HCT患者实施全切术结合131Ⅰ清甲治疗的临床疗效及安全性

目的：探讨甲状腺嗜酸细胞肿瘤( HCT)患者行甲状腺全切术结合131Ⅰ清甲治疗的临床疗效及安全性。方法选取2001年1月至2013年1月我院收治的20例HCT患者为研究对象。所有患者行甲状腺全切术结合131Ⅰ清甲治疗,观察其治疗后的并发症、甲状腺旁功能减退情况和肿瘤复发情况等。结果 HCT患者实施全切术结合131Ⅰ清甲治疗总有效率100%,未出现声嘶、感染等并发症,随访未发现肿瘤复发或死亡;甲状腺全切术联合中央区淋巴结清扫术使甲状旁腺损伤的概率增加;单纯甲状腺全切术和甲状腺全切术联合中央区淋巴结清扫术的患者在131Ⅰ治疗不同阶段,PTH水平差异无统计学意义(P>0.05)。结论单纯甲状腺全切术结合131Ⅰ清甲治疗使甲状旁腺损伤的概率较小,损伤也仅为暂时性甲状旁腺功能减低,多为1个月内恢复,安全性高。     

血清Tg变化在甲癌术后131I首次清甲中的价值

目的:评价在分化型甲状腺癌患者术后<'131>I首次清甲中血清Tg变化对于清甲效果的预测价值.方法:38例接受甲状腺全切或次全切手术后行放射性<'131>I首次清甲治疗的分化型甲状腺癌患者,应用放射免疫分析所有患者服用<'131>I前的血清Tg(TgD0),以及服用<'131>I后第5d的血清Tg(TgD5),观察清甲...     

甲亢131I治疗干预后甲状腺功能状态与血清PTH水平的相关性分析

目的 探讨甲亢131I治疗干预后甲状腺功能状态以及与血清PTH水平的相关性.方法 选取本院接受131I治疗的甲亢患者60例,同时选取接受常规药物治疗的甲亢患者65例为对照组.随访近期和较远期治疗效果.患者均知情同意并签署知情同意书.统计分析采用卡方检验以及t检验等完成,SPSS17.0 统计软件包用于数据分析.结果 两组患者治疗后TT3水平均有下降;131I治疗组治疗后1周TT3水平显著低于治疗前,治疗后3个月继续平稳下降;TT4水平变化与TT3变化趋势近似.经治疗1周,131I治疗组TT3和基础代谢率水平明显低于对照组,P<0.01;治疗后3个月 TT3、TT4以及基础代谢率水平均明显低于对照组,P<0.01.且131I治疗组治疗后3个月痊愈率显著高于对照组,P<0.01.好转率在治疗后1周可见131I治疗组显著高于对照组.对甲状旁腺激素水平的影响分析可见, 131I治疗组PTH水平治疗后1周水平升高,治疗3个月继续回升,P<0.01.而对照组PTH水平治疗后3个月才开始回升.总有效率的比较结果则提示治疗组1周和后3个月的总有效率均显著高于对照组,差异均有统计学意义.结论 131I治疗干预后甲状腺功能状态恢复快效果好,具有一定临床优势,且甲亢进展与血清PTH水平成负反馈作用,治疗效果可以通过PTH水平回升得到佐证.     

DTC术后131 I清甲治疗短期内血清Tg和TgAb变化及临床意义

目的 比较分化型甲状腺癌（DTC）患者在术后接受^131I治疗,短期内血清甲状腺球蛋白（Tg）和甲状腺球蛋白抗体（TgAb）变化及临床意义.方法 随机选取甲状腺乳头状癌（PTC）患者80例,男22例,女58例,年龄平均41.5±10.4岁,术后均接受剂量为3.7～ 5.5GBq^131I口服治疗,分别于^131I治疗前1天及治疗后第7天监测患者的Tg和TgAb,结合DTC患者治疗后^131I全身扫描结果及4～ 12个月的门诊随访结果,分析^1311I清甲治疗后短期内血清Tg和TgAb变化的临床意义.结果 治疗后血清Tg均有不同程度升高,根据Tg变化程度分组,轻微升高组42例（升高0～ 99ng/L）缓解率为47.6％,中度升高组（升高100 ～ 999ng/L） 20例缓解率为60.0％,明显升高组18例（升高≥1000ng/L）缓解率为66.7％,组间有统计学差异,上升幅度显著者缓解率高.治疗后TgAb下降组随访缓解率为75.0％ （36/48）;TgAb上升组缓解率为43.8％ （14/32）,经卡方检验,两组缓解率有统计学差异（x^2=4.0,P＜0.05）.结论 Tg在治疗后短期内上升幅度越大,提示131I的疗效和预后越好;而TgAb阳性者在治疗后短期内明显下降,也是治疗有效的征象.     

血清CEA、 Tg联合检测在甲状腺良、恶性肿瘤中的临床价值

目的 探索血清CEA、Tg联合检测在甲状腺良、恶性肿瘤中的临床价值.方法 采用化学发光法分别检测经病理证实的68例分化型甲状腺癌(DTC)术前和手术联合131I清甲治疗后、65例甲状腺腺瘤、55例正常对照的CEA、Tg水平,并将结果应用SPSS13.0软件进行统计学分析.结果 术前DTC组的CEA水平明显高于腺瘤组(P＜0.05)、Tg水平与腺瘤组差异无统计意义(P ＞0.05);DTC组患者手术联合131I清甲治疗后的Tg水平有显著性下降(P＜0.05);术后Ⅰ和Ⅱ期DTC患者的Tg、CEA水平明显低于Ⅲ和Ⅳ期的(P＜0.05).结论 血清CEA、Tg联合检测对手术及131I清甲治疗后DTC患者的治疗效果及预后判断有较大价值,CEA检测对确诊中晚期的DTC患者有辅助诊断作用.     

DTC术后131I治疗后体内残留放射性活度与半年后清甲成功关系

目的 探究分化型甲状腺癌(differentiated thyroid cancer,DTC)术后131 I治疗后患者体内残留放射性活度与半年后清甲成功之间的关系.方法 选取在桂林医学院附属医院首次接受131 I清甲治疗的91例DTC患者,收集相关临床资料及测量131 I治疗后不同时间点体内残留放射性活度,进行随访研究...     

138例131I治疗分化型甲状腺癌的回顾性分析

目的 评价131I治疗分化型甲状腺癌(DTC)术后及合并甲状腺外转移患者的疗效,并分析其常见副作用发生情况.方法 对138例经病理及影像学检查确诊为分化型甲状腺癌及合并甲状腺外转移的患者采用131I进行治疗,“清甲”、淋巴结转移、远处脏器或骨转移剂量分别为3.7GBq、5.55 GBq、7.4 GBq.结果 通过1～2次131I治疗,89例清甲患者中完全清除残留甲状腺者86例,完全清除率96.6％,不完全清除者3例.合并甲状腺外转移49例患者中,通过3～6次治疗后治愈或好转者43例.结论 分化型甲状腺癌术后应根据术后分期及复发危险度分层选择性应用131I进行清甲及对合并甲状腺外转移患者进行治疗具有较好的疗效,常见副作用相对较少,一般轻微可逆.     

131I治疗老年分化型甲状腺癌淋巴结转移的疗效评价

目的 探讨131I治疗老年分化型甲状腺癌淋巴结转移（LMDTC）的疗效.方法 对33例老年分化型甲状腺癌术后合并淋巴结转移进行131I治疗,并采用B超、CT、131I显像及Tg变化综合判断疗效.结果 33例老年分化型LMDTC,131I治疗后有27例淋巴结消除或缩小,有效率为81.8％（27/33）.结论 131I治疗老年分化型甲状腺癌淋巴结转移有较好的疗效.     

分化型甲状腺癌手术后首次131I清除残余甲状腺组织的疗效及影响因素分析

目的 观察131I首次清除分化型甲状腺癌(differentiated thyroid cancer,DTC)术后残余甲状腺组织(以下简称“清甲”)的疗效并分析影响疗效的因素.方法 将86例DTC患者分为两组:甲状腺完全切除者56例(简称“完全切除组”),甲状腺不完全切除者30例(简称“不全切除组”),一次性口服131I 1.85～5.55GBq(50～150mCi),6个月后随访,TSH刺激状态下复查颈部彩超阴性,若131 I-WBS甲状腺床无放射性浓聚,Tg＜ 5ng/mL,TgAb阴性,为“清甲完全”.结果 86例DTC患者首次131I治疗完全清甲者50例(58.1％),其中甲状腺全切除术后131I完全清甲率约69.6％(39/56),不全切除术的完全清甲率为36.7％ (11/30),经比较,两组间差异有统计学意义(P＜0.05).无颈淋巴结转移的DTC患者首次131I治疗完全清甲率为57.1％ (24/42),伴颈部淋巴结转移的患者完全清甲率为59.1％ (26/44),两组间比较差异无统计学意义(P＞0.05).结论 131I清除甲状腺切除后残余甲状腺组织安全、有效.不同手术方式导致残余甲状腺组织的多少是影响131I治疗疗效的重要因素.     

NIRAF技术辅助识别甲状旁腺的有效性及对术后甲状旁腺保护和甲状旁腺激素表达的影响

目的 探讨近红外自体荧光显像（NIRAF）技术辅助识别甲状旁腺的有效性及对术后甲状旁腺保护和甲状旁腺激素表达的影响。方法 选择2020年1月至2022年9月在邢台医学高等专科学校第二附属医院收治的122例甲状腺癌患者，其中男性95例，女性27例；年龄39～51岁，平均年龄45.23岁；病理类型，乳头状癌105例，滤泡性腺瘤17例；单侧切除术46例，双侧切除术76例。按照随机数表法将患者分为对照组和研究组，对照组患者行常规甲状腺癌手术，研究组患者在NIRAF技术辅助下行甲状腺切除术。比较两组患者甲状旁腺识别率、围术期指标、氧化应激指标、甲状腺功能、血钙、甲状旁腺激素（PTH）、免疫功能和并发症等参数。结果 研究组患者伤口长度、术中出血量、手术时间、术后引流量和住院时间与对照组比较，差异无统计学意义（P> 0.05）。两组患者均出现感染、发音困难和声音嘶哑等并发症，但差异无统计学意义（P> 0.05），而研究组患者术后低血钙和PTH减退比例明显低于对照组（22.95%vs 44.26%,6.56%vs 19.67%。P=0.013、0.032）。术后7 d两组患者CD3+CD4...     

The Effectiveness of Recombinant Human Thyroid-Stimulating Hormone versus Thyroid Hormone Withdrawal Prior to Radioiodine Remnant Ablation in Thyroid Cancer: A Meta-Analysis of Randomized Controlled Trials

We evaluated the efficacy of recombinant human thyroid-stimulating hormone (rhTSH) versus thyroid hormone withdrawal (THW) prior to radioiodine remnant ablation (RRA) in thyroid cancer. A systematic search of MEDLINE, EMBASE, the Cochrane Library, and SCOPUS was performed. Randomized controlled trials that compared ablation success between rhTSH and THW at 6 to 12 months following RRA were included in this study. Six trials with a total of 1,660 patients were included. When ablation success was defined as a thyroglobulin (Tg) cutoff of 1 ng/mL (risk ratio, 0.99; 95% confidence interval, 0.96-1.03) or a Tg cutoff of 1 ng/mL plus imaging modality (RR 0.97; 0.90-1.05), the results of rhTSH and THW were similar. There were no significant differences when ablation success was defined as a Tg cutoff of 2 ng/mL (RR 1.03; 0.95-1.11) or a Tg cutoff of 2 ng/mL plus imaging modality (RR 1.02; 0.95-1.09). When a negative ¹³¹I-whole body scan was used solely as the definition of ablation success, the effects of rhTSH and THW were not significantly different (RR 0.97; 0.93-1.02). Therefore, ablation success rates are comparable when RRA is prepared by either rhTSH or THW.     

Effect of a Low Iodine Diet vs. Restricted Iodine Diet on Postsurgical Preparation for Radioiodine Ablation Therapy in Thyroid Carcinoma Patients

Purpose

The radioiodine ablation therapy is required for patients who underwent a total thyroidectomy. Through a comparative review of a low iodine diet (LID) and a restricted iodine diet (RID), the study aims to suggest guidelines that are suitable for the conditions of Korea.

Materials and Methods

The study was conducted with 101 patients. With 24-hour urine samples from the patients after a 2-week restricted diet and after a 4-week restricted diet, the amount of iodine in the urine was estimated. The consumed radioiodine amounts for 2 hours and 24 hours were calculated.

Results

This study was conducted with 47 LID patients and 54 RID patients. The amounts of iodine in urine, the 2-week case and 4-week case for each group showed no significant differences. The amounts of iodine in urine between the two groups were both included in the range of the criteria for radioiodine ablation therapy. Also, 2 hours and 24 hours radioiodine consumption measured after 4-week restrictive diet did not show statistical differences between two groups.

Conclusion

A 2-week RID can be considered as a type of radioiodine ablation therapy after patients undergo a total thyroidectomy.     

Influence of Single Experience with Intraoperative Near-Infrared Autofluorescence on Postoperative Parathyroid Insufficiency after Thyroidectomy - A Preliminary Clinical Study

Introduction: Total thyroidectomy has become the most common thyroid procedure. This treatment method results in most postoperative hypocalcemia (PH) and hypoparathyroidism (HPT) cases due to the unwitting removal of the parathyroid glands (PTGs). Near-infrared autofluorescence (NIRAF) is a new method that helps identify PTGs. This study aimed to determine whether short-term experience with intraoperative NIRAF may influence postoperative complications after thyroidectomy.Materials and methods: Overall, 65 patients who underwent thyroidectomy by one high-volume surgeon were enrolled in the study between March 2018 and August 2021. In August 2020, the surgeon performed four operations using the NIRAF device. After that experience, the technique of operating and preserving PTGs has been totally changed. Postoperative serum calcium (Ca) and parathormone (PTH) concentrations were measured. Using retrospective study analysis, we assessed the rate of PH and HPT.Results: There was no statistically significant difference in Ca (p = 0.1612) and PTH (p = 0.3590) concentrations between groups operated on before and after the NIRAF experience. The serum concentrations of Ca and PTH of all patients were positively correlated (r = 0.4074; p = 0.0022) as well as the Ca concentration and age of patients (r = 0.3292; p = 0.0116), respectively.Conclusions: These findings suggest that short-term NIRAF experience, and changing attitude to preserving PTGs does not affect thyroidectomy outcomes, even when utilized by a highly experienced high-volume thyroid surgeon. However, continuous use of NIRAF might enhance treatment outcomes, particularly for surgeons with limited experience.     

DTC术后131I清甲治疗患者血清Tg及TgAb变化及其与病灶检出相关性分析

目的 探讨分化型甲状腺癌(DTC)患者在术后接受131I治疗后,血清甲状腺球蛋白(Tg)、甲状腺球蛋白抗体(TgAb)的变化及其与131I全身显像(Dx-WBS)结果的相关性,从而为DTC复发、转移的诊断提供依据.方法 入选我院DTC患者83例,均在行甲状腺全切或次全切手术4～6周后,给予131I治疗,半年后TSH刺激状态下(停用甲状腺素片并低碘饮食3周),检测血清Tg及TgAb,并对甲功各项指标进行复查,同时行131I全身显像检查.结果 TgAb阳性率随着Tg水平的变化而发生改变,对血清Tg的检出存在一定干扰性,将Tg与Dx-WBS二者联合进行判断,DTC复发及转移诊断准确率可达95％.结论 DTC术后131I清甲治疗半年后,Tg检测的准确性相对较高,但受TgAb干扰,存在假阴性,应与Dx-WBS进行联合作为DTC复发及转移的重要诊断指标.     

NSCLC患者血清sB7-H3和CYFRA21-1检测及临床应用

目的 探讨血清可溶性B7-H3（sB7-H3）和细胞角蛋白19片段抗原（CYFRA21-1）检测对非小细胞肺癌（non-small cell lung cancer,NSCLC）的诊断价值.方法 分别采用 ELISA和电化学发光法检测 72 例 NSCLC及 68 例肺部良性病患者血清sB7-H3 和 CYFRA21-1水平.结果 NSCLC 患者血清sB7-H3水平及阳性率[（98.34±35.17）ng/ml,61.11%]均明显高于肺部良性病患者[（70.89±20.62）ng/ml,7.32%];NSCLC 患者血清CYFRA21-1 水平及阳性率[（15.08±7.98）ng/ml,66.67%]均明显高于肺部良性病患者[（3.21±2.65）ng/ml,4.41%];差异均具有统计学意义（P〈0.05）.NSCLC 经TNM分期后,随着肿瘤分级级别的升高,sB7-H3水平[Ⅰ/Ⅱ期、Ⅲ期和Ⅳ期分别为（85.21±36.14）ng/ml、（98.62±＋40.38）ng/ml和（107.17±41.66）ng/ml],CYFRA21-1水平和[Ⅰ/Ⅱ期、Ⅲ期和Ⅳ期分别为（10.23±5.65）ng/ml、（15.52±6.84）ng/ml和（18.08±5.93）ng/ml]也升高.sB7-H3 和 CYFRA21-1联检后,灵敏度和一致性增高,特异性降低.结论 sB7-H3 和 CYFRA21-1对 NSCLC 有一定的辅助诊断价值,另外,或可应用于对TNM的分期,联检可提高对NSCLC的阳性诊断.     

Tg与TGA在分化型甲状腺癌术后监测及其疗效观察中的应用价值

目的：探讨甲状腺球蛋白（thyroglobulin,Tg）在分化型甲状腺癌（differentiated thyroid carcer,DTC）诊断及术后疗效观察中的应用价值。方法：采用放射免疫分析,对198例行甲状腺全切及次全切的DTC患者进行术后及术后半年血清Tg水平的追踪检测,同时行甲状腺球蛋白抗体（thyroglobulin antibody,TGA）的检测,并与正常对照组与转移组进行比较。结果：160例Tg〈20ng/ml的DTC患者阴性组术后1周血清Tg水平与对照组比较无明显差异（P〉0.05）;Tg水平〈10ng/ml者为56例,占35%。38例Tg〉20ng/ml阳性组术后1周时Tg水平明显高于阴性组和正常对照组（P〈0.01）。术后半年Tg水平随着病情好转逐渐下降,与术前1周之间呈明显正相关（t=4.951,P〈0.01）。23例远处转移癌的Tg水平明显高于颈部淋巴结转移组（P〈0.01）。术后Tg阴性患者其TGA增高者为25例,占20%。术后Tg阳性组TGA增高阳性率为42%。远处转移组TGA增高阳性率为56%。结论：Tg作为DTC的肿瘤标志物,在监测DTC手术效果、预后判断、复发、转移的诊断和鉴别治疗效果中具有重要的指导作用。     

BRAF V600E mutation does not predict recurrence after long-term follow-up in TNM stage I or II papillary thyroid carcinoma patients

The BRAF V600E mutation may serve as a marker of disease recurrence in well-differentiated papillary thyroid cancer (PTC). Our aim was to study if TNM stage I or II PTC patients, with and without recurrence after long-term follow-up would differ in BRAF status. BRAF status was retrospectively determined in tumour tissue from a cohort of low-risk PTC patients (n = 461) with and without recurrence after 16 years of follow-up. Initial treatment was total thyroidectomy (TTE) and radioiodine remnant ablation (RRA). Forty-six patients (9.9%) experienced disease recurrence. BRAF mutation was positive in 66% (17/26) of patients with and 68% (17/25) without recurrence (p = NS). Fifty per cent of BRAF positive and 53% of BRAF negative patients experienced disease recurrence (p = NS). Time to recurrence was 52 (range 18-144) and 36 (range 16-71) months, respectively (p = NS). Primary tumour size, nodal metastasis and local infiltration at presentation did not differ between BRAF positive and negative patients (2.0 vs 2.2 cm, 21% vs 35% and 6% vs 12%, respectively, all p = NS). Taken together, BRAF V600E is common in Finnish patients with low-risk PTC but does not predict recurrence after long-term follow-up after initial treatment with TTE and RRA.     

Clinical Outcome of Remnant Thyroid Ablation with Low Dose Radioiodine in Korean Patients with Low to Intermediate-risk Thyroid Cancer

Radioiodine activity required for remnant thyroid ablation is of great concern, to avoid unnecessary exposure to radiation and minimize adverse effects. We investigated clinical outcomes of remnant thyroid ablation with a low radioiodine activity in Korean patients with low to intermediate-risk thyroid cancer. For remnant thyroid ablation, 176 patients received radioiodine of 1.1 GBq, under a standard thyroid hormone withdrawal and a low iodine diet protocol. Serum levels of thyroid stimulating hormone stimulated thyroglobulin (off-Tg) and thyroglobulin-antibody (Tg-Ab), and a post-therapy whole body scan (RxWBS) were evaluated. Completion of remnant ablation was considered when there was no visible uptake on RxWBS and undetectable off-Tg (<1.0 ng/mL). Various factors including age, off-Tg, and histopathology were analyzed to predict ablation success rates. Of 176 patients, 68.8% (n = 121) who achieved successful remnant ablation were classified into Group A, and the remaining 55 were classified into Group B. Group A presented with significantly lower off-Tg at the first radioiodine administration (pre-ablative Tg) than those of Group B (1.2 ± 2.3 ng/mL vs. 6.2 ± 15.2 ng/mL, P = 0.027). Pre-ablative Tg was the only significant factor related with ablation success rates. Diagnostic performances of pre-ablative Tg < 10.0 ng/mL were sensitivity of 99.1%, specificity of 14.0%, positive predictive value of 71.1%, and negative predictive value of 87.5%, respectively. Single administration of low radioiodine activity could be sufficient for remnant thyroid ablation in patients with low to intermediate-risk thyroid cancer. Pre-ablative Tg with cutoff value of 10.0 ng/mL is a promising factor to predict successful remnant ablation.

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Use of hormonal parameters of phospho-calcium metabolism as a means of discriminating bone and joint disorders in patients with renal insufficiency

Serum carboxyterminal parathyroid hormone (PTH) concentration (homologous measurement of the 53-84 fragment and heterologous bovine measurement) has been measured and correlated with both clinical and radiological findings of secondary hyperparathyroidism (HPT), studied quantitatively according to a score published in literature, in 95 patients with chronic renal failure on maintenance hemodialysis. Mean serum PTH concentration (53.84) is statistically higher in patients with severe clinical and radiological evaluation of HPT than in patients with moderate or slight manifestations of HPT (M +/- DS: 515.8 +/- 243.7 pg/ml VS 271.3 +/- 166.1 pg/ml p less than 0.001). However, even with high serum concentration, serum PTH level does not allow to predict HPT severity, suggesting a retention of PTH fragments in serum without biologic activity probably.     

Postresection parathyroid hormone and parathyroid hormone decline accurately predict hypocalcemia after thyroidectomy

Hypocalcemia is the most frequent complication after total thyroidectomy. Parathyroid hormone (PTH) measurement has been proposed as an early predictor of this condition. Total thyroidectomy was performed in 39 patients. Hypocalcemia was present in 15 cases (38%). Patients undergoing hemithyroidectomy (n = 13) were considered control subjects not developing hypocalcemia. PTH was measured before surgery and 10 minutes after resection of the gland using a rapid (15 minutes) chemiluminescent immunometric assay. Patients developing hypocalcemia had lower calcium and postresection PTH levels and higher PTH decline than patients not developing hypocalcemia (P < .0001). PTH decline (cutoff value, 62.5%) had the better sensitivity (93.3%) for predicting hypocalcemia, allowing for a fairly safe early discharge. However, the best overall results corresponded to the combination of postresection PTH level (< or = 18 pg/mL [< or = 1.9 pmol/L]) and PTH decline (>62.5%), with a sensitivity of 90% and a specificity of 97.9%. Perioperative PTH measures can accurately predict hypocalcemia after thyroidectomy, granting the laboratory a key role in the immediate decision about calcium supplementation for patients at risk.