目的 探讨碘131（131I）治疗后Graves眼病（GO）预后与血清促甲状腺激素受体抗体（TRAb）水平变化之间的关系。 方法 选择2011年5月－12月初发Graves病患者238例，分为GO组124 例和非GO组114 例，分别检测131I治疗前及131I治疗后2、3、6个月甲状腺功能和TRAb，GO患者131I治疗前和治疗后6 个月进行临床活动度评分（CAS）。 结果 131I治疗前各组TRAb水平差异无统计学意义（P＞0.05），TRAb水平与GO CAS评分之间无相关；131I治疗后6个月所有患者TRAb水平显著增加；非GO组有5例新发GO，新发GO组与其他患者的TRAb水平分别为（58.7 ± 77.9）、（61.9 ± 81.1）U/L，差异无统计学意义（P＞0.05）；GO组又分为GO无变化29例，GO加重17例，GO缓解78例，三组患者TRAb水平分别为（53.5 ± 77.6）、（66.2 ± 89.9）、（66.8 ± 42.2）U/L，差异无统计学意义（P＞0.05）。 结论 131I治疗后患者TRAb水平显著增加，但TRAb水平的变化和GO预后无关，TRAb与GO的关系还需要进一步研究。
Objective To explore the effect of multi-disciplinary treatment of the Graves’ disease (GD) with huge-size thyroid during perioperative period. Methods Retrospectively analyzed the clinical data of 8 GD patients with huge-size thyroid who got treatment in Pekin Union Medical College Hospital during Jan. 2006 to Dec. 2016. All patients underwent comprehensive preparation before operation and underwent total thyroidectomy. To explore the changes of thyroid function and culture after anti-thyroid drug (ATD)/iodine preparation/arterial embolization before operation, and to summarize situation of the bleeding loss intraoperation, neck-drainage, thyroid function, and relapses after operation. Results All cases got a satisfactory operation result after standard ATD, iodine preparation (Lugol’s solution 10–15 drops for 3–4 weeks, combined with ATDs for 2–3 weeks ), and main arterial embolization of thyroid in 24 h preoperation. They got shorter operative time (2.5–4.5 h), less bleeding intraoperation (4 cases≤100 mL), less neck-drainage, and almost normal retention time. No severe or permanent complications, for example thyroid storm, abnormal voice, and hypoparathyroid occurred. They were followed as outpatients for 18–133 months, and were found a perfect long-term effect without complication and relapse. Conclusions Perioperative period management is very important to those GD patients with huge-sized thyroid, and multi-disciplinary treatment can decrease theintraoperation bleeding, as well as occurrence of thyroid storm effectively. In addition, operated subtly during surgery can protect the recurrent laryngeal nerve and parathyroid effectively.