目的 研究16层螺旋CT显像估算甲状腺重量和放射性131I治疗有ATD药物反应的格雷夫斯甲亢的临床疗效。方法 所有患者均有大于1次至多次的ATD药物反应，均为白细胞减低、或肝功能损害、或皮肤过敏反应较严重。在131I治疗前均对所有患者进行血清TT3、TT4、FT3、FT4、sTSH、TGAB、TMAB、TRAB、血尿常规、心电图、肝肾功能、甲状腺摄碘率、甲状腺CT显像估算质量等检查，禁用影响甲状腺摄碘功能的药物和食物2周以上，计算总的131I剂量，一次口服，随诊并观察1年。结果 131I治疗有ATD药物反应的格雷夫斯甲亢患者95例,完全缓解（其中甲状腺功能减低13例）75例、部分缓解14例,总有效率93.68%,无效6例,占6.32%。治疗后1年有效（包括完全缓解、部分缓解、甲低）的CT显像甲状腺质量由治疗前的42.6±15.4克缩小到29.8±8.5克（t=6.863 ，P＜0.01﹞，治疗后1年无效的CT显像甲状腺质量由治疗前53.6±18.3克缩小到48.8±17.5克（t=1.965 ，P＞0.05）。131I治疗后暂时性甲低13例，占13.68%（观察1年，与总甲低率10%比较u=1.196, P＞0.05）。并发轻度的白细胞降低、肝损、皮损共10例，占总数的10.5%。结论 CT显像对估计甲状腺重量有较大的应用价值，131I治疗有ATD药物反应的格雷夫斯甲亢患者是非常安全、简单、有效的首选治疗方法。

Objective To explore the clinical effect of 131 I treatment in patients with graves of hyperthyroidism with ATD drug reaction. Methods 95 patients with graves of hyperthyroidism had more than one time to ATD drug reaction were involved in this study. The serum levels of TT3, TT4, FT3, FT4, TSH, TGAB, TMAB and TRAB in patients before 131 I therapy were detected. The mass of thyroid in patients were estimated by CT imaging, and the iodine uptake rate of thyroid in patients was determined. The patients were taken one does of 131I and followed for one year. Results Among 95 patients, 75 cases were complete remission which including 13 cases of thyroid function decrease and 14 cases were partial remission. The total effective rate was 93.68%. The thyroid mass in these complete and partial response cases were decreased from 42.6 ± 15.4 g before the treatment to 29.8 ±8.5 g (P < 0.01). Conclusion CT imaging has great application value to estimate the thyroid weight. 131 I therapy for patients with graves of hyperthyroidism with ATD drug reaction is very safe, simple and effective treatment of choice.