甲状腺医学中的放射性碘——它在瑞典的起源以及当今面临的一些挑战。

Mattsson Sören, Johansson Lennart, Jönsson Helene, Nosslin Bertil

Department of Radiation Physics, Lund University, Malmö University Hospital, SE-20502, Malmö, Sweden.

Acta Oncol. 2006;45(8):1031-6. doi: 10.1080/02841860600635888.

In Sweden, radioactive iodine for thyroid diagnostics and therapy was introduced by Jan Waldenström (1906-1996) and Bengt Skanse (1918-1963). The paper describes the start of the clinical use of radioiodine, the various iodine isotopes available, measurement techniques and dosimetry. There are still problems to solve in relation to an optimal clinical use of radioiodine. One of the remaining challenges is to get consensus about the goal of the treatment of hyperthyreosis, as well as about a method for individual absorbed dose calculations. Careful dose estimates will prevent unnecessary radiation exposure and constitute a base for a future optimised radioiodine therapy. For the dose calculation, it is important to understand if there is any clinically significant temporary reduction in the ability of thyroid tissue to trap or retain 131I-iodide following prior administration of a diagnostic activity of 131I-iodide (stunning of the thyroid). This may be of special concern in connection with treatment of thyroid cancer and its metastases. Finally, the production capacity, availability and delivery of 123I have to be improved to increase clinical access to this radionuclide, which is optimal for diagnostic imaging and which gives lower absorbed dose and therefore also less risk for thyroid stunning than 131I.

在瑞典，用于甲状腺诊断和治疗的放射性碘是由扬·瓦尔登斯特伦（1906 - 1996）和本特·斯坎塞（1918 - 1963）引入的。本文描述了放射性碘临床应用的开端、可用的各种碘同位素、测量技术和剂量测定法。在放射性碘的最佳临床应用方面仍有问题有待解决。剩下的挑战之一是就甲状腺功能亢进症的治疗目标以及个体吸收剂量计算方法达成共识。精确的剂量估计将防止不必要的辐射暴露，并为未来优化的放射性碘治疗奠定基础。对于剂量计算而言，了解在预先给予诊断剂量的131碘化物后，甲状腺组织摄取或保留131碘化物的能力是否存在任何具有临床意义的暂时降低（甲状腺“顿抑”）非常重要。这在甲状腺癌及其转移灶的治疗中可能尤为值得关注。最后，必须提高123碘的生产能力、可获得性和供应，以增加临床对这种放射性核素的使用机会，它对于诊断成像最为理想，与131碘相比，其吸收剂量更低，因此甲状腺“顿抑”的风险也更小。