摘要：目的 探讨¹³¹I治疗重度甲状腺肿大伴甲状腺功能亢进（serious goiter to accompany hyperthyroidism, SGAH)的两种不同给药方法的治愈率、早发甲低、安全性等综合疗效。方法 统计分析口服适量剂量（3.145～3.33 MBq/每克甲状腺组织）的¹³¹I 行甲状腺减重治疗3～6月后，对减重治疗未愈者按规范每克甲状腺组织给予治疗剂量的¹³¹I行第二次治疗的二次给药治疗法（second drugs method, SDM）与对经治患者按¹³¹I治疗剂量（4.25～4.65MBq/每克甲状腺组织）结合病史、ATD治疗史、甲状腺硬度、临床症状及体征行¹³¹I治疗的一次给药治疗的一次给药治疗法(once drugs method, ODM)之间的治愈率、早发甲低、安全性等综合疗效。结果 两组SGAH患者性别、年龄、甲状腺重量、患病病程及两组经二次治疗后总治愈率差异无统计学差异（P＞0.05）；SDM组减重治愈率与ODM组一次治愈率及两组二次治愈率、早发甲低率、SDM组内各甲重组的减重治愈率及二次治愈率、ODM组内各甲重组的一次治愈率及二次治愈率差异具有统计学意义（P＜0.05）。结论 SDM的治疗安全性显著优于ODM，其早发甲低率明显低于ODM, ODM在治愈时间和治疗费用方面优于SDM。

Abstract: Objective To analyze the clinical effective of two medication methods in the ¹³¹I treatment of severe goiter patients associated with hyperthyroidism. Methods The patients were divided two groups: SDM group (Secondary drug medication）, after taking moderate doses of ¹³¹I (3.145～3.33 MBq / per gram of thyroid tissue) and applying thyroid weight loss treatment for 3 to 6 months, for the patients not healed a secondary treatment by giving them therapeutic doses of ¹³¹I according to the specification standard of per gram of thyroid tissue; ODM group (Once drug medication), for these treated patients an once ¹³¹I treatment according to the therapeutic ¹³¹I dose （4.25～4.65MBq/ per gram of thyroid tissue）. The comprehensive efficacy, including cure rate, early hypothyroidism and safety in SDM and ODM group were analyzed. Results There was no significant difference in the two groups of SGAH patient’s gender, age, thyroid weight, disease course and their overall cure rate after secondary treatment (P> 0.05). There were significant differences in the cure rate between the SDM weight loss treatment and the ODM treatment, the two group’s secondary medication cure rate and early hypothyroidism rate. Among various thyroid weight groups with SDM, the differences of their weight loss treatment cure rate and secondary cure rate were significant. Also, among various thyroid weight groups with ODM, the differences of their once treatment cure rate and secondary cure rate were significant (P＜0.05）. Conclusion SDM is significantly superior to ODM，in the treatment security as well as early hypothyroidism rate. ODM is better than SDM in cure time and cost of treatment.