Lupoli Gelsy Arianna, Fonderico Francesco, Colarusso Sara, Panico Annalisa, Cavallo Annalisa, Di Micco Lucia, Paglione Angela, Costa Luisa, Lupoli Giovanni
Department of Molecular and Clinical Endocrinology and Oncology, Faculty of Medicine and Surgery, Federico II University, Naples, Italy.
Med Sci Monit. 2005 Dec;11(12):RA368-73. Epub 2005 Nov 24.
Papillary and follicular thyroid cancers, together termed differentiated thyroid cancers (DTC), comprise the majority of thyroid carcinomas and have an optimal prognosis. Most DTCs appear as asymptomatic thyroid nodules. Fine-needle aspiration (FNA) cytology is the first diagnostic test for a thyroid nodule in a euthyroid patient. Surgery is the primary treatment for thyroid cancers. Most clinicians recommend near-total or total thyroidectomy, and then 131I ablation therapy, since its consequences are minimal and follow-up is facilitated. A total body scan (TBS) is performed 4 to 7 days after 131I treatment. At a later stage, all patients should be treated with L-tiroxine so as to suppress TSH, and must undergo a periodic evaluation of TSH and thyroglobulin (Tg), the most sensitive and specific marker of DTC. After 6-12 months, TBS with 131I is performed, a technique complementary to serum Tg evaluation. For this technique, it is also necessary to have a high serum TSH concentration, obtained by withdrawing thyroxine therapy for 4 to 6 weeks. This standard method induces hypothyroidism. An alternative method to the withdrawal of thyroid hormones in the follow-up of DTC patients is to administer recombinant human TSH (rh-TSH). After the dose of rhTSH, 131I is administered, and then TBS can be performed 48-72 hours later. Currently, several authors have explored the possibility that rh-TSH-stimulated Tg levels may represent the only necessary test to differentiate patients with persistent disease from disease-free patients, without performing a diagnostic TBS.
乳头状和滤泡状甲状腺癌统称为分化型甲状腺癌（DTC），占甲状腺癌的大多数，预后良好。大多数DTC表现为无症状的甲状腺结节。细针穿刺（FNA）细胞学检查是甲状腺功能正常患者甲状腺结节的首要诊断方法。手术是甲状腺癌的主要治疗方法。大多数临床医生推荐行近全甲状腺切除术或全甲状腺切除术，然后进行131I消融治疗，因为其后果轻微且便于随访。131I治疗后4至7天进行全身扫描（TBS）。在后期，所有患者均应接受左甲状腺素治疗以抑制促甲状腺激素（TSH），并且必须定期评估TSH和甲状腺球蛋白（Tg），Tg是DTC最敏感和特异的标志物。6至12个月后，进行131I全身扫描，这是一种与血清Tg评估互补的技术。对于该技术，还需要通过停用甲状腺素治疗4至6周来获得高血清TSH浓度。这种标准方法会导致甲状腺功能减退。在DTC患者随访中，替代停用甲状腺激素的方法是给予重组人促甲状腺激素（rh-TSH）。给予rh-TSH剂量后，再给予131I，然后可在48至72小时后进行TBS。目前，一些作者探讨了rh-TSH刺激的Tg水平可能是区分持续性疾病患者和无疾病患者的唯一必要检查的可能性，而无需进行诊断性TBS。
