Potek ščitnične orbitopatije pri bolnikih z Gravesovo boleznijo, zdravljenih z radioaktivnim jodom

Šfiligoj Planjšek, Daša (author), Gaberšček, Simona (mentor)

Izhodišče: Po zdravljenju Gravesove bolezni (GB) z radioaktivnim jodom (radiojodom) 15-20 % bolnikov doživi poslabšanje ali pojav ščitnične orbitopatije (ŠO), kar lahko običajno preprečimo z glukokortikoidi. V Evropi so ob zdravljenju z radiojodom v uporabi različni režimi zdravljenja oziroma profilakse ŠO z glukokortikoidi, optimalen režim pa zaenkrat še ni znan. Prav tako ni jasno, kdaj se je pri bolnikih s ŠO najbolj primerno odločiti za zdravljenje z radiojodom in kateri dejavniki vplivajo na uspešnost zdravljenja GB s prvim odmerkom radiojoda. Namen: Na Kliniki za nuklearno medicino, UKC Ljubljana, bolnike z GB pogosto zdravimo z radiojodom. Bolnikom s ŠO ali bolnikom z dejavniki tveganja za pojav ŠO ob zdravljenju z radiojodom rutinsko dodajamo glukokortikoide v različnih shemah in ob tem redko beležimo poslabšanje ŠO. Z raziskavo smo želeli ugotoviti, ali so naši režimi dajanja glukokortikoidov ob zdravljenju z radiojodom učinkoviti. Preiskovanci in metode dela: Z retrospektivno raziskavo smo iz medicinske dokumentacije zajeli podatke vseh bolnikov, pri katerih se je GB prvič v življenju pojavila med letoma 2005 in 2009 in so bili na Kliniki za nuklearno medicino, UKC Ljubljana, kasneje zdravljeni z radiojodom. Pri manjši skupini bolnikov z GB smo še prospektivno preverili, kateri dejavniki vplivajo na uspešnost zdravljenja GB s prvim odmerkom radiojoda. Rezultati: Ugotovili smo, da je bilo zdravljenje s prvim odmerkom radiojoda uspešnejše pri bolnikih, ki so bili mlajši, ki so imeli ob pojavu GB manjši volumen ščitnice in so bili ob pojavu GB ter pred radiojodnim zdravljenjem manj hipertirotični. Rezultati prospektivnega dela raziskave so delno potrdili rezultate retrospektivnega dela  zdravljenje s prvim odmerkom radiojoda je bilo uspešnejše pri bolnikih z manjšim volumnom ščitnice. Pri kadilcih/bivših kadilcih je bila ŠO dlje časa aktivna kot pri nekadilcih. Kratkotrajno zdravljenje z glukokortikoidi je uspešno preprečilo poslabšanje in zmanjšalo stopnjo izraženosti ŠO po zdravljenju z radiojodom. Zdravljenje z glukokortikoidi je uspešno preprečilo poslabšanje zmerne do hude aktivne ŠO po zdravljenju z radiojodom. Trajanje aktivnosti ŠO je bilo tem krajše, čim krajši je bil čas do zdravljenja z radiojodom in ni bilo povezano s številom odmerkov radiojoda, potrebnih za odpravo hipertiroze. ŠO se je po radiojodu na novo pogosteje pojavila pri tistih bolnikih z GB, ki so radiojod prejeli večkrat. Zaključki: Starejši bolniki in bolniki z večjim volumnom ščitnice bi morali za odpravo hipertiroze prejeti višjo aktivnost radiojoda. Bolniki s ŠO bi morali čim prej prenehati s kajenjem. Naši režimi dajanja glukokortikoidov ob radiojodu uspešno preprečijo poslabšanje in zmanjšajo stopnjo izraženosti ŠO. Bolniki s ŠO bi morali biti čim prej zdravljeni z radiojodom.

• Language: Slovenian
• Keywords: ščitnična orbitopatija, Gravesova bolezen, radiojod, glukokortikoidi
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2019
• PID: 20.500.12556/RUL-106263
• COBISS.SI-ID: 298564352
• Publication date in RUL: 19.02.2019

Secondary language

• Language: English
• Title: The course of thyroid associated orbitopathy in patients with Graves’ disease treated with radioactive iodine

Abstract

Background: After treating Graves’ disease (GD) with radioactive iodine (radioiodine) 15-20 % of patients experience worsening or occurrence of thyroid orbitopathy (TO), which can usually be prevented with glucocorticoids. In Europe there are different glucocorticoid regimens for the treatment or prevention of TO when treating patients with radioiodine, optimal regimen, however, is still unknown. Also, the optimal time for radioiodine treatment in TO patients and factors influencing the success of the first dose of radioiodine in GD patients is still not clear. Aim: At the Department of Nuclear Medicine, UMC Ljubljana, patients with GD are often treated with radioiodine. Along with radioiodine, patients with TO or risk factors for TO are routinely given glucocorticoids in different regimens, which rather successfuly prevent TO deterioration. In our study we wanted to evaluate the effectiveness of our glucocorticoid regimens at the radioiodine treatment. Patients and methods: In our retrospective study we collected data from medical records of all patients in whom GD first occurred between 2005 and 2009 and who were later treated with radioiodine at the Department of Nuclear Medicine, UMC Ljubljana. In a smaller group of patients with GD we also prospectively evaluated possible factors influencing the success of treatment with the first dose of radioiodine. Results: The results of our study showed a higher success of the first dose of radioiodine in patients who were younger, had a smaller thyroid volume at the onset of GD and were less hyperthyroid at the onset of GD and at the time of radioiodine treatment. The results of our prospective study partially confirmed the results of our retrospective study – treatment with the first dose of radioiodine was more successful in patients with a smaller thyroid volume. In smokers/ex smokers, TO was active longer than in non smokers. Our short glucocorticoid regimen successfully prevented worsening of TO and decreased severity of TO after radioiodine treatment. Glucocorticoid treatment successfully prevented worsening of moderate-to-severe active TO after radioiodine treatment. The shorter the time until radioiodine treatment, the shorter the duration of TO activity, which was not influenced by number of radioiodine doses needed for successful GD treatment. After radioiodine treatment, de novo occurrence of TO was more frequent in GD patients who received several radioiodine doses. Conclusions: Older patients and patients with a larger thyroid volume should receive higher radioiodine activity for successful treatment of GB with the first dose of radioiodine. Patients with TO should stop smoking as soon as possible. Our glucocorticoid regimens at the radioiodine treatment successfuly prevent worsening of TO and decrease severity of TO. Patients with TO should receive radioiodine as soon as possible.

• Keywords: thyroid orbitopathy, Graves' disease, radioiodine, glucocorticoids