graves'disease and hyperthyroidismafter radiotherapy with 131I and oral antithyroid drugs for 6-month and to compare and analyze the curative effects of 131-iodine radiotherapy and antithyroid drug treatment;2.To explore whether Graves'hyperthyroidism with abnormal glucose metabolism can be cured after 131 iodine radiotherapy for Graves'disease,and to provide theoretical basis for the first choice of 131 iodine radiotherapy for Graves'disease with abnormal glucose metabolism.Methods In this study,eighty-two patients with Graves'disease and hyperthyroidism accompanied by abnormal glucose metabolism from July 2016 to August 2018 in the Department of Endocrinology,Minda Hospital Affiliated to Hubei University for Nationalities were enrolled.These cases were divided into observation group which was given 131I radiotherapy and control group which was given antithyroid drugs.There were 41 cases in each group.The laboratory related indicators?FT3,FT4,TSH,FPG,2hPBG,HbA1c?before and after different treatment methods were followed up,collected and analyzed.Clinical symptoms,signs and laboratory examinations were used to evaluate the therapeutic effect of the two groups.1.Therapeutic effect judgement of Graves'disease hyperthyroidism:healing,effective,ineffective and hypothyroidism,complete improvement of clinical symptoms and signs,recovery of normal range of laboratory examination?FT3,FT4,TSH?as a cure,improvement of clinical symptoms and signs,recovery of laboratory examination?FT3,FT4,TSH?but not completely restored to normal range as effective;clinical symptoms and signs are not responsible.Laboratory tests?FT3,FT4,TSH?have not improved or even aggravated,which is regarded as invalid;laboratory tests?FT3,FT4,TSH?,clinical symptoms or signs conform to the diagnostic criteria of hypothyroidism,and the treatment results are regarded as hypothyroidism.2.Therapeutic effect jud-gement of abnormal glucose metabolism:clinical symptoms disappeared,laboratory examinations?FPG,2hPBG,HbA1c?returned to normal range were regarded as effective;clinical symptoms improved,laboratory examinations?FPG,2hPBG,HbA1c?decreased but not completely restored to normal range were considered effective;clinical symptoms did not improve,or even aggravated,laboratory examinations?FPG,2hPBG,HbA1c?did not.It is considered invalid if it is reduced to normal range or even increased.Results 1.There was no significant difference in age,sex,course of disease between the two groups by statistical analysis?P>0.05?.2.After six months'treatment,the improvement of Graves'disease in the observation group was:14 cases were cured?34.15%?,21 cases were effective?51.22%?,2 cases were ineffective?4.88%?,4 cases were hypothyroidism?9.76%?,the overall effective rate was 85.37%?35/41?;the improvement of abnormal glucose metabolism:5 cases were effective?12.20%?,28 cases were effective?68.29%?,8cases were ineffective?19.51%?and the overall effective rate was 80.49%?33/41?.In the control group,9 cases of Graves'disease were cured?21.95%?,20 cases were effective?48.78%?,11 cases were ineffective?26.83%?,1 case was hypothyroidism?2.44%?and the overall effective rate was 70.73%?29/41?;the improvement of glucose metabolism was significant in 2 cases?4.88%?,effective in 19 cases?46.34%?,ineffective in 20 cases?48.78%?and the overall effective rate was 51.22%?21/41?.3.In the observation group,25 patients with Graves'disease complicated with impaired glucose tolerance and 16 patients with diabetes mellitus,the total effective rate of impaired glucose tolerance was 84%?21/25?,and 75%?12/16?respectively.Before ¹³¹I treatment,the HbA1c values?%?were 5.38±0.476?%?and 9.45±0.813?%?respectively;after ¹³¹I treatment,the HbA1c values?%?were 4.93±0.343?%?and 7.13±0.409?%?respectively;in the control group,27 Graves'disease patients complicated with impaired glucose tolerance and 14 diabetes mellitus patients,including 59.26%?16/27,?and 35.71%?5/14?of patients with impaired glucose tolerance.Before ¹³¹I treatment,the HbA1c values?%?were 5.51±0.319 and9.75±0.643,respectively.After oral thyroid drug treatment,the HbA1c values?%?were 5.36±0.348and 9.13±0.863,respectively.Conclusions 1.Graves'disease with abnormal glucose metabolism,as a concurrent state of two chronic metabolic diseases?Graves'disease and abnormal glucose metabolism?,requires long-term and comprehensive treatment.2.¹³¹I treatment and drug treatment have certain therapeutic effect on Graves'disease with abnormal glucose metabolism.¹³¹I treatment has definite advantages over oral thyroid drug treatment in Graves'disease.3.¹³¹I treatment and drug treatment improved HbA1c in Graves'disease patients with abnormal glucose metabolism.Compared with oral thyroid drug therapy,¹³¹I treatment has a more significant effect on reducing HbA1c in Graves'disease patients with abnormal glucose metabolism.4.¹³¹I treatment can significantly improve the therapeutic effect of Graves'disease patients with impaired glucose tolerance,which is worthy of further clinical research and promotion.5.There was no significant difference in the effect of¹³¹I treatment and oral antithyroid drugs on FPG of patients with Graves'disease and diabetes mellitus.The number of cases with Graves'disease and diabetes mellitus included in the study was not enough,and further research was needed.