Publikationsserver der Universitätsbibliothek Marburg

Titel:Prüfung einer potentiellen strahleninduzierten Nebenschilddrüsenfunktionsstörung während einer Radioiodtherapie benigner Schilddrüsenerkrankungen
Autor:Schumacher, Serena Christine
Weitere Beteiligte: Höffken, Helmut (Dr.)
Veröffentlicht:2011
URI:https://archiv.ub.uni-marburg.de/diss/z2011/0773
URN: urn:nbn:de:hebis:04-z2011-07735
DOI: https://doi.org/10.17192/z2011.0773
DDC:610 Medizin
Titel (trans.):Evaluation of a potential parathyroid dysfunction under treatment with radioactive iodine of benign thyroid diseases
Publikationsdatum:2011-12-19
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
thyroid, Epithelkörperchen, Parathormon, I-131, parathyroid hormone, Iod-131, parathyroid gland, Nebenschilddrüse, radioactive iodine therapy, Radioiodtherapie, Schilddrüse, Strahlenschaden

Zusammenfassung:
Das Ziel der vorliegenden Arbeit war die Evaluation einer potentiellen Nebenschilddrüsenfunktionsstörung unter Radioiodtherapie benigner Schilddrüsenerkrankungen. Es sollte untersucht werden, ob es in der ersten Woche unter Radioiodtherapie zu einer Veränderung in der Nebenschilddrüsenfunktion kommt. In der Klinik für Nuklearmedizin des Universitätsklinikums Gießen-Marburg GmbH, Standort Marburg, wurde eine prospektive Kohortenstudie an insgesamt 105 Probanden (75 Frauen/30 Männer, mittleres Alter 60,62 ± 14,30 Jahre) mit einer Radioiodtherapie benigner Schilddrüsenerkrankungen durchgeführt. Die 105 Probanden wurden nach ihrer Schilddrüsenerkrankung in folgende Subgruppen unterteilt: unifokale Autonomie mit 23 Patienten, multifokale Autonomie mit 8 Patienten, disseminierte Autonomie mit 37 Patienten und in die Subgruppe Autoimmunthyreopathie vom Typ Basedow (ohne endokrine Orbitopathie) bzw. Morbus Basedow (mit endokriner Orbitopathie) mit 37 Patienten. Die Konzentration des intakten Parathormons im Serum wurde direkt vor Beginn der Radioiodtherapie am Aufnahmetag, am Tag 1, 3 und 5 der stationären Radioiodtherapie und bei der ambulanten Kontrolluntersuchung einen Monat nach Beginn der Radioiodtherapie bestimmt. Bei 99 von 105 Probanden kam es unter Radioiodtherapie zu einem Abfall der Parathormonkonzentration im Serum mit einem Tiefpunkt am dritten Tag der Therapie (Abfall um 15,71 ng/l bzw. 27,54%). Die mittlere Parathormonkonzentration im Serum betrug vor Beginn der Radioiodtherapie 48,99 ± 24,05 ng/l [n = 105], am Tag 1 nach Radioiodgabe 34,09 ± 16,25 ng/l [n = 100], am Tag 3 32,74 ± 14,11 ng/l [n = 97], am Tag 5 37,02 ± 21,52 ng/l [n = 54] und bei der Nachuntersuchung einen Monat nach Beginn der Radioiodtherapie 44,62 ± 20,54 ng/l [n = 91]. Die Patienten erhielten im Mittel eine Aktivität von 1341,43 ± 459,16 MBq [n = 105] und die Herddosis der Schilddrüse unter Radioiodtherapie lag im Mittel bei 422,53 ± 245,56 Gy [n = 101]. Die einfaktorielle Varianzanalyse über alle Daten bis zum Tag 3 bestätigte den Abfall der Parathormonkonzentration im Serum (p < 0,0001). Der Student t-Test für gepaarte Stichproben ergab einen statistisch signifikanten Abfall der Mittelwerte der Parathormonkonzentration vor Therapie zu den Mittelwerten am Tag 1 (p < 0,0001) und am Tag 3 (p < 0,0001) der Therapie. Die zweifaktorielle Varianzanalyse ergab keinen signifikanten Unterschied im Abfall der Parathormonkonzentration für die Verläufe der vier Subgruppen (p = 0,32). Es ließ sich keine Korrelation zwischen dem absoluten bzw. dem relativen Parathormonabfall und der Herddosis der Schilddrüse nachweisen. Die vorliegende Arbeit zeigt erstmalig in diesem Umfang, dass es schon in den ersten Tagen nach Radioiodgabe zu einem Abfall der Parathormonkonzentration im Serum kommt, höchstwahrscheinlich aufgrund einer akuten Nebenschilddrüsenfunktionsstörung. Es wird vermutet, dass diese Störung eine Folge der ionisierenden Strahlen des 131I ist.

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