背景甲状腺功能亢进合并肝损害是一种常见病,治疗很棘手,尤其是甲状腺象合并严重肝损害.已经证实丙基硫尿嘧啶和甲巯基嘧唑可致肝损害甚至肝衰竭或爆发性肝炎而死亡.如果以丙基硫尿嘧啶和甲巯基嘧唑控制甲状腺功能亢进,肝功能将更加恶化甚至患者死亡;如果只进行保肝治疗,甲状腺功能亢进无法控制,患者同样会恶化而死亡.目的 以131I控制甲状腺危象合并肝损害患者的甲状腺危象,同时进行内科保肝治疗,从而患者逐渐康复.方法 一次性口服131I,具体剂量由核医学专科医生根具体情况而定.结果 -甲状腺危象合并严重肝损害患者(60岁老年男性患者)一次性口服6mCi131I,甲状腺危象得到控制,肝脏功能逐渐恢复.结论 131I治疗甲状腺危象合并严重肝损害这一方法更安全、更有效、更方便、更具有可行性,值得临床广泛运用.%Introduction Thyrotoxicosis hepatitis is common.It is difficult in therapy,especially thyroid crisis with severe hepatitis,propyithiouracil-induced hepatic disfunetion and even hepatic failure or severe hepatitis or fulminant hepatitis is come to light,as is methimazolc. If propylthiouracil or methimazole controls hyperthroidism,liver disfuncfion would be deteriorated,and even patient die. If we only treat hepatitis,hyperthroidism couldn't be controlcd,the patient would also be worsen. Methods 131I therapy for oral cures hyperthyroidism,meanwhils liver dysfunction can return to normal. Results Thyrotoxie crisis was under control,and liver function had gradual return. Conclusion 131I can be recognized as the safer,more convenient and effective and feasible treatment than ATD for thyrotoxicosis hepatitis.There were no harmful side effects or complications. It should be widely apply clinically.
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