碳酸锂增强分化型甲状腺癌术后残留甲状腺131I吸收剂量的研究

目的 探讨碳酸锂对提高分化型甲状腺癌(DTC)术后残留甲状腺摄碘功能、延长有效半衰期(Teff)及增强^131I吸收剂量的作用。方法 30例DIC术后患者随机分为碳酸锂组与对照组，每组各15例。碳酸锂组给予碳酸锂250mg/次，4次／d，连用1周；对照组给予安慰剂VB4 10mg/次，3次／d，连用1周。2组均分别于服药前后测定24h甲状腺吸^131I率及Teff，通过自身前后比较、组间比较及可能影响因素相关分析以评价试验效果。结果 碳酸锂组24h吸^131I率明显提高，7ld明显延长，^131I吸收剂量明显增加，其24h吸^131I率提高与Teff延长有关。结论 碳酸锂能提高DTC术后残留甲状腺摄碘功能、延长Teff，明显增强残留甲状腺^131I吸收剂量。     

^131I治疗甲亢后致甲减的危险因素分析

目的探讨^131I治疗甲亢患者血清甲状腺球蛋白抗体（TGAb）、甲状腺微粒抗体（TMAb）、24h最高摄碘率及甲状腺质量与治疗后甲减的联系。方法根据^131I治疗后甲减的发生情况,分为甲减和非甲减两组,比较分析两组治疗前血清TGAb、TMAb、24h最高摄碘率及甲状腺质量阳性率。结果甲减组治疗前TGAb、TMAb、24h最高摄碘率及甲状腺质量的阳性率分别是38．40％、51．45％、66．67％、68．12％,非甲减组分别是27．45％、39．71％、59．15％、57．84％,除24h最高摄碘率之外两组比较差异有统计学意义（P〈0．05）。结论^131I治疗前TGAb及TMAb滴度高、甲状腺质量较小者治疗后易发生甲减。     

甲状腺乳头状癌患者术后首次131I治疗后辐射剂量率的影响因素及出院时间的探讨

目的 探讨甲状腺乳头状癌(PTC)患者术后首次131I治疗后影响辐射剂量率降低的相关因素,并预估其住院隔离时间。方法 选取2015年5月至2018年11月于南方医科大学珠江医院住院并首次行131I治疗的PTC患者167例,其中男性43例、女性124例,年龄(37.14± 12.00)岁。将所有患者按治疗剂量分为高剂量组(63例)和低剂量组(104例),于治疗后24、48、72、96 h时测量距离患者1 m处的辐射剂量率,将治疗后患者体内滞留131I活度为400 MBq时的时间点定为出院时间。采用多重线性回归方法分析影响辐射剂量率降低的相关因素。组间比较采用两独立样本非参数检验或两独立样本t检验。结果 PTC患者首次行131I治疗后的辐射剂量率随时间推移迅速下降,高剂量组治疗后的24、48 h辐射剂量率[(70.62±34.45)、15.64 μSv/h]明显高于低剂量组[(11.27±5.13)、2.03 μSv/h],且差异均有统计学意义(t=-13.581、-7.952,均P <0.01)。81.0%(51/63)和90.5%(57/63)的高剂量组患者分别可在治疗48 h和72 h后出院,99%(103/104)的低剂量组患者可在治疗24 h后出院。多重线性回归分析显示,131I剂量和2 h摄碘率对高剂量组24 h辐射剂量率的影响有统计学意义(F=9.23,复相关系数R2=0.212,P<0.01),高剂量组24 h辐射剂量率与2 h摄碘率和131I剂量呈正相关;性别、24 h摄碘率和残甲法3对高剂量组48 h辐射剂量率的影响有统计学意义(F=34.45,复相关系数R2=0.622,P<0.01),48 h辐射剂量率与24 h摄碘率和残留甲状腺体积呈正相关,与性别呈负相关;131I剂量和24 h饮水量对低剂量组24 h辐射剂量率的影响有统计学意义(F=12.76,复相关系数R2=0.186 ,P<0.01),低剂量组24 h辐射剂量率与131I剂量呈正相关,与24 h饮水量呈负相关。结论 PTC术后患者首次131I治疗24 h后,影响其辐射剂量率降低的主要因素是服用131I的剂量,而48 h后的主要影响因素是24 h甲状腺摄碘率、残留甲状腺体积和性别。低剂量组和高剂量组平均住院时间分别为1 d和2 d左右。     

治疗用碘[^131I]化钠胶囊在格雷夫斯病患者体内的药代动力学及疗效的前瞻性对照研究

目的 比较诊断期及治疗期碘[^131I]化钠胶囊与口服液在格雷夫斯病（GD）患者体内的血液药代动力学及患者甲状腺摄碘率的差异,评价两者治疗GD的疗效及安全性.方法 采用开放、平行、随机、对照的前瞻性临床研究.纳入44例GD患者[男14例,女30例,年龄（33.84±4.96）岁].其中试验组（A组,22例）诊断期口服碘[^131I]化钠口服液,治疗期口服碘[^131I]化钠胶囊;对照组（B组,22例）反之.测定2组诊断期及治疗期服药后0、5、10、20、40和80 min血放射性计数,以及2、4、6和24 h甲状腺摄碘率,采用梯形法计算两者时间曲线的AUC、峰浓度（cmax）及达峰时间（tmax）.观察3、6个月疗效及不良反应.采用SAS 9.3软件对试验数据进行多因素方差分析、t检验及χ^2检验.结果 每组各有1例失访,有效病例每组各21例.诊断期A组血放射性计数占给药放射性计数百分比（OD％）的时间曲线AUC0→t[（450.70±258.00）％·min]小于B组[（684.45±237.00）％·min],cmax[（8.43±4.00）％]低于B组[（13.28±4.20）％],Z=2.640 7、t=3.923 0,均P＜0.01;2组tmax分别为（37.27±23.10）和（34.55±21.30） min,Z=-0.335 9,P＞0.05.治疗期A、B组tmax分别为（46.36±24.98）和（28.64±19.35） min,Z=-2.681 8,P＜0.01;而2组AUC0→t和cmax差异均无统计学意义（t=1.707 4、1.357 4,均P＞0.05）.诊断期及治疗期2组摄碘率AUC0→t、cmax及tmax差异均没有统计学意义（t=0.420 8、1.596 8、0.797 8、1.688 0,Z=0.556 4、-0.013 8,均P＞0.05）.治疗后3个月A组甲状腺功能亢进症（简称甲亢）缓解者占66.7％（14/21）,B组相应比例为61.9％（13/21）,χ^2=0.104,P＞0.05;2组发生甲状腺功能减退症（简称甲减）比例分别为23.8％（5/21）和28.6％（6/21）,χ^2=0.123,P＞0.05.治疗后6个月2组甲亢和甲减发生比例差异也均无统计学意义（χ^2=1.118、1.714,均P＞0.05）.无一例出现不良反应.结论 诊断期和治疗期2种剂型碘[^131I]化     

甲状腺摄取^99mTc功能与甲状腺激素水平测定在甲状腺炎临床诊断中的联合应用

目的探讨甲状腺功能显像获得的摄锝率与甲状腺轴激素水平变化测定在甲状腺炎诊断中联合应用的价值.材料与方法对103例临床怀疑为甲状腺炎的患者进行99mTc甲状腺功能显像和甲状腺轴激素水平变化的测定.结果诊断甲状腺炎的灵敏度为88.1%,特异性为85.2%.结论99mTc甲状腺功能显像的摄锝率与甲状腺轴激素变化水平测定值出现矛盾现象时,应高度怀疑甲状腺炎的可能.     

吸碘率曲线下面积与Graves病^131I治疗效果的观察

目的:分析131I治疗格雷夫斯(Graves)病的疗效与吸碘率曲线关系以探讨确定个体化给药剂量的可能。材料和方法:152例应用131I治疗的Graves病患者,根据疗效被分为治愈组和未愈组,比较两组间年龄、甲亢病史、甲状腺重量、血清游离T4、131I治疗剂量、24小时吸碘率以及吸碘率曲线下相对面积等。结果:两组间患者在甲状腺重量、甲亢发病时间、服药剂量、血清游离T4等方面均无显著性差异。未愈组患者年龄小于治愈组,两组间24小时最大吸碘率间无明显差异,但治愈组吸碘率曲线下相对面积(72.6±18.1)明显小于未愈组(81.5±15.4,P<0.005)。所有131I治疗患者的24小时最大吸碘率(88.2±12.5)明显大于吸碘率曲线下相对面积(75.8±17.6,P<0.001)。结论:Graves病患者吸碘率曲线下面积较24小时最大吸碘率更能够反应甲状腺组织的摄碘功能,可能是用来指导给药量计算的更好参数。     

甲状腺摄取~(99m)Tc功能与甲状腺激素水平测定在甲状腺炎临床诊断中的联合应用

目的　探讨甲状腺功能显像获得的摄锝率与甲状腺轴激素水平变化测定在甲状腺炎诊断中联合应用的价值。材料与方法　对 10 3例临床怀疑为甲状腺炎的患者进行99mTc甲状腺功能显像和甲状腺轴激素水平变化的测定。结果　诊断甲状腺炎的灵敏度为 88.1% ,特异性为 85 .2 %。结论　99mTc甲状腺功能显像的摄锝率与甲状腺轴激素变化水平测定值出现矛盾现象时 ,应高度怀疑甲状腺炎的可能。     

甲状腺功能亢进症患者血浆中TNF-α1和IL-2水平的临床分析

目的 探讨Graves病(GD)、Hashimoto病(HD)等不同病因引起的甲状腺功能亢进症(简称甲亢)患者血浆中肿瘤坏死因子α1(TNF-α1)和白细胞介素2(IL-2)水平的变化特点.方法 将250例甲亢患者分为3组,其中,GD组109例、HD组80例、其他病因组61例.正常对照组为98名健康正常人.采用放射免疫分析法检测所有患者及健康正常人血浆中TNF-α1和IL-2的水平.结果 250例甲亢患者中,GD组和HD组的TNF-α1水平明显高于其他病因组(dTNF-α1 =17.638和19.248,P均＜0.01)和正常对照组(dTNF-α1=24.460和26070,P均＜0.01);IL-2水平则是明显低于其他病因组(dIL-2=2.668和2.975,P均＜0.01)和正常对照组(dIL-2=2.649和2.955,P均＜0.01).其他病因组和正常对照组间的TNF-α1和IL-2水平差异均无统计学意义(dTNF-α-=0.821,dIL-2=0.194,P均＞0.05).结论 GD、HD等白身免疫性甲状腺疾病的发生和发展伴有血浆TNF-α1、IL-2水平的改变,而高碘摄取、毒性多结节性甲状腺肿和毒性腺瘤等原因所致甲亢患者的血浆TNF-α1、IL-2水平则无特殊变化.血浆中TNF-α1和IL-2水平的检测分析对于GD和HD的鉴别诊断和疗效评价具有重要的临床意义.     

MRI弥散加权成像、甲状腺摄碘率和血清指标测定鉴别Graves甲状腺功能亢进症和无痛性甲状腺炎的研究

目的 研究MRI弥散加权成像（DWI）的表观弥散系数（ADC）、甲状腺摄131I率（RAIU）和血清指标等在Graves甲状腺功能亢进症（简称甲亢）和无痛性甲状腺炎（PT）鉴别中的价值.方法 选取102例Graves甲亢患者和37例PT患者入组.测定所有患者的血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、TSH、甲状腺球蛋白抗体（TgAb）、甲状腺过氧化物酶抗体（TPOAb）和促甲状腺激素受体抗体（TRAb）水平.采用3.0T超导型MRI仪完成MRI检查,并获得ADC.测定甲状腺24 h RAIU,并进行甲状腺静态显像.Graves甲亢患者的病理组织从接受手术的患者中获取（6例）,PT患者的病理组织从接受活检的患者中获取（2例）.采用Pearson检验明确各指标间的相关性,用受试者工作特征曲线（ROC）分析各项指标的诊断价值,确定各项指标的切分点值,并判断各项指标的诊断灵敏度、特异度、准确率、阳性预测值和阴性预测值.结果 与PT患者比较,Graves甲亢患者的ADC、TRAb和RAIU显著升高（t=15.126、7.226和31.574,P均＜0.01）.ADC、TRAb和RAIU之间存在显著的正相关性.ROC显示,RAIU、ADC和TRAb的曲线下面积大于0.900.其中,RAIU具有最好的诊断价值,当最佳切分点值确定为24.500％时,灵敏度、特异度、准确率、阳性预测值和阴性预测值均为100％.ADC比TRAb的诊断价值更高,当最佳切分点值分别确定为1.837×10^-3 mm^2/s和1.350 IU/ml时,ADC的上述统计指标分别为96.078％、91.892％、95.000％、97.059％和89.474％,TRAb的上述统计指标分别为88.235％、75.676％、84.892％、90.909％和70.000％.病理组织学结果显示：Graves甲亢以滤泡增生、滤泡上皮细胞增生以及血管扩张和充血为主要表现;PT以淋巴细胞浸润、淋巴滤泡形成以及滤泡破坏为主要表现.结论 对于Graves甲亢和PT的鉴别,RAIU、ADC和TRAb均有价值,RAIU最佳、ADC次之.ADC的显像原理是基于不同疾病细     

131I治疗分化型甲状腺癌术后患者辐射剂量预测模型的研究

目的 探讨131I治疗分化型甲状腺癌（DTC）术后患者全身辐射剂量代谢的影响因素,为辐射防护提供指导。 方法 回顾性分析2018年4至9月于3家三甲医院住院的72例DTC术后患者[男性27例、女性45例,年龄15~75（42.79±14.23）岁]的临床资料,其中同济大学附属第十人民医院23例、上海交通大学医学院附属仁济医院24例、华中科技大学同济医学院附属协和医院25例。根据服用131I后48 h全身辐射剂量是否达到安全标准将患者分为安全组（48 h全身辐射剂量≤23.30 μSv/h）和危险组（48 h全身辐射剂量>23.30 μSv/h）,比较各因素对全身辐射剂量代谢的影响。计量资料的组间比较采用成组t检验或Wilcoxon秩和检验;计数资料的组间比较采用卡方检验或Fisher确切概率法。对各变量进行单因素分析,对单因素分析中差异有统计学意义的变量采用多因素Logistic回归分析。以各单因素及多因素联合指标绘制受试者工作特征（ROC）曲线,评估其最佳临界值及诊断效能。 结果 危险组和安全组比较的单因素分析结果显示,甲状腺2 h摄碘率（t=?2.56,P=0.01）、24 h摄碘率（Z=?2.07,P=0.04）、游离三碘甲腺原氨酸（Z=?2.83,P=0.01）、游离甲状腺素（Z=?2.70,P=0.01）、甲状腺球蛋白（Tg）水平（χ2=6.80,P=0.01）、甲状腺超声提示是否存在甲状腺残留组织（Fisher确切概率法,P=0.03）等6个指标显著影响了131I治疗DTC术后患者的全身辐射剂量代谢。多因素Logistic回归分析结果显示,24 h摄碘率[OR=1.27（95%CI:1.03~1.57）]和Tg水平[OR=2.51（95%CI:1.21~5.20）]对全身辐射剂量代谢有影响（P=0.03、0.01）,24 h摄碘率和Tg水平越高的患者其48 h全身辐射剂量达到安全水平的可能性越低。24 h摄碘率+Tg水平（联合指标）诊断的ROC曲线下面积为0.76（95%CI:0.65~0.87）、灵敏度为94.87%、特异度为46.88%、最佳临界值为?0.71。 结论 24 h摄碘率和Tg水平是131I治疗DTC术后患者全身辐射剂量代谢的影响因素,利用这两个因素建立联合指标进行辐射剂量评估可为调整患者住院时长提供参考。     

The utility of thyroid nuclear imaging and other studies in the detection and treatment of underlying thyroid abnormalities in patients with endogenous subclinical thyrotoxicosis

PURPOSE: Endogenous subclinical thyrotoxicosis is diagnosed when a patient who is not taking exogenous thyroid hormone has a suppressed level of thyroid-stimulating hormone with normal levels of the free thyroid hormones thyroxine and triiodothyronine and other known causes of a suppressed thyroid-stimulating hormone level have been excluded. Although such a condition is caused by underlying thyroid disease, the specific nature and relative prevalence of these disorders and the utility of nuclear imaging and other studies in their detection remains unclear. PATIENTS AND METHODS: The authors performed a retrospective study of 50 patients with endogenous subclinical thyrotoxicosis. The results of the history and physical examination, thyroid nuclear scan, radioactive iodine uptake measurement, and thyroid antibody studies were reviewed. The results of the nuclear imaging and thyroid antibody studies were combined in an attempt to establish an underlying diagnosis for each patient. RESULTS: The thyroid nuclear imaging and antibody studies were used to establish a specific thyroid disorder in most of the patients (n = 39). These disorders included most commonly toxic multinodular goiter, various forms of autoimmune thyroid disease, and solitary toxic adenoma. A specific diagnosis was not determined in 11 patients. Therapy with I-131 radioactive iodine was administered to 14 of these patients, 13 of whom subsequently achieved a normal thyroid-stimulating hormone level. CONCLUSIONS: Most patients with endogenous subclinical thyrotoxicosis have underlying thyroid abnormalities that can be determined by nuclear imaging and, in selected cases, thyroid antibody studies.     

Clinical Significance of Diffuse Intrathoracic Uptake on Post-Therapy I-131 Scans in Thyroid Cancer Patients

Purpose

The purpose of this study was to identify the frequency and possible cause of diffuse intrathoracic uptake on post-therapy I-131 scans in thyroid cancer patients.

Methods

We retrospectively reviewed 781 post-therapy scans of 755 thyroid cancer patients who underwent total thyroidectomy and radioactive iodine therapy between January and December 2010. Diffuse intrathoracic uptake on post-therapy scans was examined, and clinical patient characteristics including sex, age, regimen for thyroid-stimulating hormone (TSH) stimulation (thyroid hormone withdrawal or recombinant human TSH injection), TSH, thyroglobulin (Tg) and anti-thyroglobulin antibody (anti-Tg Ab) levels, therapeutic dose of radioactive iodine therapy and prior history of radioactive iodine therapy were recorded.Scan findings were correlated with chest CT, chest radiographs, laboratory tests and/or clinical status. Diffuse intrathoracic uptake without evidence of pathologic condition was categorized as indeterminate. The association between clinical characteristics and intrathoracic uptake were analyzed for negative intrathoracic uptake and indeterminate uptake groups.

Results

Diffuse intrathoracic uptake on post-therapy scans was demonstrated in 39 out of 755 (5.2 %) patients, among which 3 were confirmed as lung metastasis. The 14 patients that showed high Tg or anti-Tg Ab levels were considered to be at risk of having undetected micrometastasis on other imaging modalities. The remaining 22 were indeterminate (2.9 %).Upon comparison of negative intrathoracic uptake and indeterminate uptake groups, TSH stimulation by thyroid hormone withdrawal was shown to be significantly correlated with diffuse intrathoracic uptake (p < 0.05).

Conclusion

The frequency of diffuse intrathoracic uptake on post-therapy scans was 5.2 % and could be seen in thyroid cancer patients with underlying lung metastasis as well as those without definite pathologic condition. In the latter, there was a higher frequency for diffusely increased intrathoracic uptake in those who underwent thyroid hormone withdrawal rather than recombinant human TSH injection.     

促甲状腺激素受体对分化型甲状腺癌~(131)I治疗效果预测价值

目的通过分析正常甲状腺及分化型甲状腺癌(DTC)组织中促甲状腺激素受体(TSHR)表达位置及表达强度的差异,探讨TSHR对DTC术后131I治疗效果的预测价值。方法回顾性分析DTC术后进行~(131)I清甲治疗患者49例,采用免疫组化ABC法,检测上述病例甲状腺癌组织及癌旁正常甲状腺组织中TSHR的表达位置及表达强度,根据~(131)I治疗效果分组,分析比较两组TSHR表达情况及相关临床资料。结果 49例患者病理切片中,正常甲状腺组织细胞膜TSHR表达阳性率近乎100%,甲状腺癌组织细胞膜TSHR表达阳性率为57.14%,差异有统计学意义(P<0.05);甲状腺癌组织细胞质内TSHR表达阳性率(87.76%)高于正常甲状腺组织(32.65%),差异有统计学意义(P<0.05)。一次性清甲成功患者DTC组织细胞膜上TSHR表达强度(阳性率70.00%及强阳性率46.67%)高于清甲治疗次数≥2次患者(阳性率36.84%及强阳性率15.79%),差异有统计学意义(P<0.05)。结论 DTC细胞膜TSHR的表达强度较正常甲状腺组织低,而其细胞质内TSHR表达强度升高,分化型甲状腺癌细胞膜TSHR表达强度或许能够预测~(131)I治疗效果。     

What influences early hypothyroidism after radioiodine treatment for Graves' hyperthyroidism?

OBJECTIVE: The objective of this study was to evaluate the factors influencing the occurrence of early hypothyroidism after radioiodine treatment of Graves' hyperthyroidism. MATERIAL AND METHODS: Of 147 patients with Graves' disease (GD) treated with radioactive I-131 (RAI) in our thyroid clinic between July 2003 and December 2004, 84 were followed at 2 and 4 to 5 months after treatment. The age range was 12 to 75 years and the dosage range in these patients was 7.4 to 29.9 mCi. Twenty-four were males and 60 were females. Factors possibly contributing to post-RAI hypothyroidism are: dosage of I-131, age, gender, size of the gland, initial serum free T4, free T3, thyroid-stimulating hormone (TSH) levels, pretreatment with antithyroid drugs, radioactive iodine uptake, and duration of disease. RESULTS: All patients had low TSH, elevated FT4, and elevated radioactive iodine uptake (RAIU) at 4 and/or 24 hours. Of the 84 patients followed, 46% of the males and 62% of the females became hypothyroid at 4 to 5 months (57% of the total). Twenty-one patients remained hyperthyroid and 14 patients became euthyroid. Multivariate analysis of these 84 patients showed no statistically significant single contributing factor for the development of early hypothyroidism. CONCLUSION: The early onset of hypothyroidism after RAI in GD is very common (57%) and unpredictable. Thus, after RAI treatment, all patients must be closely monitored for the development of this disorder.     

Dosimetry of radioiodine therapy in patients with nodular goiter after pretreatment with a single, low dose of recombinant human thyroid-stimulating hormone.

A single, low dose of recombinant human thyroid-stimulating hormone (rhTSH) doubles 24-h RAIU and causes a more homogeneous distribution of radioiodine on thyroid scintigrams of patients with nodular goiter. Pretreatment with rhTSH allows the therapeutic dose of (131)I to be reduced by 50%-60% without compromising the result of thyroid volume reduction. The present study focused on the dosimetric aspects of therapy with a reduced dose of (131)I after pretreatment with rhTSH in patients with nodular goiter. METHODS: Thirty-six patients were treated with (131)I to reduce thyroid volume. Nine patients were pretreated with a single dose of 0.01 mg of rhTSH, and 9 patients, with 0.03 mg of rhTSH. Two control groups of 9 patients, matched for thyroid weight and 24-h radioactive iodide uptake, were not pretreated with rhTSH. The therapeutic dose of (131)I was aimed at being sufficient to result in retention of 3.7 MBq of (131)I per gram of thyroid tissue at 24 h. Thyroid radioactivity after (131)I administration was measured every 24 h for 3 d and on days 7, 10, 14, 21, and 28. A model of iodine biokinetics was used to estimate absorbed doses in organs. Protein-bound (131)I activity was measured at 1, 2, 3, 7, and 10 d and at 2, 3, and 4 wk after (131)I therapy. RESULTS: The administered activities were 1.5 times lower in the 0.01-mg rhTSH group and 1.9 times lower in the 0.03-mg rhTSH group than in the control groups. The absorbed dose in the thyroid was similar in the rhTSH-pretreated groups and in the control groups. In the organs of excretion (bladder) and uptake (stomach) of inorganic iodide, the absorbed doses were 2- to 3-fold lower in the pretreated groups than in the control groups. The effective dose equivalent outside the thyroid was considerably lower in the rhTSH-pretreated groups than in their respective control groups (1.6-fold in the 0.01-mg rhTSH group and 2.3-fold in the 0.03-mg rhTSH group). The time course of protein-bound (131)I activity in serum and the cumulated protein-bound (131)I activity in serum did not differ significantly between rhTSH-pretreated and control groups. CONCLUSION: (131)I therapy after pretreatment with a single, low dose of rhTSH, with the dose reduced according to the rhTSH-induced increase in 24-h radioactive iodide uptake, caused lower radiation-absorbed doses in extrathyroidal organs and tissues, especially bladder and stomach, and no significant increase in the release of (131)I-labeled thyroid hormones into the circulation of patients with nodular goiter. Thus, this mode of therapy can be recommended, especially when the dose of radioiodine to be administered without rhTSH pretreatment is high.     

Respective roles of thyroglobulin, radioiodine imaging, and positron emission tomography in the assessment of thyroid cancer

Depending on the iodine supply of an area, the incidence of thyroid cancer ranges between 4 and 12/100,000 per year. To detect thyroid cancer in an early stage, the assessment of thyroid nodules includes ultrasonography, ultrasonography-guided fine-needle aspiration biopsy, and conventional scintigraphic methods using (99m)Tc-pertechnetate, (99m)Tc-sestamibi or -tetrofosmin, and (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in selected cases. After treatment of thyroid cancer, a consequent follow-up is necessary over a period of several years. For following up low-risk patients, recombinant thyroid-stimulating hormone-stimulated thyroglobulin and ultrasonography is sufficient in most cases. After total thyroidectomy and radioiodine ablation therapy, thyroid-stimulating hormone-stimulated thyroglobulin should be below the detection limit (eg, <0.5 ng/mL, R: 70-130). An increase of thyroglobulin over time is suspicious for recurrent or metastatic disease. Especially in high-risk patients, aside from the use of ultrasonography for the detection of local recurrence and cervial lymph node metastases, nuclear medicine methods such as radioiodine imaging and FDG-PET are the methods of choice for localizing metastatic disease. Radioiodine imaging detects well-differentiated recurrences and metastases with a high specificity but only moderate sensitivity. The sensitivity of radioiodine imaging depends on the activity administered. Therefore a low activity diagnostic (131)I whole-body scan (74-185 MBq) has a lower detection rate than a high activity post-therapy scan (3700-7400 MBq). In patients with low or dedifferentiated thyroid cancer and after several courses of radioiodine therapy caused by metastatic disease, iodine negative metastases may develop. In these cases, despite clearly elevated levels of thyroglobulin, radioiodine imaging is negative or demonstrates only faint iodine uptake. The method of choice to image these iodine negative metastases is FDG-PET. In recent years the combination of PET and computed tomography has been introduced. The fusion of the metabolic and morphologic information was able to increase the diagnostic accuracy, reduces pitfalls and changes therapeutic strategies in a reasonable number of patients.     

Treatment of malignant thyroid disease

Surgery is the primary form of therapy in the management of malignant thyroid disease. A near-total thyroidectomy is the preferred approach. Radioactive iodine is used for supplementary ablation therapy and for definitive therapy in differentiated tumors of papillary or follicular cell type. Thyroid-stimulating hormone (TSH) is administered in conjunction with radioactive iodine therapy, since tumor uptake appears to be directly related to endogenous TSH levels. Therapeutic doses of radioactive iodine range from 100 to 200 mCi of 131 I depending on tumor distribution. Adequate thyroid hormone replacement therapy resulting in the suppression of TSH is of considerable value in the prevention of tumor recurrence. Due to the possibility of late recurrence, patients should be followed for indefinite periods by means of diagnostic imaging studies at 1-2 yr intervals. Despite 30 yr of experience, the therapeutic efficacy of radioactive iodine remains controversial. However, in recent years, there has been mounting evidence indicating increased survival and decreased tumor recurrence in radioactive iodine-treated patients. External radiation therapy is reserved for anaplastic carcinoma and lymphoma, and adenocarcinomas that are refractory to radioactive iodine. Chemotherapy experience is limited; however, some reduction in the size of metastatic lesions has been observed after the administration of adriamycin.     

分化型甲状腺癌术后131I治疗及诊断性显像前提高TSH水平的方案及其影响

分化型甲状腺癌(DTC)术后131I治疗及诊断性显像前较高水平的促甲状腺激素(TSH)能增强131I疗效和提高显像灵敏度。提高TSH的方案主要包括甲状腺激素撤退（THW）及重组人TSH,但THW引起的急性甲状腺功能减退将导致血脂代谢异常、肾功能受损、心血管疾病和神经精神疾病,对患者的生活质量造成显著影响。笔者就目前应用于临床的两种提高TSH的方案及其对DTC患者临床和生活质量的影响进行综述。     

PET/CT imaging of thyroid cancer

Positron emission tomography (PET) is a highly sensitive, low invasive technology for cancer biology imaging. The role of F-18 FDG PET/CT in differentiated thyroid cancer (DTC) is well established, particularly in patients presenting with elevated Tg levels and negative radioactive iodine WBS. It has been demonstrated that F-18 FDG uptake represents less differentiated thyroid cancer cells or dedifferentiated cells and PET positive lesions are more likely to be resistant to I treatment. The uptake of F-18 FDG is related to tumor size, thyroid capsule invasion and histological variants with a poor prognosis. As in other cancers, early detection of recurrences improves outcomes and survival. I PET/CT can also be used to image the patients with DTC, similarly to I WBS. Compared with F-18 FDG PET/CT, its spatial resolution is only slightly degraded but increasing the imaging time reduces this difference. In addition, F-18 FDG PET/CT has been found helpful in the management of patients with anaplastic and medullary thyroid cancer. Other radiopharmaceuticals such as Ga-DOTATOC and F-18 DOPA may provide complimentary information to F-18 FDG PET/CT in the detection of recurrent thyroid cancer.