Comparison of the effect of 131I and 131I combined with hepatic protective drug treatment for Graves' disease patients with hepatic dysfunction

Objective To analyze the change of thyroid hormone levels and hepatic function indices before and after the treatment of 131 I and 131I combined with a hepatic protective drug in Graves' disease patients with hepatic dysfunction,and to compare their treatment effect.Methods All 120 patients with Graves' disease,who had hepatic dysfunction associated with Graves' disease,were randomly divided into two groups.Sixty cases in the treatment group received 131 I combined with reduced glutathione tablets,while another 60 cases in the control group underwent 131I treatment only.FT3,FT4,TSH,ALT,AST and total bilirubin (TBIL) of all patients were tested 1 month,3 months and 6 months after the treatment to evaluate the progress of Graves' disease and hepatic function.FT3,FT4 and TSH were detected with electrochemical luminescence method; ALT and AST were detected with rate method; TBIL was detected with diazonium salt method.T-test and x2 test were used for statistical analysis.Results One,three and six months after 131I treatment,FT3 and FT4 decreased significantly,and TSH increased significantly.FT3 ≤ (17.13 ±5.22 ) pmol/L,FT4 ≤ (51.26 ±20.60) pmol/L,TSH≥ (0.11 ±0.09) mU/L in the treatment group and FT3≤( 17.41 ±5.18) pmol/l,FT4 ≤(50.60 ±20.45) pmol/L,TSH≥(0.12 ±0.09) mU/L in the control group (t=5.1843-14.8564,all P ＜0.01 ).There was no significant difference between the treatment group and the control group (t =0.1478-0.3902,all P ＞0.05).One month,three months and six months after treatment,the hepatic function indices of patients in the treatment group were significantly decreased (ALT ≤(74.00±26.00) U/L,AST ≤ (68.00 ±27.00) U/L,TBIL ≤ (20.60 ±4.40) μmol/L,t =6.4080-13.8795,all P ＜0.01 ).One month after treatment the hepatic function indices of patients in the control group decreased compared to the values before treatment,but there was no significance (t =1.3262-1.9700,all P ＞0.05 ).At 3 and 6 months after treatment,the hepatic function indices of these control group patients were significantly reduced ( ALT≤ (64.00 ± 17.00) U/L,AST≤ (65.00 ± 16.00) U/L,TBIL≤(21.40 ±4.50) μmol/L; t =6.0144- 10.5171,all P ＜0.01 ).Six months after treatment,the cure rates of Graves' disease in the treatment group and control group were 80.0％ (48/60) and 78.3％ (47/60),respectively and the effective rates were 98.3％ (59/60) and 95.0％ (57/60),respectively (x2 =0.0505,1.0344,both P ＞ 0.05 ). Hepatic dysfunction cure rates in the treatment group and control group were 88.3％ (53/60) and 65％ (39/60),respectively and the effective rates were 96.7％ (58/60) and 88.3％(50/60),respectively (x2 =9.1304,8.1067,both P ＜ 0.05 ).Conclusion 131I therapy is a good choice for Graves' disease patients with hepatic dysfunction; combined with hepatic protective drug,it can promote the recovery of hepatic function. Key words: Graves' disease ;  Liver diseases;  Iodine radioisotopes ;  Glutathione