Efficacy of 131I treatment for 840 cases of Graves＇ disease combined with hepatic function injury

Abstract

Objective To assess the efficacy of 1311 treatment for Graves＇ disease （GD） complicated with hepatic function injury in order to provide guidance for clinical practice. Methods A total of 840 GD cases complicated with hepatic function injury were retrospectively reviewed after 131I treatment. Analy- sis of variance and Dunnett t test were used to compare serum FT3, FT4, and TSH levels before and 1, 3, and 6 months after 131I therapy. R x C table X2 test was used to compare therapeutic efficacies among cases with different degrees and types of hepatic function injuries. Analysis of variance and Dunnett t test were used to evaluate recovery time of different degrees of hepatic function injuries. Cross classification 2 x 2 ta- ble correlation analysis was adopted to assess the correlation between 1311 therapeutic efficacies of GD and recovery efficacies of hepatic function. Results The curative rate for GD was 76.8% （645/840）. There were significant changes of FF3（ （25.74 ±5.81）, （15.54 ±4.12）, （12.76 ±2.35） and （7.95 ± 1.64） pmol/L, respectively ; F = 5007. 958, t = 54. 455, 69. 297 and 94. 976, all P 〈 0.05 ）, FT4 （ （ 75.84 ±16.78 ）, （45.69±8.96）, （36.81 ±5.03） and （25. 17 ±4.46） pmol/L, respectively; F=3876.410, t = 513. 602, 664. 871 and 863. 157, allP〈0.05） and TSH （（0.01±0.02）, （0.02±0.08）, （0.85 ±0. 36） and （ 1.26 ±0.54） mU/L, respectively; F = 3050. 430, t = 2. 627, 46. 989 and 78. 315, all P 〈 0. 05 ） before and 1,3, and 6 months after 131I treatment. The curative rate of hepatic function abnormality was 79.2% （665/840）. For mild, medium and severe hepatic function injury patients, curative rates were 88.4% （420/475）, 68.8% （214/311） and 57.4% （31/54）, respectively. The curative rate of patients with mild hepatic function injury was significantly higher than those with medium and severe hepatic function injury （X2 = 46. 338, 37. 100, respectively, both P 〈 0.01 ） , and the recovery time was significantly shorter in patients with mild hepatic function injury than medium and severe injury （ （2.0 ±0.6） vs （3.2 ±0.8） vs （4.3 ±1.4） months x^2 = 21. 886, 21. 307, both P 〈 0.01 ）. The curative rates for hepatic function inju- ry type measured with mainly enzyme rise, mainly bilirubin rise and mixed rise were 85.1% （480/564） , 56.3% （49/87） and 72.0% （136/189）. A statistically significant better curative rate was shown for hepat- ic function injury type with mainly enzyme rise （X2 =41. 009, 16. 444, both P 〈0.01 ）. No cases had obvi- ous function injury aggravation after 131I treatment. There was a significantly correlated association between outcomes of hepatic function recovery and GD therapeutic efficacy （X2 = 309. 142, r = 0. 519, both P 〈 0. 05 ）. Conclusions The curative rate of GD patients treated with 131I depends on hepatic dysfunction. The curative rate is highest in those with mild hepatic function injury, followed by those with medium and severe hepatic function injury. The recovery time is shortest in patients with mild hepatic function injury, followed by those with medium and severe hepatic function injury. Key words: Graves＇ disease; Injuries; Liver; Radiotherapy; Iodine radioisotopes