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131I治疗格雷夫斯甲亢指南(2021版)
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ENGLISH ABSTRACT
131I治疗格雷夫斯甲亢指南(2021版)
中华医学会核医学分会 
作者及单位信息
·
DOI： 10.3760/cma.j.cn321828-20201109-00405
Clinical guidelines for
131I treatment of Graves′ hyperthyroidism (2021 edition)
Chinese Society of Nuclear Medicine
Li Lin
Li Sijin
Authors Info & Affiliations
Chinese Society of Nuclear Medicine
Li Lin
Li Sijin
·
DOI： 10.3760/cma.j.cn321828-20201109-00405
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摘要
格雷夫斯甲状腺功能亢进症(Graves′ hyperthyroidism, GH)是一种常见的自身免疫性内分泌疾病，其发病率在经历上升后，近年逐渐趋于稳定。 131I、抗甲状腺药物(antithyroid drugs, ATD)和手术均为甲状腺功能亢进症(简称甲亢)的一线治疗方法。3种方法治疗后患者生活质量无明显差异，可根据患者的病情、意愿、可利用的医疗条件进行个体化选择。 131I疗效确切、临床结局可预期、安全、方便。 131I治疗的目标是使患者达到非甲亢状态(non-hyperthyroid status)，即恢复正常甲状腺功能；或发生甲状腺功能减退症(简称甲减)后补充甲状腺激素以达到并维持正常甲状腺功能，二者之一均为达到治疗目标。
引用本文
中华医学会核医学分会. 131I治疗格雷夫斯甲亢指南(2021版) [J]. 中华核医学与分子影像杂志,2021,41(04)：242-253.
DOI:10.3760/cma.j.cn321828-20201109-00405PERMISSIONS
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格雷夫斯甲状腺功能亢进症(Graves′ hyperthyroidism, GH)是一种常见的自身免疫性内分泌疾病，其发病率在经历上升后，近年逐渐趋于稳定。
131I、抗甲状腺药物(antithyroid drugs, ATD)和手术均为甲状腺功能亢进症(简称甲亢)的一线治疗方法。3种方法治疗后患者生活质量无明显差异，可根据患者的病情、意愿、可利用的医疗条件进行个体化选择。
131I疗效确切、临床结局可预期、安全、方便。
131I治疗的目标是使患者达到非甲亢状态(non-hyperthyroid status)，即恢复正常甲状腺功能；或发生甲状腺功能减退症(简称甲减)后补充甲状腺激素以达到并维持正常甲状腺功能，二者之一均为达到治疗目标。
中华医学会核医学分会于2013年组织专家制定了《
131I治疗格雷夫斯甲亢指南(2013版)》(简称2013版指南)
[
1
]。由于诊断和治疗技术的不断进步，指南亟需修订和更新。中华医学会核医学分会于2019年6月在武汉召开了指南更新启动会并成立指南编写委员会。经过1年多的努力，特别是在新型冠状病毒肺炎疫情常态化防控情况下，编写委员会成员克服困难，进行了多次线上交流沟通，最终成稿。本次指南修订以2013版指南为基本参考，秉承创新、传承、与时俱进的指导思想，根据近年来的研究进展及证据进行推荐(
表1
)；以临床问题为导向，增幅较多的主要是"问题"阐释部分。
| 强度分级 | 推荐强度涵义 |
|---|---|
| A | 强力推荐。循证证据肯定，能够改善健康的结局，利大于弊 |
| B | 推荐。循证证据良好，能够改善健康的结局，利大于弊 |
| C | 推荐。基于专家意见 |
| D | 反对推荐。基于专家意见 |
| E | 反对推荐。循证证据良好，不能改善健康结局或对于健康结局弊大于利 |
| F | 强力反对推荐。循证医学肯定，不能改善健康结局或对于健康结局弊大于利 |
| I | 不推荐或者不作为常规推荐。推荐或反对推荐的循证证据不足、缺乏或结果矛盾，利弊无法评判 |
展开表格
131I治疗格雷夫斯甲亢的方案推荐分级
注：甲亢为甲状腺功能亢进症的简称
本指南涉及9个方面：(1) GH的定义和流行病学；(2) GH诊断和治疗；(3) GH
131I治疗原理、适应证和禁忌证；(4) GH
131I治疗前准备；(5) GH
131I治疗实施；(6) GH
131I治疗后随访；(7)特殊情况处理；(8)儿童及青少年GH
131I治疗；(9) GH
131I治疗辐射安全问题。指南编撰采取问题条款和推荐条款并进模式，全文共计38项问题条款，41项推荐条款。
本指南仅代表当前的观点和认识，不具有强制性和法律约束力。随着科学研究的进展及实践经验的积累，指南中的相关内容将不断完善与更新。
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