de Klerk J M, de Keizer B, Zelissen P M, Lips C M, Koppeschaar H P
Department of Nuclear Medicine, University Medical Centre Utrecht, The Netherlands.
Nucl Med Commun. 2000 Jun;21(6):529-32. doi: 10.1097/00006231-200006000-00005.
Differentiated thyroid cancer is treated by (near) total thyroidectomy followed by radioiodine (131I) ablation of the residual active tissue in the thyroid bed. Controversy remains concerning the use and the dose of pre-ablative diagnostic 131I scintigraphy. This study was designed to assess the efficacy of thyroid ablation by high-dose 131I without pre-ablative diagnostic 131I scintigraphy. Ninety-three patients were treated with (near) total thyroidectomy and with a high ablative dose of 131I (3700-7400 MBq). A preablative 131I diagnostic scintigram was not performed. To assess the efficacy of the treatment, all patients were studied with a diagnostic 131I scintigram and with thyroglobulin plasma assays 1 year later after withdrawal of L-thyroxine for 4-6 weeks. The main criterion for a successful ablation was the absence of thyroid bed activity. An additional criterion was a thyroglobulin value of <10 microg x l(-1). Successful ablation according to the main criterion was obtained in 88% of patients. Forty patients (43%) showed no neck uptake and had undetectable serum thyroglobulin. Twenty-two patients (25%) had serum thyroglobulin concentrations between 1 and 10 microg x l(-1). Twenty-six patients (27%) had thyroglobulin >10 microg x l(-1), 19 patients showing residual thyroid uptake or metastatic lesions. We conclude that high-dose radioiodine ablation without prior diagnostic scintigraphy results in a high rate of successful ablation, preventing repeat 131I treatment.
分化型甲状腺癌的治疗方法是行（近）全甲状腺切除术，随后用放射性碘（131I）消融甲状腺床残留的活性组织。关于消融前诊断性131I闪烁扫描的应用及剂量仍存在争议。本研究旨在评估不进行消融前诊断性131I闪烁扫描而采用高剂量131I进行甲状腺消融的疗效。93例患者接受了（近）全甲状腺切除术及高剂量的131I消融治疗（3700 - 7400 MBq）。未进行消融前131I诊断性闪烁扫描。为评估治疗效果，所有患者在停用左甲状腺素4 - 6周后1年，接受了诊断性131I闪烁扫描及甲状腺球蛋白血浆检测。成功消融的主要标准是甲状腺床无活性。另一个标准是甲状腺球蛋白值<10 μg×l-1。根据主要标准，88%的患者实现了成功消融。40例患者（43%）颈部无摄取且血清甲状腺球蛋白检测不到。22例患者（25%）血清甲状腺球蛋白浓度在1至10 μg×l-1之间。26例患者（27%）甲状腺球蛋白>10 μg×l-1，其中19例显示有甲状腺残留摄取或转移灶。我们得出结论，不进行术前诊断性闪烁扫描而采用高剂量放射性碘消融可获得较高的成功消融率，避免了重复131I治疗。
