Analysis Of Curative Effect And Influencing Factors Of Giant Goiter With Hyperthyroidism Treated By ¹³¹Ⅰ

Objective:To analysis of¹³¹Ⅰ treatment effect and its influencing factors in patients with giant goiter and hyperthyroidism,aiming at providing reference for the selection of clinical treatment options for this disease.Methods:Retrospective analysis of 391 patients with giant goiter and hyperthyroidism treated with¹³¹Ⅰ in our hospital from June 2007 to December 2017,including 182 males and 209females,with an average age of（50.7±12.3）years.The clinical data of patients before and after¹³¹Ⅰ treatment were collected,including age,gender,course of disease,thyroid hormone and antibody level,¹³¹Ⅰ rate of thyroid,thyroid ultrasound results,thyroid SPECT imaging results,¹³¹Ⅰ treatment dose and treatment times,etc.The average dose of¹³¹Ⅰ per patient per gram of thyroid tissue was 5.76±1.65 MBq/g（155.5±44.6 uCi/g）,and the mean total dose of¹³¹Ⅰ was 955.8±461.7 MBq（35.4±17.1 mCi）.The efficacy was divided into:complete remission,hypothyroidism,partial remission,and ineffectiveness.T-test and chi-square test were employed to evaluate the date set.Logistic regression was used to analyze the factors affecting efficacy.Results:1、357 patients were effectively followed up,accounting for 91.3%,and the follow-up period was 0.5-10 years（mean 5.7±4.2 years）.Symptoms,physical symptoms and comorbidities were completely relieved in 133 patients;146 patients were converted to hypothyroidism;17 patients experienced increased complications after treatment（eg,conversion to liver disease,heart failure,etc.）and 2 patients died.2、The complete remission rate of hyperthyroidism after¹³¹Ⅰ treatment was 37.3%（133cases）,the partial remission rate was 16.5%（59 cases）,the hypothyroidism rate was40.9%（146 cases）,and the ineffective rate was 5.3%（19 cases）.The total clinical cure rate（including complete remission and hypothyroidism）was 88.3%（315 cases）,and the effective rate was 94.7%（338 cases）.3、Analysis of the patient’s SPECT weight results showed that the patient’s thyroid mass reduction rate after treatment was 52.3%to 86.7%,with an average of（66.4±17.9）%.Among them,65 cases were reduced by 25%to 50%,and 292 cases were reduced by more than 50%.4、Logistic regression analysis of all independent variables showed that the patient’s course,thyroid mass,TRAb level,TGAb level,treatment course and¹³¹Ⅰ dose per gram of thyroid tissue were related to the efficacy of¹³¹Ⅰ treatment,including thyroid mass and per gram of thyroid tissue.The¹³¹Ⅰ dose was the most relevant.5、Patients with huge goiter with hyperthyroidism complicated with complication,131I treatment also given symptomatic supportive treatment,with hyperthyroidism symptoms improved and cured,52.2%of patients with comorbid symptoms improved or normal within 1 to 6 months,no merger The disease continues to worsen.Conclusion:1、There was a statistically significant difference in the mean thyroid weight and hypothyroidismbetweenpatientswithgiantgoiterandhyperthyroidism（X²=25.32³6.04,P<0.01）.The thyroid mass was negatively correlated with the incidence of hypothyroidism,ie the thyroid mass was small.The incidence of hypothyroidism is higher.2、The mean thyroid weight and the number of¹³¹Ⅰ treatments in patients with giant goiter and hyperthyroidism were statistically significant（X2=31.02,P<0.01）.The thyroid mass was positively correlated with the number of¹³¹Ⅰ treatments.Patients who received two or more¹³¹Ⅰ treatments.The mean thyroid mass was higher than that of the single 131I treatment group.3、The number of¹³¹Ⅰ treatments and the incidence of hypothyroidism in patients with giant goiter and hyperthyroidism were statistically significant（X²=24.48,P<0.01）.The number of treatments of¹³¹Ⅰ was negatively correlated with the incidence of hypothyroidism.The rate of hypothyroidism was higher than that of the two or more treatment groups.4、The patient’s thyroid mass and the¹³¹Ⅰ dose per gram of thyroid tissue are critical in clinical practice.