COMBINATION OF MOLECULAR ADSORBENT RECIRCULATING SYSTEM AND RADIOIODINE FOR THE TREATMENT OF CONCURRENT HYPERTHYROIDISM AND SEVERE LIVER DYSFUNCTION: A RETROSPECTIVE COHORT STUDY.
OBJECTIVE
The treatment of hyperthyroidism associated with severe liver dysfunction (LD) is a clinical challenge, and there has been no unified examination of this problem. The objective of this study was to assess the efficacy and safety of radioiodine (131I) in combination with a molecular adsorbent recirculating system (MARS) for the treatment of hyperthyroidism complicated by severe liver LD.


METHODS
A total of 116 hyperthyroidism patients with concomitant LD who received MARS treatment were studied retrospectively. The patients were grouped according to whether or not they also received131I treatment: Group 1 (59 patients) received131I following MARS treatment, while Group 2 (57 cases) received only MARS. Clinical outcomes, including thyroid hormone levels, liver function parameters, and therapeutic efficacy were calculated.


RESULTS
The overall response rate was significantly greater in Group 1 than in Group 2 (P<.01). The clinical indicators improved significantly in both groups 3 months after treatment compared with before treatment (P<.05), but Group 1 showed a greater improvement. Compared with Group 1, patients in Group 2 had a longer stay in hospital (P<.05), and received more frequent MARS treatments (P<.05).


CONCLUSIONS
The combination of MARS and131I for the treatment of hyperthyroidism complicated by severe LD was effective and safe. The use of this system could rapidly improve liver function and metabolism, allowing131I therapy to be applied as early as possible with a shortened recovery time of liver function.


BACKGROUND
ALSS = artificial liver support system ALT = alanine transaminase AST = aspartate transaminase ATD = antithyroid drugs DBil = direct bilirubin FT3 = free tri-iodothyronine FT4 = free thyroxine131I = radioiodine INR = international normalized ratio LD = liver dysfunction MARS = molecular adsorbent recirculating system MELD = model for end-stage liver disease PT = prothrombin time TBil = total bilirubin TSH = thyroid-stimulating hormone.
Qing
Q
Zhang
Yanxing
Y
Guan
Tianxin
T
Xiang
Shaozheng
S
Liu
Qingjie
Q
Chen
Qing
Q
Zhang
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D058625:End Stage Liver Disease / Q000150:complications / Q000628:therapy; D019317:Evidence-Based Medicine; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications* / Q000532:radiotherapy / Q000628:therapy*; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008107:Liver Diseases / Q000150:complications* / Q000532:radiotherapy / Q000628:therapy*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D013960:Thyroid Function Tests; D013963:Thyroid Hormones / Q000097:blood; D016896:Treatment Outcome; D055815:Young Adult
D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D013963:Thyroid Hormones