分化型甲状腺癌术后首次不同剂量131I清除残留甲状腺组织的临床观察

目的 探讨分化型甲状腺癌术后首次不同剂量131 I清除残留甲状腺组织(清甲)的临床效果.方法 将84例分化型甲状腺癌患者随机分为观察组(131I清甲剂量>100 mCi)和对照组(131I清甲剂量≤100 mCi)各42例.观察组空腹一次性口服131 I 100~120 mCi,对照组空腹一次性口服131 I 30~40 mCi.清甲半年后行131 I甲状腺显像检查,对两组清甲成功率进行评价,并检测促甲状腺激素(TSH)、甲状旁腺素(PTH)和甲状腺球蛋白(TG)水平,以及两组不良反应发生情况.结果 观察组乳头状癌与滤泡状癌清甲成功率与对照组比较,差异无统计学意义(P>0.05).同组内乳头状癌与滤泡状癌清甲成功率比较,差异无统计学意义(P>0.05).清甲前血清TSH浓度≥30 mIU/mL与血清TSH浓度﹤30 mIU/mL比较,差异具有统计学意义(P<0.05).清甲前血清Tg值﹤30 ng/mL与血清Tg值≥30 ng/mL比较,差异具有统计学意义(P<0.05).清甲6个月后,观察组TSH和PTH水平均显著高于对照组,Tg水平显著低于对照组,差异具有统计学意义(P<0.05).对照组胃肠道反应及泪腺功能紊乱发生率均低于观察组,差异具有统计学意义(P<0.05).对照组唾液腺功能紊乱及颈部疼痛发生率与观察组比较,差异无统计学意义(P>0.05).结论 分化型甲状腺癌术后首次应用131 I与剂量无太大关系,且低剂量的不良反应少于高剂量,低剂量131 I方案值得推广.

Clinical Observation of Different Doses of 131 I for the First Time to Remove Residual Thyroid Tissue After Surgical Treatment of Differentiated Thyroid Carcinoma

Objective To investigate the clinical effect of different doses of 131 I for the first time to clear the residual thyroid tissue after the operation of differentiated thyroid carcinoma.Methods 84 patients with differentiated thyroid cancer pa-tients were randomly divided into 2 groups(131I dose>100 mCi)and control group(131I dose ≤100 mCi),each group were 42 patients.Patients in the observation group were treated with oral 100~120 mCi 131 I,and patients in the control group were treated with oral mCi 131 I 30~40.Thyroid imaging examination and evaluate the success rate of remove residual thyroid tissue after half a year after radioiodine 131I of the 2 groups,and detection of thyroid stimulating hormone (TSH),parathyroid hormone(PTH)and thyroglobulin(TG)levels,as well as the occurrence of adverse reactions of the the groups.Results Compared with the control group,there was no significant difference between the control group and papillary carcinoma of the observation group compared with the control group(P>0.05).There was no significant difference in the success rate of follicular carcinoma and papillary car -cinoma in the same group(P>0.05).A clear comparison of serum TSH concentration before 30 mIU/mL and serum TSH con-centration was less than 30 mIU/mL,the difference was statistically significant (P<0.05).A clear serum Tg<30 ng/mL and ser-um Tg value was more than 30ng/mL,the difference was statistically significant (P<0.05).After 6 months,the levels of TSH and PTH in the observation group were significantly higher than those in the control group ,the level of Tg was significantly lower than that of the control group,the difference was statistically significant (P<0.05).The control group of gastrointestinal tract reaction and lacrimal gland dysfunction were lower than those in the observation group , the difference was statistically significant ( P<0.05).In control group,there was no significant difference in salivary gland function disorder and neck pain between the 2 groups (P>0.05).Conclusion Differentiated thyroid carcinoma after the first application of 131I dose have not much relationship,and low dose of adverse reaction is less than high dose ,low dose 131 I program is worth promoting.