Randolph Gregory W, Daniels Gilbert H
Department of Otology and Laryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Thyroid. 2002 Nov;12(11):989-96. doi: 10.1089/105072502320908321.
We performed a retrospective record review of patients who received large lobar remnant ablation after surgery for well-differentiated thyroid carcinoma including 30 with papillary carcinoma, 14 with follicular carcinoma, and 6 with Hürthle cell carcinoma. We compared these 50 patients to a group of patients who underwent total or near-total thyroidectomy for well-differentiated thyroid carcinoma. The ablation group was treated with single outpatient doses of 29.9 mCi (131)I to prepare for whole-body radioiodine scanning. Subsequent serum thyrotropin (TSH) concentration during thyroid hormone withdrawal was greater than 25 microU/mL in 94% of patients. The mean TSH in this population (76 microU/mL) was not statistically different from a group of 50 patients who underwent total or near-total thyroidectomy (mean, TSH 71 microU/ml p = 0.84). Twenty-four hour radioiodine uptake post-29.9 mCi (131)I ablation was less than 1% in 80% of patients. The mean radioiodine uptake (0.8%) in the lobe ablation population was significantly lower than in patients treated with total thyroidectomy (mean, 2.4%, p < 0.001). There was minimal morbidity after 29.9 mCi (131)I ablation of large lobar remnants. Outpatient 29.9 mCi (131)I ablation is a safe, effective, and less costly alternative to completion thyroidectomy in selected patients. Although we included patients with both papillary and follicular carcinoma in our review, we recommend this method for patients with minimally invasive follicular carcinoma requiring whole body scanning, even with large postsurgical remnants in place.
我们对接受大的叶状残余组织消融术的高分化甲状腺癌患者进行了回顾性病历审查，其中包括30例乳头状癌患者、14例滤泡状癌患者和6例许特莱细胞癌患者。我们将这50例患者与一组因高分化甲状腺癌接受甲状腺全切除术或近全切除术的患者进行了比较。消融组接受单次门诊剂量的29.9毫居里（131）I治疗，以准备全身放射性碘扫描。在甲状腺激素撤药期间，94%的患者随后的血清促甲状腺激素（TSH）浓度大于25微单位/毫升。该人群的平均TSH（76微单位/毫升）与一组接受甲状腺全切除术或近全切除术的50例患者（平均TSH 71微单位/毫升，p = ；0.84）无统计学差异。29.9毫居里（131）I消融术后24小时放射性碘摄取率在80%的患者中低于1%。叶状残余组织消融人群的平均放射性碘摄取率（0.8%）显著低于接受甲状腺全切除术的患者（平均2.4%，p < ；0.001）。29.9毫居里（131）I消融大的叶状残余组织后发病率极低。门诊29.9毫居里（131）I消融术对于部分患者来说是一种安全、有效且成本较低的替代甲状腺全切术的方法。尽管我们在审查中纳入了乳头状癌和滤泡状癌患者，但我们建议对于需要全身扫描的微小浸润性滤泡状癌患者采用这种方法，即使术后有大的残余组织。
