分化型甲状腺癌131I治疗前刺激性Tg与最佳治疗反应的关系

背景与目的：初始治疗（手术+¹³¹I+TSH抑制）后的疗效反应对动态评估患者的复发风险至关重要。本研究旨在探讨¹³¹I治疗前刺激性甲状腺球蛋白（preablative-stimulated thyroglobulin,ps-Tg）对最佳治疗反应的预测价值。方法：纳入中位随访74.5个月的分化型甲状腺癌（differentiated thyroid carcinoma,DTC）患者136例,根据治疗反应评估体系将其治疗效果分为4组：最佳治疗反应（excellent response,ER）（86例）、疗效不确切（indeterminate response,IDR）（18例）、血清学反应欠佳（biochemical incomplete response,BIR）（4例）和影像学反应欠佳（structural incomplete response,SIR）（28例）。采用χ²检验、Fisher精确检验和Kruskal-Wallis秩和检验比较4组患者的基本临床特征,建立ps-Tg及肿瘤大小与ER关系的受试者工作特征（receiver operating characteristic,ROC）曲线获得最佳界值点,对影响ER的因素进行多因素分析,进一步采用Kaplan-Meier曲线评估ps-Tg及肿瘤大小发生非ER的累积风险,使用log-rank法对差异进行统计学分析。结果：4组间ps-Tg水平、肿瘤大小、腺外侵犯、多灶性、淋巴结分期以及TNM分期差异有统计学意义（P＜0.05）,而性别和年龄差异无统计学意义（P＞0.05）。ps-Tg以及肿瘤大小与ER关系的ROC曲线下面积分别为0.865和0.666,当ps-Tg以9.05 ng/mL为界值预测ER时,灵敏度和特异度较高（分别为83.7%和80.0%）,肿瘤直径以1.05 cm为界值点时的灵敏度和特异度分别为53.5%和72.0%。多因素分析显示ps-Tg和肿瘤大小可以作为预测ER的独立因素（OR=20.571,P=0.015;OR=3.291,P=0.008）。随着肿瘤直径的增大,ps-Tg≥9.05组患者的非ER风险明显高于ps-Tg＜9.05组（P=0.000 3）。结论：ps-Tg（界值点为9.05 ng/mL）可用于预测本组患者最佳治疗反应,其与肿瘤大小结合可以更全面地预测初始治疗后的疗效。     

治疗前刺激性甲状腺球蛋白阴性合并淋巴结转移的分化型甲状腺癌131I治疗后的临床转归

背景与目的：治疗前刺激性甲状腺球蛋白（preablative stimulated thyroglobulin,ps-Tg）阴性和¹³¹I显像阴性往往提示分化型甲状腺癌（differentiated thyroid cancer,DTC）患者无病生存状态,然而临床上常遇到ps-Tg阴性伴¹³¹I显像示淋巴结转移的情况。探讨甲状腺全切术后ps-Tg阴性伴¹³¹I显像示淋巴结转移患者的临床转归及其影响因素。方法：2015年5月—2018年1月在青岛大学附属医院首次行¹³¹I治疗的ps-Tg<2 ng/mL伴淋巴结转移的DTC患者130例,随访6~36个月,根据临床转归情况分为满意（excellent response,ER）、不确切（indeterminate response,IDR）、影像学反应欠佳（structural incomplete response,SIR）3组,比较3组患者的性别、年龄、原发肿瘤大小、腺外浸润、T分期、术后N分期、淋巴结转移率、复发风险分层、¹³¹I治疗剂量、ps-Tg及甲状腺球蛋白抗体（thyroglobulin antibody,TgAb）等特征的差异,对有意义的因素进一步行亚组分析。结果：3组患者在N分期（χ²=11.274,P=0.024）、ps-Tg（H=9.579,P=0.008）和TgAb（H=11.632,P=0.003）方面差异有统计学意义,在性别（χ²=0.559,P=0.756）、年龄（F=0.408,P=0.666）、原发肿瘤大小（H=1.834,P=0.400）、腺外浸润（χ²=1.345,P=0.510）、T分期（χ²=4.494,P=0.610）、淋巴结转移率（H=3.358,P=0.187）、复发风险分层（χ²=3.008,P=0.556）和首次131I治疗剂量（H=1.335,P=0.513）方面差异均无统计学意义。术后分期N₀组14例,100.00%（14/14）达到ER,N_1a组18例,其中77.78%（14/18）达ER,22.22%（4/18）达IDR,N_1b组98例,63.26%（62/98）达ER,18.37%（18/98）达IDR,18.37%（18/98）达SIR。IDR组的中位ps-Tg水平为1.85 ng/mL显著高于ER组的1.09 ng/mL（t=2.976,P=0.003）和SIR组的0.39 ng/mL（t=2.468,P=0.014）,而SIR组的中位TgAb水平为713.10 U/mL,显著高于ER组的40.42 U/mL（t=3.409,P=0.001）和IDR组的39.02 U/mL（t=2.381,P=0.017）。结论：对于ps-Tg阴性、首次¹³¹I治疗后扫描发现淋巴结转移的患者,术后N分期、ps-Tg及TgAb水平可作为预测其临床转归的敏感指标。术后分期为N_1b、ps-Tg水平很低但TgAb水平明显升高者更易出现治疗反应欠佳。     

甲状腺癌131I清甲治疗前后Tg及TgAb测定值分析

摘 要：［目的］ 分析甲状腺癌131I清甲治疗后随访中甲状腺球蛋白（Tg）及甲状腺球蛋白抗体（TgAb）变化的意义。［方法］ 回顾性80例甲状腺癌患者,行甲状腺全切术或次全切术加淋巴结清扫术后实施131I清甲治疗前1d和治疗后7d及治疗后半年Tg和TgAb水平变化情况。［结果］ 术前Tg阳性组37例患者治疗前1d和治疗后7d的 Tg和TgAb水平明显高于131I清甲治疗半年后和对照组的Tg和TgAb水平,而治疗后半年的Tg和TgAb水平与对照组比较差异无统计学意义（P＞0.05）。术前Tg阴性组43例患者治疗前1d和治疗后7d 的Tg和TgAb水平明显高于131I清甲治疗半年后和对照组的Tg和TgAb水平,而清甲治疗后半年的Tg和TgAb水平与对照组比较差异无统计学意义（P＞0.05）。阳性组治疗后有30例患者Tg水平转阴,转阴率81.08%。Tg水平和TgAb水平间无明显相关性（r=-0.068,P＞0.05）。术前阳性组缓解率（81.08%）低于阴性组（90.70%）,但差异无统计学意义（χ2=0.115,P=0.735）。［结论］ 甲状腺癌患者Tg水平和TgAb水平随着治疗后时间的延长下降趋势越明显。131I清甲治疗后加强对Tg和TgAb水平的监测对判断预后具有重要作用。     

首次131I治疗前刺激性甲状腺球蛋白在预测颈部及远处转移性分化型甲状腺癌的意义

背景与目的：由于受到残余甲状腺等多种因素的影响,刺激性甲状腺球蛋白(stimulated thyroglobulin,sTg)在首次¹³¹I治疗前对分化型甲状腺癌(differentiated thyroid carcinoma,DTC)复发转移的诊断价值尚有争议。该研究旨在探讨sTg在首次¹³¹I治疗前预测DTC患者颈部及远处转移的意义。方法：106例行甲状腺全切术及颈淋巴结清扫术的DTC患者,首次¹³¹I治疗前1天测sTg水平,¹³¹I治疗后5~7 d行¹³¹I全身显像和SPECT/CT断层融合显像。根据是否存在转移,将所有患者分为无转移组(M0)和颈部淋巴结转移组(M1)和远处转移组(M2),比较组间sTg值差异有无统计学意义,并通过ROC曲线及最佳诊断界值点(diagnostic critical point,DCP)评估sTg值预测转移的价值。结果：M0组、M1组和M2组的sTg值的四分位数间距分别为0.47~9.57、12.34~50.86和69.47~462.00 ng/mL。M1组、M2组与M0组的sTg相比差异均有统计学意义(P<0.01和P<0.01)。sTg值的ROC曲线下面积分别为0.872、0.964,DCP分别为23.95和20.93 ng/mL,灵敏度、特异度、准确度分别为68.42%、100%、92.31%和85.71%、100%、95.40%。结论：首次¹³¹I治疗前检测sTg值对DTC转移有重要的预测价值,对远处转移的预测价值更大。     

甲状腺球蛋白抗体测定在分化型甲状腺癌131I治疗中的临床意义

甲状腺球蛋白（thyroglobulin,Tg）是分化型甲状腺癌（differentiated thyroid carcinoma,DTC）患者治疗后随访的主要血清标志物,Tg的测定会受到甲状腺球蛋白抗体（thyroglobulin antibody,TgAb）的影响,限制了Tg作为肿瘤标志物在DTC随访中的作用。因此,有关TgAb阳性患者的随访一直是临床工作中的难题,有研究指出TgAb可以作为替补肿瘤标志物用于DTC的监测,但有关TgAb与DTC治疗后疾病状态与预后间的关系尚存争议。主要就TgAb在DTC患者¹³¹I治疗中的临床意义进行综述,以期为TgAb阳性患者的临床决策提供更多依据。     

中低危分化型甲状腺癌低剂量131I治疗后短期转归的临床分析

背景与目的：2015版美国甲状腺协会（American Thyroid Association,ATA）指南首次提出治疗反应评估体系（response-to-therapy assessment system,RTAS）。该研究根据此评估体系,探讨低剂量（1 110 MBq）¹³¹I在中低危分化型甲状腺癌（differentiated thyroid carcinoma,DTC）清甲治疗后短期内不同转归的影响因素。方法：回顾性分析2015年1月—2017年1月166例中低危DTC患者资料,男性50例,女性116例,平均年龄（39.61±10.23）岁。首次清甲剂量为1 110MBq,取得清甲前及清甲后6~12个月刺激性甲状腺球蛋白（stimulated thyroglobulin,sTg）及诊断性全身显像（diagnosticwhole body scan,Dx-WBS）,根据结果分为最佳治疗反应（excellent response,ER）组与非最佳反应（non-excellent response,NER）组。采用两样本t检验、Mann-Whitney U秩和检验及χ²检验进行组间临床病理资料比较,采用Logistic回归分析影响清甲疗效的因素,采用受试者工作特征（receiver operating characteristic,ROC）曲线确定最佳界值。结果：ER组127例,NER组39例,ER率为76.5%（127/166）。治疗后短期随访ER组清甲治疗前sTg（preablative sTg,ps-Tg）明显低于NER组［1.5（0.04-30.57）ng/mL vs 17.6（0.04-21.52）ng/mL;U=2 479,P<0.05］,且性别、年龄差异有统计学意义,男性及年龄稍小者更易出现NER。多因素分析显示,ps-Tg水平、肿瘤大小、淋巴结转移数目、性别、年龄及多灶性均为影响清甲疗效的相关因素（OR：0.361~2.875）。ROC曲线分析显示,ps-Tg最佳临界值为2.0 ng/mL。结论：ps-Tg水平较低、病灶较小、淋巴结转移数目较少、男性、年龄较小及单灶患者清甲治疗后短期内更易达到ER;且以ps-Tg值2.0 ng/mL为最佳临界点,对预测治疗后短期临床转归有较高的灵敏度和特异度。     

131I治疗分化型甲状腺癌后定期随访指标的临床评价

目的：探讨 TSH 刺激血清甲状腺球蛋白（Tg）、抗甲状腺球蛋白抗体（TgAb）与131 I 全身显像（WBS）三项随访指标对131 I 治疗分化型甲状腺癌（DTC）预后判断的临床意义。方法：回顾性研究2002-2013年期间424例在我科进行131 I 治疗的 DTC 病历资料,将 TSH 刺激血清 Tg、TgAb 与 WBS 之间的关系进行分析。结果：TSH 刺激血清 Tg 及 TgAb 同时测定均为阴性组与 WBS 的诊断符合率明显高于血清 Tg 单独测定阴性组（P ﹤0.05）。TSH 刺激血清 Tg 阳性结果与 WBS 阳性诊断对 DTC 未治愈、复发或转移的诊断一致性检验结果：Kappa 值为0.587,表明这两者之间存在一定的一致性,但并不十分理想。结论：由于 TgAb 的干扰,在进行 TSH 刺激血清 Tg 检验同时必须做血清 TgAb 的检验,并且即使 TSH 刺激血清 Tg 及 TgAb 同时测定也可出现假阴性。因此,WBS 仍是不可缺少的重要随访指标。     

分化型甲状腺癌患者术后放射性131I治疗效果的影响因素分析

目的 探讨分化型甲状腺癌(DTC)患者术后放射性131I治疗效果的影响因素.方法 选取115例手术后首次行131I治疗的DTC患者作为研究对象,根据治疗后131I全身显影结果将其分为清甲成功组与清甲未成功组,前者完全清除残余甲状腺组织,后者未完全清除残余甲状腺组织.影响因素分析先采用x2检验进行单因素分析,然后选择有统计学意义的指标进行非条件logistic回归分析.结果 115例DTC患者,其中51例患者在术后经首次131I治疗即成功清除残余甲状腺组织,治疗成功率为44.3％.清甲成功组与清甲未成功组性别、年龄、体质指数(BMI)、病理类型差异无统计学意义(P＞0.05),2组患者手术方式、131I首次治疗剂量、131I首次治疗前促甲状腺激素(TSH)以及甲状腺球蛋白(Tg)水平差异有统计学意义(P＜0.05).多因素非条件Logistic回归分析显示:131I首次治疗剂量、131I首次治疗前TSH以及Tg水平等指标是影响DTC患者术后放射性131I治疗效果的独立相关因素(P＜0.05),手术方式是非独立相关因素(P＞0.05).结论 131I首次治疗剂量、131I首次治疗前TSH以及Tg水平是影响DTC患者术后放射性131I治疗效果的重要因素.     

Ps-Tg水平在分化型甲状腺癌诊疗中的应用

血清甲状腺球蛋白（thyroglobulin,Tg）是分化型甲状腺癌（differentiated thyroid carcinoma,DTC）术后随访最常用的血清标志物,用于监测DTC复发及转移。然而血清Tg的检测受到多种因素的干扰,如术后残余甲状腺组织、促甲状腺激素（thyroid stimulating hormone,TSH）、甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)等。因此已往认为术后131I治疗前检测激性 Tg（preablative stimulated thyroglobulin,ps-Tg）（TSH>30 μIU/ml刺激状态下的 Tg 水平）水平意义不大。2009年美国ATA指南指出,DTC 患者ps-Tg水平在疾病状态的预测中有一定作用。近年来也有越来越多的研究表明,术前血清 Tg 水平的监测具有重要的临床价值。本文旨在对Tg在甲状腺癌患者疾病监测中的所受到的干扰因素及DTC 术后诊疗过程中的意义进行综述。     

可疑甲状腺球蛋白增高性分化型甲状腺癌患者经131I治疗后的临床转归

背景与目的： 分化型甲状腺癌（differentiated thyroid cancer,DTC）中可疑甲状腺球蛋白（thyroglobulin,Tg）水平增高但无明确结构性病灶者预后差异大,临床治疗决策存在较大争议,本研究拟探究¹³¹I治疗及不同治疗剂量对于这类患者临床转归的影响。方法： 回顾并分析2007—2021年就诊于北京协和医院核医学科的138例DTC全切术后可疑Tg水平增高的患者,依据首次¹³¹I治疗剂量分为低（剂量为1.11 GBq）、中（1.11 GBq<剂量≤3.70 GBq）、高（3.70 GBq<剂量≤7.40 GBq）3组,观察不同剂量¹³¹I治疗后6个月的短期及后续未再行其他干预患者的长期疗效,并进一步观察经初始治疗评估为生化疗效不佳（biochemical incomplete response,BIR）患者的临床转归。采用受试者工作特征（receiver operating characteristic,ROC）曲线评估预测结构性疗效不佳（structural incomplete response,SIR）和远处转移的刺激性Tg（stimulated Tg,sTg）的最佳界值点。结果： 低、中、高3个剂量组中分别有6.7%、13.5%、7.0%的患者短期疗效达到疗效满意（excellent response,ER）,3组间总体疗效差异无统计学意义（H=1.02,P=0.60）。常规随访下3组患者的长期疗效同样差异无统计学意义（H=2.94,P=0.23）。经初始治疗评估为BIR的患者经常规随访和再次¹³¹I治疗后的临床转归差异无统计学意义（U=324.5,P=0.15）。预测SIR和远处转移的sTg最佳界值点分别为27.5和61.7 ng/mL。结论： 可疑Tg水平增高的DTC患者复发率较高,以27.5 ng/mL为sTg界值点有助于尽早识别这部分患者。¹³¹I治疗有助于术后可疑Tg水平增高患者快速达到ER,但高剂量¹³¹I治疗未对患者的预后产生增益效应;再次¹³¹I治疗对于BIR患者未显示出进一步获益。     

Lenvatinib for the Treatment of Radioiodine-Refractory Differentiated Thyroid Cancer: Treatment Optimization for Maximum Clinical Benefit

BackgroundLenvatinib is a multitargeted tyrosine kinase inhibitor approved for treating patients with locally recurrent or metastatic progressive radioiodine-refractory differentiated thyroid cancer (RR-DTC). In this review, we discuss recent developments in the optimization of RR-DTC treatment with lenvatinib.SummaryInitiation of lenvatinib treatment before a worsening of Eastern Cooperative Oncology Group performance status and elevated neutrophil-to-lymphocyte ratio could benefit patients with progressive RR-DTC. The median duration of response with lenvatinib was inversely correlated with a smaller tumor burden, and prognosis was significantly worse in patients with a high tumor burden. An 18 mg/day starting dose of lenvatinib was not noninferior to 24 mg/day and had a comparable safety profile. Timely management of adverse events is crucial, as patients with shorter dose interruptions benefitted more from lenvatinib treatment. Caution should be exercised when initiating lenvatinib in patients who have tumor infiltration into the trachea or other organs, or certain histological subtypes of DTC, as these are risk factors for fistula formation or organ perforation. The Study of (E7080) LEnvatinib in Differentiated Cancer of the Thyroid (SELECT) eligibility criteria should be considered prior to initiating lenvatinib treatment.ConclusionsCurrent evidence indicates that patients benefit most from lenvatinib treatment that is initiated earlier in advanced disease when the disease burden is low. A starting dose of lenvatinib 24 mg/day, with dose modifications as required, yields better outcomes as compared to 18 mg/day. Appropriate supportive care, including timely identification of adverse events, is essential to manage toxicities associated with lenvatinib, avoid longer dose interruptions, and maximize efficacy.     

Importance of Postoperative Stimulated Thyroglobulin Level at the Time of 131I Ablation Therapy for Differentiated Thyroid Cancer

Background: Serum thyroglobulin detection plays an essential role during the follow-up of thyroid cancerpatients treated with total/near total thyroidectomy and radioiodine ablation. The aim of this retrospective studywas to evaluate the relationship between stimulated serum thyroglobulin (Tg) level at the time of high dose 131Iablation and risk of recurrence, using a three-level classification in patients with differentiated thyroid cancer(DTC) according to the ATA guidelines. Also we investigated the relationship between postoperative stimulatedTg at the time of ablation and DxWBS results at 8-10 months thereafter. Materials and Methods: Patientswith radioiodine accumulation were regarded as scan positive (scan+). If there was no relevant pathologicalradioiodine accumulation or minimal local accumulation in the thyroid bed region, this were regarded as scannegative (scan-) at the time of DxWBS. We classified patients in 3 groups as low, intermediate and high riskgroup for assessment of risk of recurrence according to the revised ATA guidelines. Also, we divided patients into3 groups based on the stimulated serum Tg levels at the time of 131I ablation therapy. Groups 1-3 consisted ofpatients who had Tg levels of ≤2 ng/ml, 2-10 ng/ml, and ≥10 ng/ml, respectively. Results: A total of 221 consecutivepatients were included. In the high risk group according to the ATA guideline, while 45.5% of demonstratedScan(+) Tg(+), 27.3% of patients demonstrated Scan(-) Tg(-); in the intermediate group, the figures were 2.3%and 90.0% while in the low risk group, they were 0.6% and 96.4%. In 9 of 11 patients with metastases (81.8%),stimulated serum Tg level at the time of radioiodine ablation therapy was over 10, however in 1 patient (9.1%)it was <2ng/mL and in one patient it was 2-10ng/mL (p=0.005). Aggressive subtypes of DTC were found in 8 of221 patients and serum Tg levels were ≤2ng/ml in 4 of these 8. Conclusions: We conclude that TSH-stimulatedserum thyroglobulin level at the time of ablation may not determine risk of recurrence. Therefore, DxWBSshould be performed at 8-12 months after ablation therapy.     

Baseline Stimulated Thyroglobulin Level as a Good Predictor of Successful Ablation after Adjuvant Radioiodine Treatment for Differentiated Thyroid Cancers

Background: To determine the predictive value of the baseline stimulated thyroglobulin (STg) level for ablation outcome in patients undergoing adjuvant remnant radioiodine ablation (RRA) for differentiated thyroid carcinoma (DTC). Materials and Methods: This retrospective study accrued 64 patients (23 male and 41 female; mean age of 40±14 years) who had total thyroidectomy followed by RRA for DTC from January 2012 till April 2014. Patients with positive anti-Tg antibodies and distant metastasis on post-ablative whole body iodine scans(TWBIS) were excluded. Baseline STg was used to predict successful ablation (follow-up STg <2 ng/ml, negative diagnostic WBIS and negative ultrasound neck) at 7-12 months follow-up. Results: Overall, successful ablation was noted in 37 (58%) patients while ablation failed in 27 (42%). Using the ROC curve, a cut-off level of baseline STg level of ≤14.5 ng/ml was found to be most sensitive and specific for predicting successful ablation. Successful ablation was thus noted in 25/28 (89%) of patients with baseline STg ≤ 14.5 ng/ml and 12/36 (33%) patients with baseline STg >14.5 ng/ml ((p value <0.05). Age >40 years, female gender, PTS >2 cm, papillary histopathology, positive cervical nodes and positive TWBIS were significant predictors of ablation failure. Conclusions: We conclude that in patients with total thyroidectomy followed by I-131 ablation for DTC, the baseline STg level is a good predictor of successful ablation based on a stringent triple negative criteria (i.e. follow-up STg < 2 ng/ ml, a negative DWBIS and a negative US neck).     

抗甲状腺球蛋白抗体对分化型甲状腺癌患者术后血甲状腺球蛋白监测的影响

目的了解1对已行双侧甲状腺全切术后分化型甲状腺癌患者进行血甲状腺球蛋白监测(Tg)时,血清抗甲状腺球蛋白抗体水平的影响。方法对2003年1月~2006年3月收治的83例分化型甲状腺癌患者的血清抗Tg抗体和Tg水平进行检测,并分析不同水平的抗Tg抗体对血Tg水平和全身性131I扫描结果符合率的影响。结果当血清中抗Tg抗体>100IU/mL时,血Tg的监测意义明显下降。结论Tg是分化型甲状腺癌较好的随诊指标,但在监测血Tg时应注意患者的血清中抗Tg抗体水平。     

碘难治性分化型甲状腺癌靶向治疗新进展

近年来，靶向治疗为碘难治性分化型甲状腺癌带来了革命性的突破。新型靶向药物的研发，让更多晚期分化型甲状腺癌患者获得了更好的生存。以索拉非尼和仑伐替尼为代表的多靶点小分子酪氨酸激酶抑制剂显著提升了患者的无进展生存期。与此同时，靶向BRAF及靶向RET的新型酪氨酸激酶抑制剂同样也取得了瞩目的疗效，丰富了甲状腺癌的治疗手段。本文就靶向治疗在碘难治性分化型甲状腺癌中的最新研究进展进行综述。     

碘难治性分化型甲状腺癌诱导再分化治疗研究进展

分化型甲状腺癌（DTC）大多进展缓慢,经手术、促甲状腺素抑制治疗和（或）放射性碘（RAI）等规范化治疗后总体预后好,但仍有部分患者治疗后出现复发或远处转移,并可能在自然病程或治疗过程中丧失摄碘能力,不能从后续RAI治疗中获益,成为碘难治性分化型甲状腺癌（RAIRDTC）。RAIR-DTC患者可选择的治疗方法有限,且效果欠佳。近年来,随着对RAIR-DTC分子机制研究的不断深入,诱导再分化联合RAI治疗在RAIR-DTC中展现出一定的应用前景。本文综述了信号通路抑制剂、组蛋白去乙酰化酶抑制剂（HDACi）、DNA甲基化酶抑制剂、维甲酸类药物及过氧化物酶体增殖物激活受体（PPAR）激动剂在RAIR-DTC诱导再分化治疗中的进展。     

分化型甲状腺癌术后促甲状腺激素抑制治疗分析

目前对于分化型甲状腺癌的治疗方法通常为手术治疗合并放射碘治疗以及甲状腺激素替代治疗,并且根据疾病的不同分期,患者的促甲状腺激素(thyrotropin,TSH)应维持在低于正常或极低水平.目前对于TSH抑制治疗的争议主要存在于最佳抑制程度,即是否应将TSH抑制到＜0.1 mU/L还是保持在0.1～0.4 mU/L以达到最佳疗效,以及在不同分期患者中,TSH抑制治疗的有效性.全文对TSH抑制治疗对甲状腺癌的应用进行分析,并对TSH抑制治疗的利弊、抑制程度进行讨论,以及目前存在的关于TSH抑制治疗的争议进行阐述.     

The Use of Post-ablation Stimulated Thyroglobulin in Predicting Clinical Outcomes in Differentiated Thyroid Carcinoma – What Cut-off Values Should We Use?

Aims

Recently published international guidelines recommended using the stimulated thyroglobulin (sTg) post-radioactive iodine (RAI) ablation, in conjunction with tumour stage, as a risk stratification factor. The choice of cut-off values for sTg, namely 1 and 10 ng/ml, was, however, largely based on the functional sensitivities of the assays used, with relatively few published data addressing the prognostic impact of alternative cut-off values. Our study aims to provide data on the prognostic value of sTg at different levels of sensitivities and specificities.

Controversies in Radioiodine Treatment of Low- and Intermediate-risk Thyroid Cancer

In differentiated thyroid cancer, radioiodine therapy (RIT) is usually carried out after thyroidectomy. Although the potent beneficial effects of radioiodine are undisputed in high-risk patients, much controversy remains surrounding many aspects of RIT in low- and intermediate-risk patients. Other than the indication for postoperative RIT, controversies also include, among others, the intent of RIT and the choice of activity for RIT or the mode of thyroid stimulating hormone stimulation. Furthermore, there is even controversy on the definition of what constitutes low- or intermediate-risk patients. Here the various issues will be discussed and an overview of the different points of view in a number of more prominent national and international guidelines and current literature is presented.