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| 儿科Grave病的放射性碘治疗 |
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| Radioiodine treatment for pediactric Graves' disease |
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| Ma C., Kuang A., Xie J., Liu G. 2009/5/29 18:39:20 |
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Cochrane Database of Systematic Reviews, 2008, Volume 0, Issue 3
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| Background: Pediatric Graves' disease (GD) is an autoimmune disease in which excessive amounts of thyroid hormones circulate in the blood. Treatments for pediatric GD include antithyroid drugs (ATD), thyroidectomy and radioiodine. Up to date, the optimal therapy remains controversial. Objectives: To assess the effects of radioiodine treatment for pediatric GD. Search strategy: Studies were obtained from computerized searches of MEDLINE, EMBASE, The Cochrane Library, China National Infrastructure (CNKI) and paper collections of conferences held in Chinese. Selection criteria: Randomised controlled trials, controlled clinical trials and prospective cohort studies comparing the effects of radioiodine with ATD or thyroidectomy with a duration of follow-up at least one year. Data collection and analysis: Two authors independently assessed study quality, extracted data and interviewed authors of all potentially relevant studies by telephone or electronic mail to verify randomization procedures. One author entered data into a data extraction form and another author verified the results of this procedure. Main results: Two prospective controlled clinical trials involving 167 patients were included. All of them were of low quality. Radioiodine treatment versus ATD showed benefits in achieving euthyroidism (relative risk (RR) 1.70, 95% confidence interval (CI) 1.29 to 2.24). Radioiodine treatment showed a higher incidence of hypothyroidism compared with ATD (RR 6.46, 95% CI 1.16 to 35.81). No significant differences in modifying Graves' opthalmopathy (worsening or appearance) between radioiodine treatment and ATD (RR 1.30, 95% CI 0.56 to 3.00) were observed. No trial evaluated mortality, health related quality of life, economic outcomes or compliance with treatments. Authors' conclusions: The limited results in Chinese suggest that a gland specific lower dosage of radioiodine treatment is potentially effective for pediatric GD, but a significant higher incidence of hypothyroidism compared with ATD was observed. However, we could not identify a well designed trial to provide strong evidence for radioiodine in the treatment of pediatric GD. High-quality randomised controlled clinical trials are needed to guide treatment choice. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. |
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| Correspondence Address: Ma, C.; Department of Nuclear Medicine, Medical College Qingdao University, No. 16, Jiangsu Road, Qingdao, Shandong Province, 266003, China; email: machaopony@hotmail.com |
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 疾病资源中心
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
医学数据库
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